Dr Ann McPherson: The GP who believes she should be allowed help to end her life
The Monday Interview: A growing number of medical professionals are supporting the idea of assisted dying. Dr Ann McPherson – who herself has only months to live – tells Jeremy Laurance why
Monday 24 January 2011
Some accuse her of advocating "medical killing". Others claim that she is destroying the trust between doctors and patients. But Ann McPherson is not deterred as she prepares to step up her campaign to change the law on assisted dying – at the same time as preparing for her own death.
As the joint author of a million-selling guide to teenage health (Diary of a Teenage Health Freak, now translated into 27 languages) and the founder of the first – hugely successful – website where patients could share experiences of disease ( healthtalkonline.org), she is one of the best known GPs in the country.
Those projects grew directly from her experience as the mother of three children and, later, as a patient with breast cancer, suffering the indignities familiar to millions who have had their bodies poisoned with chemotherapy but which are underplayed by doctors.
Now McPherson is putting her uncanny ability to see things from the other side of the doctor's desk at the service of a new group: the dying. Modern medicine ignores their needs, she says. She wants doctors to be allowed to help terminally ill patients end their lives.
"Death is seen as a technological defeat," she says. "Palliative care specialists see it as a failure if patients want an assisted death. I think that's ridiculous – it should be part of good palliative care. We have got into a terrible mess about keeping people alive when they shouldn't be."
The problem is personal – McPherson is herself dying. Having seen off breast cancer in the 1990s, she was diagnosed in 2007 with pancreatic cancer, one of the deadliest cancers, with a 4 per cent survival rate at five years. She had surgery – the removal of the pancreas, part of the intestine and the stomach in a major operation called a Whipple procedure. She recovered, but suffered a recurrence in 2009. This time the cancer had spread to her lungs. Now, she lives day to day, she says, each morning attaching a small vacuum pump to a tube inserted in her chest to drain the fluid that has accumulated overnight.
At 65, McPherson's illness has given her a new profile as Britain's best known terminally ill doctor. Typically, she has used it to bolster her campaign, challenging the medical establishment to lift its opposition to assisted dying. The British Medical Association and the Royal Colleges of Physicians, Anaesthetists and GPs are all against assisted dying. Only the Royal Colleges of Psychiatrists and Nurses are neutral on the issue. None is in favour.
The group McPherson launched last October, Healthcare Professionals for Assisted Dying, has gathered 340 members in three months by word of mouth alone, including some of the most eminent names in the profession. There are 19 professors, 32 consultants and 145 doctors. Supporters include Sir Terence English, the heart transplant pioneer; Sir Ian Chalmers, a founder of the Cochrane Collaboration for evidence-based medicine; Raymond Tallis, the former chair of the ethics committee at the Royal College of Physicians; and Sir Graeme Catto, the former head of the General Medical Council.
McPherson argues that those medical bodies which oppose assisted dying do not reflect the views of their members, which are more evenly divided. A survey in 2009 found that 39 per cent of GPs and consultants backed a change in the law to permit assisted dying, while 49 per cent opposed it. In contrast, the British Social Attitudes 2010 survey found 82 per cent of the public in favour of a change in the law.
"Our mission is to influence the medical bodies to ensure the medical voice is heard," McPherson says. "We want an open debate. I think the tide of change is sweeping over them. All the surveys show that when the public are asked, in whatever way, a majority say that people who want the option of an assisted death should have it. The profession is out of step with the public on this."
In matters of life and death, the views of doctors carry considerable weight and the opposition of the major medical bodies is thus a roadblock to reform. The defeat of Lord Joffe's Assisted Dying for the Terminally Ill Bill in May 2006 – the last attempt to change the law – was attributed in large part to the decisions of the Royal Colleges of Physicians and GPs to oppose the reform.
The Royal College of Nursing changed its stance in 2009 from outright opposition to one of studied neutrality, after its general secretary Peter Carter, acknowledged that opinion among nurses was split. McPherson wants the remaining medical colleges to do the same, leaving the issue for society to decide.
Her illness has not stopped her working. When I arrived at the large, comfortable house, full of light and colour, in north Oxford that McPherson shares with her husband, the noted epidemiologist Professor Klim McPherson, she was in a meeting with a potential donor for one of her many projects. Books, pictures and family photographs occupy every inch of wall space, and there are piles of children's things by the sofa.
McPherson has already survived much longer than she, or anyone else, expected. Always a slight figure, now she looks as if a breath of wind would carry her away. Her weight has dropped to less than eight stone – three stone below normal – but the effect is countered by the thick, dark curls that frame her narrow face, and by her steely determination.
She was born and brought up in London, the daughter of a tailor who later became an official of the Communist party. But she was closer to her mother, who died seven years ago at the age of 93 after refusing the offer of dialysis when her kidneys failed in her final weeks. "My mother was adamant about what she wanted," McPherson says. "It was very difficult because the hospital was keen to dialyse and resuscitate her. But she had had a very good life. All her friends were dying, and she had had enough".
Mother and daughter were, on this issue, at one. But being much younger, McPherson remains "desperate to get things done". And she has set herself a new goal: living long enough to see the birth of her youngest daughter's first child, her sixth grandchild, expected in the summer.
She is in no hurry to die – quite the opposite. But she wants what she believes many in her position would want: the option to end her life in a manner and at a time of her own choosing. "There has not been a time when I wanted it – I may or may not want it – I just don't know. It's a choice issue. It's about having that option. Like having Viagra in the cupboard."
Her campaign began by accident. She wrote an article in the British Medical Journal in July 2009, two weeks after she discovered her cancer had returned, in which she castigated the medical establishment for its insularity on the issue. "Part of the problem is that those deciding on the legal and political issues concerning assisted dying are not those facing immediate death themselves," she wrote. "Why can't people have a rational discussion about assisted dying? Why can't it be available for those who want it as a choice?"
She was inundated with emails and letters in response, almost all in support, many from eminent names in the profession. "It made me think that given how many doctors were for a change in the law, we ought to form a group." It was launched in October and has generated a "very good" response.
She rejects the arguments of those who say that assisted dying undermines trust in the medical profession. "I have had three or four patients in my career as a GP who definitely wanted an assisted death despite having very good palliative care. They were not in pain – they had just had enough. I felt that not being able to help them affected my relationship with them. It is the other way round – not being able to assist undermines trust."
Some places, notably Oregon and Washington in the US, permit assisted dying, and demand in those states implies that about 1,000 people annually might make use of the legislation in the UK – one in 500 of all deaths. In Oregon, one in three of those cared for in hospices at the end of their lives had considered seeking an assisted death, suggesting that it brings comfort to far more people than actually use it.
McPherson acknowledges that people may be depressed, or feel a burden, or come under pressure from relatives. But these issues are not peculiar to dying – they apply in other areas such as abortion.
Like the Abortion Act, an Assisted Dying Act would be about giving people – in this case the terminally ill – the right to choose. And as with abortion "you would probably need two doctors to approve it".
She is sure it will come one day, as is her rapidly growing body of supporters.
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