Half of UK doctors remain concerned about changing laws on physician-assisted dying

21st November 2023

Nearly half of UK doctors think that a physician-assisted dying law ‘would negatively impact the medical profession’, a new survey has found.

More than 1,000 General Medical Council-registered doctors responded to an online survey last month, which asked for their views on whether physician-assisted dying should be legalised and explored to what extent they would be prepared to be involved in the process.

Around 48% of respondents were against the legalisation, while nearly 45% said they supported the prospect. Some 47% said a physician-assisted dying law would negatively impact the medical profession.

The survey, which spanned seven days and was conducted by Doctors.net.uk, found that concerns among those opposed included ‘a risk of undermining trust’ between doctors and patients, conflict with colleagues, ‘increased administrative workload’ and ‘a change to the ethos of medicine’.

In addition, the survey asked how involved in the process doctors would be willing to be, should physician-assisted dying be legalised.

It found that almost a third of doctors would be ‘unwilling to provide information or have a discussion with a patient’ about it.

‘Nearly six in 10 (58%) said they would provide information or have a discussion with a patient about it, with three in 10 unwilling to do so. A minority of respondents said they would be willing to go further by either prescribing or administering lethal drugs,’ the survey report said.

The two most popular reasons against legalising physician-assisted dying given by the survey’s responders were ‘to protect vulnerable people from risk of coercion’, and because the ‘focus should be on improving palliative care’.

Among those responding in support, more than nine in 10 said the reasons they held that view were ‘to prevent suffering’ and ‘to give patients dignity in their final days’.

More than a quarter (26%) thought legalising physician-assisted dying would have a positive impact on the medical profession, but nearly half (47%) thought the opposite. One in 10 (11%) believed it would have a neutral impact, while 16% were unsure.

Physician-assisted dying is currently an offence in England, Wales and Northern Ireland. In Scotland, a person assisting in a suicide can be prosecuted under related crimes such as murder. 

A new law is expected to be proposed in Scotland, and at Westminster, the Health and Social Care Committee is preparing to publish findings from its inquiry into assisted dying/assisted suicide.

A BMA survey in 2020 found that GPs were ‘generally more opposed’ to physician-assisted dying than other doctors.

And in 2021, the BMA said it would move to a neutral stance on physician-assisted dying.

A version of this article was originally published by our sister publication Pulse.

Study assessed nurse-led palliative care intervention on patients’ quality of life

27th September 2021

A randomised trial of an oncology nurse-led palliative care intervention did not improve patient-reported outcomes at 3 months.

In patients with advanced cancer, there is a considerable impairment of most aspects of their quality of life. A holistic approach to cancer care should pay some attention to a patient’s emotional needs since many of those with cancer experience depression or anxiety as a central symptom. However, research suggests that the proportion of physician-patient consultations devoted to quality of life issues is limited although a nurse-led palliative care intervention has been shown to lead to improvements in patient’s quality of life.

To further strengthen the evidence base for the value of a nurse-led palliative care intervention, a team from the Palliative Research Centre, University of Pittsburgh, US, developed the Care Management by Oncology Nurses to Address Supportive Care Needs (CONNECT) intervention. While the pilot study found a high level of satisfaction with the intervention, it lacked a control arm and this led the team decided to examine the impact of the CONNECT intervention compared with standard oncology care among patients with advanced cancers. For the purposes of the study, patients with advanced, metastatic solid tumours were defined as those for whom the oncologist agreed with the statement “would not be surprised if the patient died next year”.

Enrolled patients were randomised to the CONNECT intervention or usual oncology care, which was defined as best practice oncology care. Patients randomised to the CONNECT arm received a monthly visit from a trained oncology nurse for a period of three months and the intervention itself was based on the chronic care model. Three primary outcome measures were used and designed to assess quality of life used and completed at baseline and after three months. The first was the Functional Assessment of Chronic illness therapy-palliative care (FACIT-Pal), where higher scores indicate better quality of life. The second assessed symptom burden with the Edmonton Symptom Assessment Scale (ESAS), for which higher scores reflect a greater symptom burden. The final measure was the Hospital Anxiety and Depression scale (HADS) where again, higher scores indicated greater levels of anxiety and depression.

Findings
A total of 672 patients with a mean age of 69.3 years (53.6% female) were enrolled and randomised to the palliative care intervention, CONNECT (336) or standard care. The two most common cancers were lung (36%) and gastrointestinal (19.5%). Among CONNECT patients, the mean number of completed visits was 2.2 and 56% of patients received 3 visits. With respect to the 3-month changes in the three outcome measures, there were no significant differences. For example, the mean FACIT-Pal scores were 130.7 and 134.1 (CONNECT vs standard care, adjusted mean difference = 1.20, p = 0.55). Similarly, there were no differences in the ESAS (adjusted mean difference = -.2.46, p = 0.11) or HADS scores.

The authors concluded that further work is required to identify effective palliative care interventions for those with advanced cancer.

Citation
Schenker Y et al. Effect of an Oncology Nurse–Led Primary Palliative Care Intervention on Patients with Advanced Cancer. The CONNECT Cluster Randomized Clinical Trial. JAMA Int Med 2021