Intended for healthcare professionals

Assisted dying

The BMJ has provided a platform for debate on assisted dying for over 15 years. The depth of personal, professional, and religious feeling on the matter is divided worldwide, as much among doctors as it is among the general public.

Proponents of physician assisted dying (or assisted suicide—even the terminology is controversial [see below]), including The BMJ, claim that it gives dying people choice and control over their death and can prevent intolerable suffering.

But many fear consequences for vulnerable people, for society, and for the medical profession if doctors were actively to induce death.

See:

Law that sought to permit doctors in England and Wales to prescribe lethal drugs for eligible patients to take themselves failed in a Commons vote in 2015.

Oregon has had assisted dying law since 1997. It is legal in seven other US jurisdictions and Victoria, Australia. In 2016, Canada legalised “medical assistance in dying” (see: https://www.bmj.com/content/364/bmj.l412 https://www.bmj.com/content/360/bmj.k503). Belgium and the Netherlands permit voluntary euthanasia, and not only for dying patients (see: https://www.bmj.com/content/351/bmj.h4481 https://www.bmj.com/content/364/bmj.l415 ).

As many as 80% of the UK public support legal assisted dying. “Legalisation is a decision for society not doctors,” said The BMJ in 2012. But key medical organisations remain actively opposed, including the BMA.

The BMJ has also published the personal testimony of doctors who have legally hastened patients’ deaths and of patients who wanted and chose the option, and their families.

The RCP is polling its members for their views on assisted dying. John Temple, past president of The BMA, argues that medical bodies should adopt more balanced policies, recognising the wide range of opinions on this matter. Anthea Mowat and John Chisholm explain why The BMA does not poll members on nuanced ethical questions.

The BMJ continues to strive to represent all voices in the debate.

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Definitions under dispute

Proponents and opponents of assisted dying do not all agree on the terminology used to describe the process.

Assisted dying—Proponents of the Assisted Dying Bill 2015 in England and Wales argue that this term best describes prescribing life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting strict legal safeguards. Assisted dying, as defined like this, is legal and regulated in the US states of California, Colorado, Hawaii, Montana, Oregon, Vermont, and Washington, and in Washington, DC. In 2017, similar legislation was passed in Victoria, Australia.

Assisted suicide—This term is often intended to describe giving assistance to die to people with long term progressive conditions and other people who are not dying, in addition to patients with a terminal illness. The drugs are self administered. Some opponents of assisted dying do not accept that it is different from assisted suicide. Assisted suicide, as defined like this, is permitted in Switzerland.

Voluntary euthanasia—This term describes a doctor directly administering life ending drugs to a patient who has given consent. Voluntary euthanasia is permitted in Belgium, Luxembourg, and the Netherlands. In 2016, Canada legalised both voluntary euthanasia and assisted dying for people whose death is “reasonably foreseeable,” in what it calls “medical assistance in dying.”

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