Regarding Polly Toynbee’s article (MPs are voting on the next stage of the assisted dying bill. This is their chance to create a legacy. 15 May), in June 2018, I received a bone marrow transplant for myelofibrosis – a condition that, only a few years earlier, would have led to a fairly uncomfortable and painful death. My consultant at the time, whom I liked and respected greatly, was not hopeful the transplant would succeed. My quality of life had been steadily deteriorating, and the two years that followed the transplant were extremely difficult. I remain immunocompromised and live with chronic health conditions that require monitoring, and yet, despite everything, I have had a number of years of life well lived.
Had you asked my opinion of assisted dying eight, five or three years ago, I might have responded very differently. My views then would have been shaped by pain, the mental toll of illness, the isolation it brings and the deep sense of guilt over the burden I felt I placed on those close to me, and over the NHS resources I consume.
Medical opinions often differ, and I’ve witnessed how care can shift depending on how a patient presents – mood, appearance and speech all have an effect on our treatment. In an unequal society, how can we ensure that a decision as final as assisted dying is truly free from undue influence or even prejudice?
The risk is that the bill could unintentionally set us on a path where choosing to die becomes seen as a selfless or responsible act, disproportionately affecting the poorest and most vulnerable in our society, and safeguards will be eroded as society becomes “trained” to see assisted dying as just another life option. Current societal norms of compassion for the weakest and the poorest in society will become eroded as assisted dying replaces improved funding for compassionate and comprehensive palliative care.David GibbonCardiff
The Royal College of Psychiatrists’ position risks underestimating both the safeguards in the assisted dying bill and the capacity of terminally ill people to make autonomous, informed decisions about their lives (Royal College of Psychiatrists says it cannot yet support assisted dying bill, 14 May). Kim Leadbeater’s bill applies only to mentally competent adults with a terminal diagnosis and a prognosis of six months or less. It includes clear protections to ensure that choices are freely made and not influenced by untreated mental illness. Suggesting that psychiatrists are unable to assess this not only undermines our expertise but risks denying dying individuals the right to make decisions about their own bodies in their final days.
Autonomy in healthcare is a fundamental principle. Every day, patients make complex, life-altering choices about surgery, treatment refusal, even palliative sedation. That the same liberty should be withheld at the end of life is not only inconsistent but deeply unjust.
With more than 25 years’ experience of supporting families in their most challenging and vulnerable moments, I know that compassion and clinical rigour can and must coexist. Other countries have shown that it is possible to create safe, ethical systems of care for terminally ill patients who may be considering assisted dying. In this country, only those with the means to travel to Dignitas can exercise this choice. We have, in effect, a two-tier system: access to assisted dying is available, but only to the wealthy. That is not a safeguard, it is an elitist injustice.Dr Sabina DosaniChild and adolescent psychiatrist; visiting researcher and ambassador for medical and health humanities, University of East Anglia
We should not be surprised that MPs are changing their minds on the assisted dying bill (At least five more MPs decide to vote against England and Wales assisted dying bill, 14 May). In the House of Commons, assisted dying may present as a “for or against” voting issue, but the reality of decision-making is far less straightforward. Besides aye and nay, other valid positions can easily be overlooked – for example, “yes if”, “no unless”, “not yet”, “don’t know”.
Dividing lines run through the cabinet, parliament, the medical profession, the charitable sector, communities and families. They also run through individuals, not least those who are or may become terminally ill. The lines move as circumstances change; people change their minds – often.
The legislative process has catalysed debate around assisted dying. Regrettably, the debate has been unduly affected by the process, especially since a private member’s bill is being considered. More time for wider deliberation and discussion, without the pressure of parliamentary timetables, would have been welcome. Given the subject, any legislation would always be controversial – some would say rightly so – but legislation should follow a broader, more deliberate national discussion. Here, the horse appears to have found itself behind the cart.
Full disclosure: I am living with an incurable illness. Before and since diagnosis, I have been firmly against assisted dying, in principle and in practice. If media coverage is anything to go by, stark realities surrounding end-of-life issues seem to be overshadowed by exchanges of sincerely held but stridently expressed views. It feels as if people are in danger of losing out to process; we must do better.Name and address supplied
Thank you for Lucy Webster’s measured piece on assisted dying (The assisted dying lobby isn’t being honest with you – disabled people are at risk from this bill, 14 May). As a person with complex health problems, including multiple sclerosis and brain haemorrhage, I believe that the passing of this bill will be the very thin edge of a terrifying wedge.
With disabled people’s rights under attack by successive governments, who is to say that in 10 or 20 years’ time, the supposedly “economically inactive” will not be encouraged to cease being a burden on their families and society. I am not economically inactive – I receive personal independence payment, and I spend it; I enjoy my life immensely, despite its limitations. I never, ever thought that a Labour government would decide to consign people unable to work to the scrapheap or, potentially, open the door to an even worse outcome.Harriet ConnidesEast Finchley, London