FIRST, I should declare an interest: I'm a semi-retired GP who has a faith in Christ. Rohese Devereux-Taylor's article ("Issue of the week: Assisted dying legislation", The Herald, April 13) was a good summary of the situation. Can we now talk about practicalities for Scotland assuming that assisted dying becomes possible? Let's make the following big assumptions:
1) That good palliative care as an alternative must continue to be available to all and doesn't become a Cinderella specialty.
2) That GPs will have to be paid to take on this extra work.
3) That 50 per cent of GPs would agree to take on the duties of assisting dying. This would squeeze out the other routine work of caring for those who wish to continue living. These willing GPs would be less likely to build up trust with the chronic sick, mentally ill and elderly as a result. This would increase the work on the other 50 per cent of GPs. Did I mention that there is a shortage of GPs of around 20 per cent already in some areas? This would not help.
4) That if patients had a GP who won't assist dying, they would swap to a willing GP's "list" who would know them less well and be less able to judge their competence, mental state, and the pressure on them to die. The new GP will have a perverse incentive to get new customers just to keep his income stable because his list would dwindle due to lack of patient's trust and, of course, having fewer living patients.
5) That, like other countries which also assist dying, a large proportion of people who qualify for it, refuse to take the lethal pills for a long time after receiving them and sometimes never take them and end up dying naturally.
6) That when assisting dying becomes legal, well-off people will pay privately for it and the poor will suffer longer and will have even fewer GPs available to care for them. The Inverse Care Law that Julian Tudor-Hart coined will happen in spades. Of course the government could fund the patient who wants to die: "If you earn less than £20,000/year you can be killed for free!" Crowd-funding to afford assisted dying could become a new trend: "Local MP asks for help to die – £50,000 collected already"! They say all politicians careers end in a failure but allowing your life to end because of some form signed by a human seems a failure in hope, in trust and in denial that life is a gift we cannot and must not refuse.
Let me close with a vignette from practice: I consulted a retired person in indifferent health who was refusing preventative medicine after years of taking it. I asked why and the reply was "I don't care if I die soon as this country is such a mess." Could I /would I /should I sign the assisted dying form for that patient? Would you? Let's clear up our mess before we sign anything and let doctors stick to their Hippocratic Oath.
Alastair Rigg,
Kirtlehowe, 3 The Meadow, Eaglesfield.
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