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Recent rapid responses
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Displaying 1-3 out of 3 published
28 June 2012
In view of the overwhelming rejection of Prof Tallis' views by the BMA this week, perhaps he will understand a little better why most medics feel the profession should stop promoting assisted suicide and keep on assisting the dying in the UK with appropriate palliative care which still arguably leads the world in the field.
Competing interests: CNK member
St Mary's University College, Waldegrave Rd TW14SX
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Both public and politicians have the reasonable expectation that medical professional bodies will offer an overall judgement on the desirability of legislation if it affects medical practice or if doctors have special experience on the issue in question. There is nothing different in principle about professional bodies advising on the desirability of legislation about one issue of practical morality and public policy than any other: whether it’s health service reform, smoking or alcohol policy, assisted death etc. Where a policy is strongly divisive, a responsible organisation will consult, measure and publish its members’ views – as the Royal College of Physicians (RCP) did over the English health reforms recently. An informed public will be interested in the extent of that division as well as an overall judgement. It is for public and ultimately our representatives in parliament to reflect on individual and aggregated opinion from all sources, but especially from those with special experience – as doctors should have in matters affecting medical practice. That’s common sense, not paternalism.
Nobody has ever made the fatuous suggestion that legislation about assisted death (or anything else) is other than for society to decide. But I would certainly hope that the British Economics Association (if such a thing existed) had a greater influence on economic policy than the local cricket club or the best teller of anecdotes.
The problem is that neutrality is not neutral(1) . By withholding any public judgement, proponents of change interpret ‘neutrality’ as acceptance – which is presumably why neutrality (an achievable second best) is the preferred position by those doctors who want change. This was evident (as Tallis seems to have forgotten) when the RCP had a brief dalliance with neutrality on the assisted death issue many years ago, leading to efforts to correct misimpressions. RCP’s current carefully worded position that “it couldn’t support legal change at the present time”, coupled with the data from its consultation (2) offers responsible, principled information to guide interested parties. We owe public and politicians (& perhaps our members too) no less.
1 Saunders J. Ethical Decision Making in Professional Bodies. Clin Med 2006;6:13-15
2 Saunders J. What do physicians think about physician assisted suicide and euthanasia? Clin Med 2008;8:243-5
Competing interests: JS is chair of the Ethical Issues Committee, Royal College of Physicians of London, represented RCP before the HoL Select Committee and had the lead role in the 2006 RCP consultation on assisted death. Views expressed are his own.
Nevill Hall Hospital, Abergavenny, NP7 7EG
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18 June 2012
Death is never neutral
Sam Shuster, Emeritus Professor of Dermatology, Newcastle University
Opposition to euthanasia by professional healthcare bodies can only be justified if they have good reasons that are unavailable to non-professionals. Instead the oppositionists offer the rituals of an ethos they claim to be unchangeable – not so, as a pre-Shipman houseman in 1951, I was often instructed by my consultants (one a royal physician) to assist death; or they magnify the risk of abuse as if the inevitability of a bad apple means dumping the whole barrel; and they overplay their fear that patients might wish to change their mind, although confirmation of this must await resurrection.
But simply replacing opposition by neutrality1 is not sufficient: health professionals are more aware of the consequences of medical disorders than are their patients, and rightly, therefore, consider it a duty to give advice about the undesirable consequences of a great range of medical states. The medical state of dying can also have unwanted effects – not death; that’s its cure – but pain, distress and dehumanisation, so touchingly described recently2. Doctors and nurses know this; but patients don’t until it’s too late – and most would find that knowledge too painful anyway – which is why neutrality is too neutral, and why we advise and act on our patients’ behalf, as indeed they expect us to do.
Medical neutrality about euthanasia (with a patient information booklet on dying, and a government health warning on death?) would be a cowardly avoidance of the problem. Instead we should grasp the responsibility and give advice based on our professional experience; and that means the first step may be neutrality1, but only with the continued, logical drive for the humanitarian acceptance of euthanasia.
1. McPherson. Without assisted dying our mum died slowly and in pain. BMJ 2012 ; 344:e4155
2. R Tallis. Professional bodies should stop opposing assisted dying. BMJ 2012; 344:e4007
Competing interests: None declared
University of Newcastle upon Tyne, Woodbridge, UK
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