BMJ  2005;331 (24 September), doi:10.1136/bmj.331.7518.0-g

Editor's choice

A time to die

Ask friends about the deaths of their loved ones, and the "bad death" stories crowd out the "good death" ones. Reflections along the lines of "They wouldn't let a dog die like my old Dad died," recur uncomfortably often. This is presumably one of the reasons why public support for legislation to permit assisted dying exceeds 80% (p 681). While doctors' attitudes are harder to summarise, there are signs that a majority of UK doctors now favour legalisation of physician assisted suicide with stringent safeguards (p 686).

In this issue we've assembled five articles that discuss assisted dying from a range or perspectives. We've also included a review of a film about EXIT, the Swiss organisation that provides "suicide assistance" (p 702). Our intention is not to tell you what to think but to arm you with information to help you make up your mind. Are you for, against, or—like the BMA and the royal colleges of general practitioners and physicians—neutral? Since doctors are likely to have a key role in assisted dying we think they should decide where they stand, and why.

The immediate context for this current concern is next month's debate in the House of Lords on the issues raised by Lord Joffe's bill on assisted dying for the terminally ill, which ran out of time before the general election last May. The most significant development since then has been the decision of this year's annual representative meeting of the BMA to drop its opposition to the legalisation of assisted dying (p686). The legislators might now begin to move—if the public wants the law changed and doctors have dropped their opposition to it.

It's hard to tell from where we sit whether a majority of doctors have dropped their opposition to assisted dying. Any mention of euthanasia in the BMJ seems to precipitate a barrage of criticism from opponents of a change in the law that drowns out the messages of support. Do the opponents have more, or better, arguments than the supporters of a change in the law? Are they more numerous, better organised, or just noisier? We'll be watching carefully the feedback to these articles. So, one suspects, will the government.

Elsewhere we publish feedback to an earlier idea floated in the journal: scenario planning for academic medicine. Respondents to an online poll rated the "Global academic partnership" (main concern: to improve global health) the most creative and desirable scenario but also the least likely. "Academic Inc" (the triumph of the market) was rated the most distasteful but the most likely scenario (p 672). Among a cluster of letters on the topic, one reports on an intriguing method to improve collaboration between academic departments—a modified form of speed dating. Members of one department were rotated at three minute intervals between stations "manned" by members of another department, with the chance for interested pairs to follow up their introductions over coffee (p 695).

Tony Delamothe, deputy editor

(tdelamothe{at}bmj.com)

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Relevant Articles

Hit parade
BMJ 2005 331: 972. [Extract] [Full Text]

Time to legalise assisted dying?: RCGP is not neutral: it opposes a change in legislation
Mayur K Lakhani
BMJ 2005 331: 841. [Extract] [Full Text] [PDF]

Time to legalise assisted dying?: BMA should take an active role, whatever that may be
Michael G Peckitt
BMJ 2005 331: 841. [Extract] [Full Text]

Time to legalise assisted dying?: No, thank you
Thomas H Emmett
BMJ 2005 331: 842. [Extract] [Full Text]

Time to legalise assisted dying?: Doctors cannot simultaneously be patient centred and reject assisted suicide
Hazel Smith and Richard Smith
BMJ 2005 331: 842-843. [Extract] [Full Text]

Academic medicine scenarios: final votes
BMJ 2005 331: 672. [Extract] [Full Text] [PDF]

Time for change
M A Branthwaite
BMJ 2005 331: 681-683. [Extract] [Full Text] [PDF]

Changes in BMA policy on assisted dying
Ann Sommerville
BMJ 2005 331: 686-688. [Extract] [Full Text] [PDF]

Five futures for academic medicine: "Speed networking" may be one way forward
Matthew J Ridd and Alison R G Shaw
BMJ 2005 331: 695. [Extract] [Full Text]

EXIT—le droit de mourir
Raghav Chawla
BMJ 2005 331: 702. [Extract] [Full Text]

Rapid Responses:

