Patients' trust in doctors must not be compromised by assisted dying
There are concerns around whether enough doctors would opt in to participate in assisted dying services (Alamy)
4 min read
While research shows patients would prefer to discuss assisted dying with a familiar and trusted doctor, experience from other countries suggests this may be difficult to achieve in practice.
Over several months in 2024, a representative group of people in England met online and in person to deliberate whether assisted dying should be legalised. This Citizens’ Jury, commissioned by the Nuffield Council on Bioethics, was the first of its kind in England. It provided valuable insights into not only what the public think about assisted dying, but also why they think it.
A key topic discussed by the Jury was the involvement of healthcare professionals. Jurors expressed a desire for the ‘right’ professionals to be involved—specifically, someone the patient knew and trusted. This reflected frustrations with accessing consistent GP care, including repeating their medical history to different doctors and struggling to receive continuous support.
While it is understandable that people want to discuss assisted dying with a familiar doctor, experience from other countries suggests this may be difficult in practice. In jurisdictions where assisted dying is legal, many doctors are unwilling to take on the role.
In Canada, more than 5,000 assisted deaths—mostly euthanasia—were carried out by around 80 healthcare professionals, primarily from assisted dying or MAID teams. In Switzerland, most doctors involved in day-to-day care are not part of the process. Palliative care doctors, in particular, are often reluctant to participate. Instead, volunteer doctors from Right to Die Associations typically take the lead.
Looking abroad, a key difficulty in opt-in systems is finding a willing doctor
Reluctance is not always due to opposition. One Dutch doctor explained: “I can discuss with the patient, with the team and agree it is the best option, but to take away the life in a moment and inject the medication—that is something else… I’m not still ready for that.”
So, while the Jury wanted trusted doctors they knew to be involved, this might be challenging.
The Jury was asked whether doctors should opt in or opt out of the service. Views were mixed. Some recognised that participating might conflict with doctors’ values, others feared that an opt-in approach could result in a postcode lottery.
If the law does change in England and Wales and most doctors do not opt in, would the public still want assisted dying to be legal?
Looking abroad, a key difficulty in opt-in systems is finding a willing doctor. Patients and families often need to navigate complex healthcare systems during a time of emotional and physical distress. However, even when the assisting doctor was unfamiliar, bereaved families often said patients were simply grateful for the support.
A new amendment to the UK bill replaces the High Court mechanism with a review panel. The panel could maintain a list of opted-in doctors, providing easier access without fully integrating into mainstream healthcare.
For doctors who choose to participate, assisted dying can have an emotional impact. In the Netherlands, where the practice is more integrated, one doctor shared: “Sometimes you read about physicians who perform six euthanasia cases within half a year. I can absolutely not imagine that. For me, it really takes a year before I get over it and think: ‘Ok, now I’m ready for a new trajectory.’”
In Canada, for MAID team members this may be a core part of their role— as it’s something not feasible or desirable for all.
Some doctors worry that discussing assisted dying could damage their relationship with patients. They fear trust could be lost if they are unwilling to assist. Others are concerned that raising the subject could make patients feel pressured. An opt-in system could help preserve trust, allowing doctors to refer patients to external services without direct involvement.
Trust is central to this debate. In Switzerland, institutional trust is a concern, with many hospitals limiting or banning assisted deaths on site. Trust was strained during the pandemic, when decisions like blanket Do Not Resuscitate orders raised public concern.
If assisted dying is legalised in England and Wales, creating a trusted, transparent system — one that supports patients without compromising healthcare relationships — will be essential, and best served outside of the NHS.
Nancy Preston is a Professor of Supportive and Palliative Care and Co-Director of the International Observatory on End-of-Life Care at Lancaster University
