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Having the option of an assisted death “takes the fear out of the dying process” for terminally ill patients, a US medic says.
Dr Ryan Spielvogel has supported patients through the process since it was legalised in California in June 2016, and visited the UK last week to share his experience with MPs in Westminster – who will vote on a Bill next week – and Scotland.
The dad-of-three said: “Helping people end their suffering is one of the highest callings I have ever answered and it’s one of the most important and rewarding things I have ever done as a doctor.”
Patients in California must be terminally ill, mentally competent adults with a prognosis of six months or less to be eligible.
Some 4,287 people had ended their lives through assisted dying in the state by the end of 2023. Last year, 1,281 were prescribed life-ending medication and 858 died after taking it.
When the law changed, GP Dr Spielvogel was not entirely sure how he felt about it but agreed to take part in training.
He remembers clearly the first patient he saw – an 80-year-old man with chronic kidney disease for whom dialysis was not working.
Speaking to him “challenged my ideas about death”, Dr Spielvogel said, as the patient explained that he was suffering intolerably and did not want his family to remember him bed-bound.
After further assessments, the man was found eligible. Dr Spielvogel said: “I prescribed the medication and he took it the next day. I talked with his daughter afterwards and she told me things I’ll never forget.
“They had a memorial for her dad while he was still alive. Friends and family came from out of town and they spent the day watching his favourite movies, listening to his favourite songs.”
At sunset, the family gathered on the porch and the patient drank the medication before passing peacefully.
Dr Spielvogel, 40, added: “She was so grateful that her father had the opportunity to do this and that his death had been so beautiful, rather than traumatic.
“It was a paradigm-shifting moment when I realised that death doesn’t have to be this incredibly painstaking, inexorable slog to the finish.”
Data shows that 30% of patients prescribed the medication do not take it. But the family doctor said many find “tremendous comfort” and emotional relief in having the option.
He added: “It takes the fear out of the dying process because they know that if things get too bad, they have that.
“Just the prescription takes the fear and anxiety away and allows those people to live, so they don’t have to be constantly worrying about dying.”
Dr Spielvogel said he believed a doctor’s job was to mitigate suffering, which can sometimes mean doing “short-term harm with the goal of less suffering overall”.
He said: “Isn’t it causing a person immense amounts of harm to force them to go through suffering that they didn’t want and that’s unnecessary?”
Concerns about coercion are often raised in bad faith because “there have been no documented cases or suspected cases of coercion regarding assisted dying in any jurisdiction where it is legal”, the doctor added.
And although end-of-life care can often manage discomfort, it cannot always prevent people feeling a deep loss of autonomy and dignity.
He said: “The notion that all we have to do is provide everyone with high quality palliative care and that will be that is laughable and factually inaccurate.
“Anyone who has any degree of experience with palliative care or has seen family members die knows that’s not the case, that there is still suffering at the end of life. How much suffering is too much? That’s up to the individual. This is just an option.”
Claims that complications in the dying process are common are also unfounded, Dr Spielvogel said. He added: “Even when it’s taking a few hours, that person is comfortably asleep.
“Assisted deaths are the most peaceful deaths I have ever witnessed, and I’ve witnessed a lot of deaths.”