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Leading surgeon voices support for assisted dying as Bill goes through Parliament

© Shutterstock / Ground PictureCancer patients and their carers often have problems accessing end-of-life care.
Cancer patients and their carers often have problems accessing end-of-life care.

A leading Scottish cancer surgeon is backing the assisted dying Bill.

Professor Jim McCaul operates on patients with head and neck cancers, some of whom are diagnosed at an advanced stage with a low chance of survival.

They include those who present with late-stage disease when treatment for a cure is not possible.

The professor reveals that the challenges of securing palliative care for some terminally ill patients is a considerable struggle for many doctors and, consequently, some are unable to have a peaceful and dignified death.

His support comes as the Assisted Dying Bill – introduced by MSP Liam McArthur – makes its way through the Scottish Parliament.

‘I’ve seen people with cancer have their airway blocked or drown in their own blood’

Professor McCaul, who works in the west of Scotland, said: “Sadly, the last stages of some head and neck cancers can mean doing everything possible, and more at times, to avoid patients suffocating or dying from haemorrhaging from cancer-damaged blood vessels near the site of the cancer.

“I have experience of people with advanced cancer who have steadily and slowly had their airway blocked by cancer and then died.

“A worse terminal event is where cancer erodes through a large neck artery and someone dies with very distressing, very rapid bleeding, drowning in their own blood until they lose consciousness and die.

“I have known this happen with family members present, at home and in hospital. The tragedy of these situations is that we have known this was going to happen – from scans and smaller ‘herald’ bleeds – in patients where surgery and other cancer treatments have been exhausted.

“It is my belief that patients in these circumstances should have the opportunity to choose the time of their inevitable death and die a far better, less distressing, more peaceful and far more dignified end.”

But, he added, the possibility of good and effective end-of-life treatment is outwith many patients’ reach. He said: “The necessary palliative care for this challenging time at the end of life is not always easy to get and after 30 years as a surgeon I feel strongly that a safe and regulated system for assisted dying would be a very beneficial option to offer some patients.

“Honesty with patients is paramount in treatment or pathway choices. It is what I would want for myself if I were in the same situation and knew the imminent risks of a very distressing death.”

He added: “The grief reaction which follows loss of those close to us is different when death is inevitable but peaceful and calm.

“Suddenly losing a loved one, even when death is known to be close, in a fountain of their own blood, or suffocated by cancer, is a very different experience and much harder for those left behind. The 21st-century reality is that one in two of us will get cancer and one in three will die of it.

“Giving control to those who are at the end of their lives with cancer would be so much better for them and for their family and friends.”

However, he said: “Such a system must have very highly controlled conditions which always mean that anyone wishing it must be terminally ill and be deemed so by two experienced doctors familiar with that area of terminal illness.”

Doctors divided

Professor McCaul is one of several doctors who are now supporting assisted dying at a time when doctors are hugely divided on the issue. Other leading advocates include Professor Graeme Catto, former chairman of the General Medical Council and retired kidney specialist at Aberdeen Royal Infirmary among many senior roles in medicine. He has advanced prostate cancer.

A British Medical Association survey showed more UK doctors supported a law change than oppose it – 50% for and 39% against.

The Office for National Statistics has been asked to investigate how many dying people in the UK take their own lives and how many travel abroad for assisted dying.

More than 2,500 UK doctors of all faiths and none have signed a letter of protest stating their opposition against it. The letter, organised by the medics’ group Our Duty Of Care, has 390 Scottish signatories. They are joined by Humanists against assisted dying and urge more investment in palliative care, adding that legalising physician-assisted dying will put frail and disabled people under pressure to use it for fear of being a burden on their families.

They also argue that palliative care suffers in countries which have legalised assisted dying while others say it has improved.

Palliative care is provided by a mix of charitable hospices, NHS specialist care, Macmillan nurses and under-pressure GP practices.

Testaments from families of relatives who die at home reveal that they have at times desperately waited on palliative care nurses to drive up their street with pain relief for distressed patients.

Free vote in Parliament

MSPs are expected to have a free vote, with McArthur saying “robust safeguards” are included in the Bill.

Former First Minister Nicola Sturgeon says she is “veering away” from voting on assisted dying.

Current First Minister Humza Yousaf has indicated that he does not support the proposed legislation, which is opposed by the Church of Scotland, the Catholic Church in Scotland and the Scottish Association of Mosques.

Scottish Labour leader Anas Sarwar says he has “yet to be convinced” to support it.

In 2010, MSPs rejected Margo MacDonald’s End of Life Assistance Bill by 85 votes to 16. The independent MSP had Parkinson’s Disease and died in 2014. The following year, Scottish Greens MSP Patrick Harvie’s Assisted Suicide Bill was rejected by 82 votes to 36.

The Scottish Government said: “We are committed to offering people timely and high‑quality palliative care where they feel most comfortable. For many, but not all, this will be at home, supported by their family and friends and cared for by primary care teams and care staff.

“We are also developing and delivering a new strategy on palliative care and we have appointed a National Clinical Lead for Palliative and End of Life Care.”