Read all Rapid Responses

Involuntary Assisted Dying
Abdillahi Sheikh Mohamed
bmj.com, 23 Sep 2005 [Full text]
Do you count heads to determine what is right?
Eugene B Wu
bmj.com, 24 Sep 2005 [Full text]
RCGP abandons neutral position
Peter J Saunders
bmj.com, 24 Sep 2005 [Full text]
Assisted Dying: RCGP is not neutral: it opposes a change in legislation
Mayur K Lakhani
bmj.com, 24 Sep 2005 [Full text]
Re: Assisted Dying: RCGP is not neutral: it opposes a change in legislation
Tony Delamothe
bmj.com, 24 Sep 2005 [Full text]
Supporting change requires great courage
Don C Aston
bmj.com, 25 Sep 2005 [Full text]
Protect the weak
Joseph J De Murtinho-Braga
bmj.com, 25 Sep 2005 [Full text]
BMJ seems far from 'neutral'
Trevor Stammers
bmj.com, 25 Sep 2005 [Full text]
No to Physician Assisted Suicide
Dominic Beer
bmj.com, 25 Sep 2005 [Full text]
Putting People First
Michael A Varnam
bmj.com, 25 Sep 2005 [Full text]
Doctors cannot simultaneously be patient centred and reject assisted suicide
Hazel Smith, et al.
bmj.com, 25 Sep 2005 [Full text]
Assisting letting go
Ian P Donald
bmj.com, 25 Sep 2005 [Full text]
Responsibility for One's Life
Neil J Ritchie
bmj.com, 25 Sep 2005 [Full text]
Assisted dying, the unseen costs to the profession
Peter J Horden
bmj.com, 25 Sep 2005 [Full text]
Is the BMA really neutral?
MARK A HARNEY
bmj.com, 25 Sep 2005 [Full text]
BMA out of touch
John T Wenham
bmj.com, 26 Sep 2005 [Full text]
A time to live
Rhona A Knight
bmj.com, 26 Sep 2005 [Full text]
Assisted Dying Bill for the Terminally-Ill
Teresa M Lynch
bmj.com, 26 Sep 2005 [Full text]
Re: Putting People First
Michael O'Donnell
bmj.com, 26 Sep 2005 [Full text]
No to euthanasia by stealth
peter d williams
bmj.com, 26 Sep 2005 [Full text]
Assisted Dying: A perception of junior doctors views.
Alistair G Rogers
bmj.com, 26 Sep 2005 [Full text]
Whose campaign ?
Richard Hain
bmj.com, 26 Sep 2005 [Full text]
A neutral position is evading our responsibilities
Timothy Stopford Hinks
bmj.com, 26 Sep 2005 [Full text]
Time to live
Elzbieta Anna Gawor, et al.
bmj.com, 26 Sep 2005 [Full text]
killing and letting die
ADRIAN A PIERRY
bmj.com, 26 Sep 2005 [Full text]
Re: Doctors cannot simultaneously be patient centred and reject assisted suicide
Peter KK Au-Yeung
bmj.com, 26 Sep 2005 [Full text]
Handling suicide in the terminally ill
David J Evans
bmj.com, 26 Sep 2005 [Full text]
We are all patients
Marco Michele Sinisi
bmj.com, 26 Sep 2005 [Full text]
Support for assisted dying for terminally ill
Elaine Murphy
bmj.com, 26 Sep 2005 [Full text]
Sad day for Britain
Mark L Withoos
bmj.com, 26 Sep 2005 [Full text]
In favour of Euthanasia.
Euan G Dodds
bmj.com, 26 Sep 2005 [Full text]
Scarce signs of a majority
David A Jones
bmj.com, 26 Sep 2005 [Full text]
Responsibility for Survival
Neil J Ritchie
bmj.com, 26 Sep 2005 [Full text]
First, do no harm.
Patricia M O'Brien
bmj.com, 26 Sep 2005 [Full text]
A time to stand firm
Jeffrey B Stephenson
bmj.com, 27 Sep 2005 [Full text]
