APM Survey Rebuttal

Earlier this week, you may have seen a survey conducted by the Association for Palliative Medicine of Great Britain and Ireland, which claims that most palliative care doctors would refuse to participate in assisted dying if it were legalised. Having looked at the survey, of just 58 respondents, it is important that we challenge these assertions. Below is a brief rebuttal and a quote from the Medical Advisory Group (which includes palliative care specialists) supporting Liam McArthur’s Scottish Bill proposal.

APM Survey Rebuttal 

·       Firstly, the survey sample size is very small – only 58 people responded. This sample size is not representative of Scotland’s wider palliative care community, where thousands of practitioners are involved in delivering palliative care.

·       40,000+ people die each year in Scotland with a palliative care need. We must be careful that the views of 58 doctors (which is a tiny minority of those involved in palliative care in Scotland) do not have undue influence on the end-of-life care choices available for our population.

·       The 2020 BMA poll (sample size over 30,000) showed 34% of respondents with a license to practice in the UK said they would be prepared to actively participate in the assisted dying process should the law change. This equates to thousands of licensed doctors across the UK.

·       The APM survey results do not specify the participant’s experience in palliative care or area of work, therefore, caution must be taken here. Likewise, a large proportion of palliative care is not undertaken by specialists (those surveyed) as it is the role of every GP, Cardiologist, Oncologist, Haematologist, Geriatrician, Hepatologist etc., i.e. every doctor. Palliative care provision also includes nurses, social workers, physios, OTs, psychologists, and carers – none of whom were surveyed.

·       On the first page, they mention how “only 2 doctors were willing to administer these drugs.” However, this is not in line with Liam McArthur’s proposal, where it has been repeatedly affirmed that only the patient themselves would take the medication. The wording in the survey falsely intimates that doctors would be delivering lethal drugs – this is not the case and would remain a criminal offence.

·       We know that those opposed are more likely to respond to a survey of this kind. And those who are not opposed are afraid to state a view, as evidenced by the consultation response where hundreds of practitioners said they were supportive but wished to remain anonymous whilst it remained illegal.

·       Where assisted dying is legal, support amongst doctors grows as the practice becomes accepted and data is accumulated showing it to be a safe, robustly regulated, and peaceful death. In the USA, where assisted dying is legal in ten states, acceptance has grown over the decades. Medscape recently did a survey of 5000 US doctors showing that support for AD has risen. More specialists (57%) than primary care physicians (51%) are in favour of assisted dying being legal, with the number of doctors willing to prescribe going up each year as practitioners are assured by the data.

·       Liam McArthur has repeatedly stressed that, where possible, he fully intends to accommodate conscientious objection for practitioners who do not wish to take part in assisted dying whilst also making provision for those who are willing to prescribe medication for the patient to take.

In response to the APM survey of 58 doctors opposed to assisted dying, members of the Medical Advisory Group said:

“We are encouraged to see colleagues engaging with the debate on assisted dying. However, the survey does not explain the volumes of palliative medicines administered, on a daily basis, to keep patients sedated due to uncontrolled pain and severe end-of-life agitation, which is a possible deterrent for many doctors working in this field. Or the number of patients who state to nurses and carers that they wouldn’t leave animals in this state, as they experience the total effects of dying in the modern age.

The survey would have been more useful to the ongoing development of the proposal if it had come from a multidisciplinary group larger than 58 people and had constructively addressed the specific proposal. Where the survey report highlights vulnerabilities in safeguards, they have not provided any evidence to back up this statement. An evidence-based approach is imperative, given the level of scrutiny afforded to this topic.

It is important to remember what palliative care was originally about – providing comfort and alleviating suffering, which is what this option/bill will do for many. We support the ongoing work to develop more and better palliative care and are reassured that in countries where assisted dying is legal, there has been an increase in investment in palliative care.

We know that having the choice of assisted dying gives comfort and reassurance to the terminally ill. By not providing access to assisted dying or having the option available to many facing the end of their life in Scotland, we are not honouring our patient’s wishes.”