Author's reply. RE: Proposed Assisted Dying Bill: implications for mental healthcare and psychiatrists

We thank Drs Findlay, Bryden and Breen for their comments on our editorial¹ on assisted dying. Dr Findlay rightly clarifies that even though the legislation we refer to is being considered by the UK parliament, it only applies to England and Wales. This error occurred inadvertently through successive revisions of an earlier draft. A synopsis of previous attempts to pass such a Bill was also suggested by one of the peer reviewers of our article, and we do refer readers to suitable literature. However, given space and reference limitations, we were unable to provide a reasonable history of assisted dying legislation, which is extensive and nuanced.

Instead, the substance of our editorial concerns issues of medical and psychiatric care that supersede regional and political systems and lie predominantly in the realms of medical ethics and comprehensive service provision. We believe patients and families are not best served if different jurisdictions adopt distinct procedures and processes for implementation and follow markedly different political processes for deliberation. Such an approach is likely to create inequalities of access and potential harms; therefore we advocate a broader consensus, and guidance needs to be achieved by health and social care professionals.

In addition, we allude to the failures of international implementations referred to in the House of Lords record. Given current variations in service provision and the challenges of regulation, we argue that safe implementation should, in the first instance, be coordinated at a national level, and that alongside this, careful surveillance and research of harms and benefits is necessary.

Drs Bryden and Breen both make compelling and compassionate arguments. For example, Dr Bryden's comments regarding the motivations of those seeking assisted dying and the stigma associated with those judged as not actively contributing to society are on point. We agree with their sentiments even though they arrive at somewhat different conclusions, but this further highlights the challenges we face. End-of-life care is personal, and each person will want a particular level of care and support, some moving towards assisted dying while others remain firmly against the possibility. This is where legislation will need to incorporate personalised options such as advanced directives and novel measures to assess capacity. However, given the many scenarios in which assisted dying may be sought and the likely complexities of each person's situation, any legislation will need to be flexible and accommodating while ensuring that choice and dignity are not compromised.