We can't agree about much, but couldn't we all agree that everybody should have an advance directive?
Richard Smith
bmj.com, 27 Sep 2005 [Full text]
A Time to Die in Comfort
Dr Michael W Platt
bmj.com, 27 Sep 2005 [Full text]
Disappointing bias: BMJ should know better.
Simon I R Noble
bmj.com, 28 Sep 2005 [Full text]
The answer is no
Keith M Rigg
bmj.com, 27 Sep 2005 [Full text]
A loss of neutrality at the BMA
Andrew D Butterworth
bmj.com, 27 Sep 2005 [Full text]
Re: Doctors cannot simultaneously be patient centred and reject assisted suicide
Christopher Harrison
bmj.com, 27 Sep 2005 [Full text]
Palliative care rather than Euthanasia
John Kelly
bmj.com, 27 Sep 2005 [Full text]
Slippery slope
Christine M Hudson
bmj.com, 27 Sep 2005 [Full text]
in opposition to Joffe
Helen E. Sperry
bmj.com, 27 Sep 2005 [Full text]
Hard cases make bad laws
Peter J Saunders
bmj.com, 27 Sep 2005 [Full text]
No need for euthanasia
Simon L Purnell
bmj.com, 27 Sep 2005 [Full text]
BMJ website guilty of publication bias?
Dr. David W. Pitches
bmj.com, 28 Sep 2005 [Full text]
No wooly thinking please
James V Gallagher
bmj.com, 27 Sep 2005 [Full text]
Conflict of interest
Mick Tarry
bmj.com, 27 Sep 2005 [Full text]
PAS must not be legalised
Timothy S Maughan
bmj.com, 27 Sep 2005 [Full text]
A personal response as a professional, a researcher, a relative and a cancer patient
Yvonne Yi Wood Mak
bmj.com, 27 Sep 2005 [Full text]
we need GOOD palliative care
Richard A Knox
bmj.com, 27 Sep 2005 [Full text]
A responsibility too far
Matthew H Lillicrap
bmj.com, 27 Sep 2005 [Full text]
Permitting death
Matthew P Doogue
bmj.com, 27 Sep 2005 [Full text]
The X Factor
Joanne E Bramall
bmj.com, 27 Sep 2005 [Full text]
Good death vs PAS
Philip Pearson
bmj.com, 27 Sep 2005 [Full text]
The Counsel of Despair
Roderick JH Isaacs, MA Cantab
bmj.com, 27 Sep 2005 [Full text]
Beware the "reasonable"..
Naomi R Beer
bmj.com, 27 Sep 2005 [Full text]
Balanced Information?
John Keown
bmj.com, 27 Sep 2005 [Full text]
warning from Dutch experince
sarah gwynne, et al.
bmj.com, 28 Sep 2005 [Full text]
“Do you have a gun in your bag? He probably needs a gun!”
Scott A Murray
bmj.com, 28 Sep 2005 [Full text]
Avoiding Uncontrollable Slippage
Wiktor S Zbrzezniak
bmj.com, 28 Sep 2005 [Full text]
Re: Protect the weak
Sarah L Janes
bmj.com, 28 Sep 2005 [Full text]
Physician assisted suicide?: Choosing the Right Path
Gowri Anandarajah
bmj.com, 28 Sep 2005 [Full text]
Further erosion...
Leeroy William
bmj.com, 28 Sep 2005 [Full text]
Neither give a deadly drug to anybody who asks... nor make a suggestion to this effect.
Peter Alexander Kiehlmann
bmj.com, 28 Sep 2005 [Full text]
Protection of the vulnerable
Mark A Lee
bmj.com, 3 Oct 2005 [Full text]
The view from incurable pain
Mark Houghton
bmj.com, 28 Sep 2005 [Full text]
Its not our decision to make
suzanne H Perkins
bmj.com, 28 Sep 2005 [Full text]
Evidence and appropriate services before a change in the law
Andrew Thorns
bmj.com, 28 Sep 2005 [Full text]
