Observations End of Life Care

Our professional bodies should stop opposing assisted dying

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e4115 (Published 13 June 2012) Cite this as: BMJ 2012;344:e4115
  1. Raymond Tallis, emeritus professor of geriatric medicine, University of Manchester and chair, Healthcare Professionals for Assisted Dying
  1. raymond{at}rtallis.wanadoo.co.uk

The BMA and some royal colleges are publicly opposed to legislation to permit assisted dying for terminally ill mentally competent adults (box). It is not the place here to rehearse what we, as members of Healthcare Professionals for Assisted Dying (HPAD), believe is the powerful case for such legislation, but rather to argue that the proper stance of our professional bodies should be one of neutrality.1 HPAD was founded by Ann McPherson and her friend Professor Joe Collier in 2010 to challenge the stance of the medical establishment.

Medical bodies’ stances on assisted dying

Opposed
  • BMA

  • Royal College of Physicians of London

  • Royal College of Surgeons of England

  • Royal College of General Practitioners

  • Association of Palliative Medicine

No position
  • General Medical Council

  • Royal College of Anaesthetists

  • Royal College of Obstetricians and Gynaecologists

  • Royal College of Paediatrics and Child Health

  • Royal College of Physicians of Edinburgh

  • Royal College of Surgeons Edinburgh

Neutral
  • Royal Society of Medicine

  • Royal College of Nursing

  • Royal College of Nursing Scotland

  • Royal College of Psychiatrists

At the heart of the case for neutrality is that the decriminalisation of assisted dying should be a matter for society as a whole to decide, and no particular group should have disproportionate influence on this decision. The view of society is clear: the respected British Social Attitudes series, which uses representative samples of the UK population, has consistently shown that more than 80% of the general population, including 70% of those with religious beliefs, support assisted dying.2 This is not an unthinking or ill informed response: support for assisted suicide for people who have severe illnesses but are not terminally ill is much lower, at about 40%.3 Our professional organisations, committed to shaking off the paternalism of the past, should not use their influence to impose the beliefs of some of their members on patients: this is inconsistent with the idea of patient centred care and the principle of “no decision about me without me.” The analogy with the opposition of the medical profession to the death penalty, which may be at odds with majority opinion, is flawed: those who want to bring back hanging are not asking for execution for their loved ones or themselves.

The publicly stated opposition of some medical bodies to assisted dying has been cited by many opponents of a change to the law, but this ignores the division of opinion within the professions, as shown by the fluctuating positions adopted by bodies such as the BMA and the Royal College of Physicians, which have been neutral in the past. The most reliable information suggests that between 30% and 40% of doctors are in favour of decriminalisation,4 5 and the result of a recent survey found that a clear majority of doctors think that medical bodies should be neutral. Their voices have been silenced: they are not being represented by their representative bodies. It is interesting to speculate why this should be so: it is possible that those opposed to assisted dying have been over-represented in forums where the matter has been discussed, often because they are supported by well organised groups affiliated with religious institutions.

The primary grounds for the BMA’s opposition to euthanasia and assisted dying are that it is alien to the traditional ethos and focus of medicine.6 Secondary reasons are related to patient safety and a detrimental effect on societal attitudes and the patient-doctor relationship. The monstrous cruelty of walking away from a dying patient who is suffering unbearably seems more obviously contrary to the ethos of medicine. International experience has shown that placing assisted dying within the framework of the law would increase, not threaten, patient safety and have an entirely beneficial effect on trust in doctors.7 8 9

Individual healthcare professionals, as responsible citizens, are of course entitled and perhaps obliged to express their views on the ethical and clinical case for or against, and the potential social impact of, a law to allow assisted dying for terminally ill people. Doctors’ representative bodies, however, should be confined to speaking about those areas where they have an expertise that goes beyond that of the general public—for example, advising on the necessary safeguards and codes of practice should any law be passed, and on matters such as assessing prognosis and setting guidelines for optimal end of life care.

Given the overwhelming support for assisted dying in society as a whole—and given also that there are healthcare professionals of good will, different faiths, and expertise in palliative care, with passionate views on both sides of the debate—we believe that the proper stance of healthcare professional bodies is one of neutrality. Members of HPAD therefore ask the BMA and those royal colleges that have declared themselves opposed to assisted dying to reconsider their position.

Notes

Cite this as: BMJ 2012;344:e4115

Footnotes

  • Competing interests: None declared.

  • McPherson T. My mum wanted assisted dying but we watched her die slowly and in pain. BMJ 2012;344:e4007.

  • Warlow C. Ann McPherson [obituary]. BMJ 2011;342:d3424

References