(11/14) ‘The Doctor-Patient Relationship’

A concern about the introduction of ‘assisted dying’ is the possible damage it might do to the doctor-patient relationship. I am not a medical doctor, so I invited Dr Brendan O’Shea to contribute his considered opinion. Prof Brendan O’Shea is a GP in Co. Kildare, and is also Adjunct Assistant Professor for Public Health and Primary Care at Trinity College Dublin. He is also a member of Irish Doctors supporting Medical Assistance in Dying (MAiD) in Ireland (www.maid.ie). MAiD is the preferred term for doctors because it emphasises their role in the process. It is also the term used for the legislation in Canada.


Dr Brendan O’Shea writes —


The discussions people have with their doctors in relation to end of life, end of life planning, dying, death and bereavement are important. Done well, they can greatly alleviate some of the suffering people and their households experience around dying, death and grief. Done poorly, they can markedly worsen the pain and suffering.


At present, doctors in many instances are uncertain regarding what to say, how to open discussions, and are acutely concerned that by opening a discussion, they may make matters worse for people under their care. The international evidence also shows that when doctors and people attending them for care do open these discussions, it can make things substantially easier.


In our stressed health system, it is challenging to find a little time and privacy, but the evidence suggests that when we do this, and especially when we have a little structure around the discussion of end-of-life issues, that uncertainty is reduced, there is a better understanding of the problems, and better working out of solutions.


GPs are doctors for whom long-term relationships are important. GPs strive to keep the whole person in mind, and in the context of their households. GPs are trained in communication skills, and also have a particular responsibility for overall co-ordination of medical care. GPs are skilled and experienced in exploring sensitive, highly personal issues as part of their core medical practice.


If it is decided to make MAiD available as a choice for people in Ireland, it is likely that GPs will be able to avail of modular professional training on the new service. Some GPs will have a serious ethical concern and may not be able to engage in a conversation about MAiD. Others (often within the same practice) will be comfortable, and skilful in exploring MAiD as an option with their patients. It is likely that a minority of GPs will actively participate in the delivery of MAiD as a service, if it is introduced within specific limitations.


MAiD is an important and challenging topic for doctors, and for people who attend for medical care. Given the large volume of international experience, I am confident that it can be usefully and safely provided, and that GPs will be involved in many instances, and will be of assistance to people and their households.


I have already had a discussion with my own GP, who is now aware of my views in relation to my own care. I presently enjoy very good health, but I understand that that may not always be the case. My own GP is comfortable and very understanding regarding MAiD, should it become a choice at end of life, and though the possibility of my requiring it is very small, I am happier that my GP is aware of my wishes, and particularly my own concerns regarding over-medicalisation at end of life.


Irish Doctors Supporting Medical Assistance in Dying in Ireland works closely with End of Life Ireland to advocate for legislation to allow Voluntary Assisted Dying in Ireland.