Clarification from BMJ Editorial
Birte Twisselmann
bmj.com, 28 Sep 2005 [Full text]
BMJ Editors; please treat authors equally!
Chris J. Bronsdon
bmj.com, 29 Sep 2005 [Full text]
Afraid to express despair.
Julie Rowlands
bmj.com, 28 Sep 2005 [Full text]
Euthanasia debate is a religious issue
Keith G Buchan
bmj.com, 29 Sep 2005 [Full text]
A time to die
Peter J Barrett-Lee
bmj.com, 29 Sep 2005 [Full text]
Neutrality and the BMA
James W. Gerrard
bmj.com, 29 Sep 2005 [Full text]
Autonomy and Choices
Kate Coleman
bmj.com, 29 Sep 2005 [Full text]
Assisted Living versus Assisted Dying
Bertie Mo
bmj.com, 29 Sep 2005 [Full text]
Re: Clarification from BMJ Editorial
Christopher Harrison
bmj.com, 29 Sep 2005 [Full text]
Beware: slippery slope ahead
Dan Martin
bmj.com, 29 Sep 2005 [Full text]
no thankyou.
thomas h emmett
bmj.com, 29 Sep 2005 [Full text]
Beware the slippery slope
Stephen P Linton
bmj.com, 29 Sep 2005 [Full text]
PAS would be stepping backwards
Hannah L Bowdler
bmj.com, 29 Sep 2005 [Full text]
An average impassioned objection
John P Snelling
bmj.com, 29 Sep 2005 [Full text]
Physician Assisted Suicide
B Anthony Bell
bmj.com, 29 Sep 2005 [Full text]
No to change in the law
Rebecca J Moss
bmj.com, 29 Sep 2005 [Full text]
And No Ambulance Down In The Valley
Dr. Herbert H. Nehrlich
bmj.com, 29 Sep 2005 [Full text]
The BMA's position
Michael G Peckitt
bmj.com, 29 Sep 2005 [Full text]
Of Cat & Bags
Rob J George
bmj.com, 29 Sep 2005 [Full text]
Re: The BMA's position
John Stone
bmj.com, 30 Sep 2005 [Full text]
Managing patient's suffering by killing - the right approach?
K S Chan, et al.
bmj.com, 29 Sep 2005 [Full text]
Stand up and be counted
Joanne Brady
bmj.com, 30 Sep 2005 [Full text]
A time to die?
Caroline Hampton
bmj.com, 30 Sep 2005 [Full text]
Death stories
Claire L Hookey
bmj.com, 30 Sep 2005 [Full text]
BMJ editors, what are your views on euthanasia please?
Chris J Bronsdon
bmj.com, 30 Sep 2005 [Full text]
Legalising assisted dying? The public thinks so… Doctors are debating… but do our patients want it?
Sarah E Wenham
bmj.com, 30 Sep 2005 [Full text]
Re: A loss of neutrality at the BMA
Jay Ilangaratne
bmj.com, 30 Sep 2005 [Full text]
we're only human...
stephen a willott
bmj.com, 30 Sep 2005 [Full text]
We must work together
Simon Kenwright
bmj.com, 30 Sep 2005 [Full text]
Re: A time to die
ambreen akhtar
bmj.com, 30 Sep 2005 [Full text]
Please stop fallacious slippery slope arguments
Richard Lindley
bmj.com, 30 Sep 2005 [Full text]
Re: We must work together
Peter KK Au-Yeung
bmj.com, 1 Oct 2005 [Full text]
Re: Please stop fallacious slippery slope arguments
Jay Ilangaratne
bmj.com, 1 Oct 2005 [Full text]
Assisted dying..being honest
Robin BD Fisher
bmj.com, 1 Oct 2005 [Full text]
I stand against killing people
Christine L Paterson
bmj.com, 1 Oct 2005 [Full text]
Euthanasia is wrong
Gervase Vernon
bmj.com, 1 Oct 2005 [Full text]
A time to die or to receive definitive treatment.
Richard G Fiddian-Green
