Dr Peter Hunter: The end of a person's life may be a very stressful time. People approaching the end of their life may require a considerable amount of care, and this may place a strain on families and carers. The decision to access voluntary assisted dying must be a voluntary and informed decision made by the person themselves. This does not mean the person cannot discuss their decision with their family or carers, but care must be taken to ensure the person is not being pressured by others.
We, as doctors, should already be alert to coercion in a range of healthcare decision scenarios, for example which treatment, if any, should a patient undergo and whether surgery is the best option for a particular condition. Families and carers can apply pressure to patients in any of a number of situations. You should always ensure there is sufficient time to discuss and understand the reasons a person is requesting voluntary assisted dying. These discussions will provide insight into the person's concerns and why they think accessing voluntary assisted dying will address the suffering.
If a person requests access to voluntary assisted dying because they are concerned they are a burden on their family, you should explore their situation. This may include looking at other options for supported care or respite care. You should also explore why the person has raised this concern and what they mean by it. Some people may say they feel like they are a burden to family because their family are struggling. Others may use this as a way to start a conversation about their struggles with their current situation.
Other indicators of possible coercion, often detected during a consultation with carer present, could include excessive deferment by patient to carer for answers, reassurance and explanation, carer talking over the top of patient and answering on their behalf, inconsistencies in patient's answers to questions from the doctor about suffering, disease experience and voluntary assisted dying in general. For this reason, it might be helpful to talk with the patient away from their family or usual carers to see if there is potential coercion.
Reviewed 16 June 2022