Matt Morgan , 2025-04-16 09:45:00
- Matt Morgan, consultant in intensive care medicine
- mmorgan{at}bmj.com
Follow Matt on X @dr_mattmorgan
I’ve been sitting on my hands over the topic of assisted dying. Not because I’m scared, or irritated, or confused. I’ve purposely not spoken out owing to something much more serious.
Because of my writing, I’m often expected to have opinions on everything that touches medicine. Talks that I give often end with a tough question, such as, “Should we experiment on animals?” or “Is the NHS broken?” And I love these tough questions—although I still prefer tough answers, “No” or “Yes.”
But it’s also OK not to have an opinion on some, or even many, issues involving medicine. In today’s fractured world, where small streams of difference swell to gulfs of conflict, I’d argue that it’s essential not to have an opinion on things that are “not for you.” And to say so. Or to say nothing. Hubris can be deadly.
On assisted dying, it’s not even that I don’t have opinions. I do. I have loads. Too many. They’re jumbled throughout parts of my brain, surfacing when I think of patients from the past or about my own future health; when I talk to overseas colleagues working in places where assisted dying is well established; or at times when simply discussing assisted dying would be a disaster. The main reason I’ve kept quiet about whether we should allow assisted dying is that my only real, honest answer is, “I don’t know.” And that’s OK, too.
In my world of critical care, the need for assisted dying is vanishingly rare. Patients are so unwell that, if their best interests are no longer served by medical interventions that prolong death and not life, withdrawing life sustaining treatments will overwhelmingly result in a so called “good death.” Not always, but almost. And although I go to work intending to save a life, sometimes saving a death is more important.
So, I’m extremely understanding of people with chronic disease or disability who talk of pain, distress, or a lack of dignity. But equally, I don’t meet these people during their home lives, I don’t talk with them before they’re critically ill, and I don’t treat them in their community to see their joy or pain during a normal week. I’m not an expert in palliative care: I don’t understand the advances in pain management and support at the end of life for people who are not critically ill but are dying.
Temporary custodians
I want to stay fiercely neutral. And this is not a cop-out. This instead does as Aneurin Bevan recommended: “The purpose of power is to give it away.” I don’t even think that assisted dying is a particularly medical question. Of course, it needs to be informed by the science and humanity of those who do care for such people. But “care” is a broad church, with doctors occupying a narrow pew. The question of assisted dying is often framed as a medical dilemma, but in truth it’s no more a clinical issue than the decision to print a book is a question of paper manufacturing.
Medicine may provide the means, the prognosis, much care, and the relief of suffering, but it doesn’t own the moral, philosophical, or human weight of the decision itself. So, a balance struck in the current discourse between medical voices and those from the rest of life should be encouraged, as long as it’s done with good intentions. It’s a matter of autonomy, of the boundaries of state power, and of what it means to live a life that truly is one’s own.
Doctors have a role as temporary custodians and guides for the body and for the person who inhabits that body during life and death. But they are not, and should not be, the sole authors of life’s final page. And so, in truth, “I don’t know”—and please read these medical words knowing that they are but a tiny fraction of what’s written on a much bigger page.
Footnotes
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Competing interests: I have read and understood the BMJ Group policy and declare that I have no competing interests.
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I am an honorary visiting professor at Cardiff University, an adjunct clinical professor at Curtin University, Australia, a consultant in intensive care medicine in Cardiff, and an editor of BMJ OnExamination.