bmj.com, 1 Oct 2005 [Full text]
Death is the enemy
Janice Allister
bmj.com, 2 Oct 2005 [Full text]
Opposed to PAS
A. Elizabeth Walker
bmj.com, 2 Oct 2005 [Full text]
Time to Die - a response
Helen B Hosker
bmj.com, 3 Oct 2005 [Full text]
A United Response
Helen Herbert
bmj.com, 3 Oct 2005 [Full text]
We must work together : reply to Dr Au-Yeung's question
Simon Kenwright
bmj.com, 3 Oct 2005 [Full text]
A Primary Care Perspective
Nabil F Raphael
bmj.com, 3 Oct 2005 [Full text]
Re: Slippery slope arguments
Rob J George
bmj.com, 3 Oct 2005 [Full text]
The Doctors Role
Anna C Williams
bmj.com, 3 Oct 2005 [Full text]
Professional responses to euthanasia debate
David R Katz
bmj.com, 3 Oct 2005 [Full text]
Re: Re: Slippery slope arguments
Richard M Lindley
bmj.com, 4 Oct 2005 [Full text]
A worrying subject for the doctors of tomorow
John Greenall
bmj.com, 5 Oct 2005 [Full text]
Compassion need not kill
George L. Chalmers
bmj.com, 5 Oct 2005 [Full text]
Re: Do you count heads to determine what is right?
Christopher B Millner
bmj.com, 5 Oct 2005 [Full text]
Life is precious
Patrick T Haynes
bmj.com, 5 Oct 2005 [Full text]
The wrong picture
david s sharpe
bmj.com, 5 Oct 2005 [Full text]
Euthanasia or assisted suicide is the wrong intervention
Ian Basnett
bmj.com, 6 Oct 2005 [Full text]
Assisted Dying for the Terminally Ill Bill
Carole E O'Reilly
bmj.com, 6 Oct 2005 [Full text]
A Time to Die but not to be killed
Nicholas Jackson
bmj.com, 6 Oct 2005 [Full text]
A time to die (1) Hidden consequencies of euthanasia
David R Clegg
bmj.com, 7 Oct 2005 [Full text]
Underneath the Arguments
William A Henderson
bmj.com, 7 Oct 2005 [Full text]
Re : Euthanasia : the slippery slope.
srivatsa gopal vyasarayani
bmj.com, 9 Oct 2005 [Full text]
Patients have a right to Hippocratic Doctors
Dr Adrian Treloar
bmj.com, 9 Oct 2005 [Full text]
Contestbility and Assisted Dying
Daniel J Albert
bmj.com, 10 Oct 2005 [Full text]
Uncle Dan Refused Resuscitation
Dr. Herbert H. Nehrlich
bmj.com, 10 Oct 2005 [Full text]
Assisted Dying
Pat C Sartori
bmj.com, 11 Oct 2005 [Full text]
When I Grow Up
Anika K Lillicrap
bmj.com, 12 Oct 2005 [Full text]
Re: Support for assisted dying for terminally ill
srivatsa gopal vyasarayani
bmj.com, 12 Oct 2005 [Full text]
who decides?
B.C Rao
bmj.com, 12 Oct 2005 [Full text]
We don't know enough about death.
David C. Mackereth
bmj.com, 13 Oct 2005 [Full text]
Re: When I Grow Up
James W. Gerrard
bmj.com, 13 Oct 2005 [Full text]
Euthanasia and physician assisted suicide
Cornelia Fung
bmj.com, 16 Oct 2005 [Full text]
Against assisted dying
Yee-ming Wu
bmj.com, 21 Oct 2005 [Full text]
Have We Lost The Plot?
Amanda T Harlow
bmj.com, 26 Oct 2005 [Full text]
Assisted Dying for the Terminally Ill Bill
Raymond C Tallis
bmj.com, 26 Oct 2005 [Full text]
Doctor, please do not kill your patients
Cecilia WaiMan Kwan
bmj.com, 2 Nov 2005 [Full text]
No change required.
John F Scullion
bmj.com, 10 Nov 2005 [Full text]
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