Professor James MacCabe alongside Dr Harry Markfort brought together clinicians and academics from across the country for this 64th Maudsley Debate, chaired by Professor Khalida Ismail. The motion tabled was, “this house believes doctors should be legally permitted to assist terminally ill patients to end their life”.
Before the debate began, the audience were polled on their current views on the topic, being offered the choice of for, against or abstaining. Over half the audience voted in favour of the motion prior to the debate, leading speakers for the motion to comment this was their side’s debate to lose.
Professor Khalida Ismail, Professor of Psychiatry & Medicine at the IoPPN and Consultant Psychiatrist in Palliative Care, introduced the initial speaker for the motion, Dr Julian Neal, a former NHS doctor with 25-years’ experience delivering palliative care. Dr Neal spoke of not shortening someone’s life, but shortening their death, with an emphasis on what we think of as a “good death” not always being possible for someone with terminal illness. He prompted the audience to consider how “first, do no harm” would apply when someone is suffering.
Speaking first against the motion was Baroness Finlay of Llandaff, Professor of Palliative Medicine at Cardiff University, and Crossbench Peer at the House of Lords. Having previously spoken at the 39th Maudsley Debate on assisted dying in 2010, Baroness Finlay made the case for the importance of specialist palliative care being available to all who need it, to live well. Her argument stressed how difficult it is to provide someone with an accurate prognosis and ensure they are free of any coercion when assisted dying becomes an option presented to terminally ill people.
Returning to argument for the motion was Dr Tim Howard, a retired GP, former GMC fitness to practice chair and medical practitioners tribunal service member. Dr Howard opened his case by asking the audience a single question, how would you like to die? He went on to examine the benefits and limitations of palliative care, and what this can mean for a small number of people with terminal illness. He concluded by emphasising that assisted dying would be a choice for just a few people and would offer them some management of the inevitable.
Dr Miro Griffiths was welcomed as the final speaker against the motion. Dr Griffiths is an Associate Professor of Social Policy and Disability Studies, and government policy adviser. His initial point to the audience was to question whether the support for the principle of assisted dying does not take into consideration the individuals affected. He argued that it is not a question of giving someone control over the end of their life, as desires are shaped by circumstance. This can include fear, institutional biases and quiet messages from society about the quality of their life. He emphasised that this is particularly true of disabled people and latterly made the point that someone diagnosed with a terminal illness would almost certainly also be considered a disabled person.
Following the six-minute cases made by all four speakers the floor was opened for audience questions. After a lively 20-minute discussion between the audience and speakers, each side was offered two-minutes to summarise their point. Dr Neal for the motion impressed upon the audience the question of whether it is better to allow someone to choose their death or elongate their dying? Speaking against the motion, Dr Griffiths asked the audience to examine what is hidden behind the word choice – will society support us as our needs change or abandon us? He concluded with questioning if we are prepared to live within a society that can organise the means of a person’s death with greater clarity than we can organise the support and needs of their life?
Professor MacCabe led a post-debate poll, with the audience swinging somewhat towards the against argument compared to the initial results, but a majority still voting for the motion.
The recording of this debate is available to view, alongside recordings of previous debates on the Maudsley Debates page.
