Why neutrality on assisted dying is not an option for doctors’ professional organisationsBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4591 (Published 09 July 2012) Cite this as: BMJ 2012;345:e4591
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John Saunders misunderstands neutrality (Why neutrality on assisted dying is not an option for doctors’ professional organisations). A neutral stance on assisted dying would reflect the wide range of opinion among doctors on the issue. It would acknowledge and respect patients’ and healthcare professionals’ individual choices, and would not pass judgement on those patients who feel that they would or would not want the option of assisted dying.
No one would deny that medical and professional bodies are reasonably expected to “offer an overall judgment on the desirability of legislation if it affects medical practice”, as Dr Saunders advocates. What HPAD argues is that: a) such judgement should not be definitive; b) in this case, the subject of that judgement should be legislation itself and not principle – the BMA would be right to take a position on the benefits and problems of an assisted dying law, but should not oppose assisted dying in principle; and, as a corollary, c) the medical bodies would be in a better position to offer genuine judgement on the desirability of legislation if it were to take a neutral position on the principle of assisted dying.
Healthcare Professionals for Assisted Dying does not and will not campaign for the BMA or other representative bodies to move to a position of support for assisted dying. Neutrality is not “an achievable second best” for us – it is the best and most appropriate position for the representative bodies to take. Taking a neutral position would allow the medical organisations to promote palliative care whilst genuinely engaging with the struggles and dilemmas of those patients whose suffering cannot be alleviated by palliative care.
Competing interests: Chair of Healthcare Professionals for Assisted Dying and previous Chair of Royal College of Physicians Committee on Ethical Issues in Medicine
The two issues in assisted dying should be kept separate. Firstly , there is the basic one as to whether an individual – particularly one who is dying - can have a degree of suffering that makes death a preferable alternative. Compare this to abortion – should Society allow abortion in certain circumstances ? This is not primarily one for a collective medical response , particularly when the basis for that response is so unsound. It would be remarkable if our profession held views at such variance with the rest of the population – and so contrary to what has been part of medical practice until relatively recently. Until we are clearer on this point , the BMA should remain neutral . Secondly there is the issue – both for assisted dying and abortion – on their delivery as part of medical care. That is where the Colleges and other professional organisations should be involved.
Various polls have used simple – and usually prejudiced - questions . Delamothe highlights the problems with the recent BMJ poll (1). Pressure groups opposing assisted dying have greater numbers and resources than those supporting change but both are only a small part of the whole. We need to know the opinion of the middle ground – those who do not necessarily object to the principle but have concerns about the practice. The poll held by the RCGP seemed designed to produce an answer wanted by a chairman with a strong commitment to conventional palliative care. The RCP made a reasonable attempt at consultation , but it is the College with strong representation from those in conventional palliative care. The ARM of the BMA is a very flawed means for deciding policy of this type and if members of pressure groups feel they have to use the system to attend and influence policy , that could have an adverse effect on the voting on other agenda items. The past 30-40 years have been a period of a fairly remorseless drive to prolong existence at all costs with a few press worthy steps in the other direction. The former excuse of “double effect” opiate use for the terminally ill is no longer valid. Although not supporting assisted dying , the editorial by Ranaan Gillon emphasises where this trend has reached (2)
The problem with the present hostility to assisted dying is that it is being left to case law without adequate discussion of the underlying issues involved and without attempting to see how these might be resolved
1 Tony Delamothe Editorial note on results of assisted dying poll BMJ 2012 ; 345: e4582
2 Editorial Sanctity of life law has gone too far BMJ 2012;345:e4637
Competing interests: HPAD , Dignity in Dying
I think most general practitioners involved in palliative care would agree with Professor Saunders that neutrality on assisted dying is not a position that we as GPs can adopt. Our own royal college made a clear statement in 2005 to the effect that good clinical and palliative care can be provided within existing legislation and that a change in legislation was not needed or desirable.
Competing interests: No competing interests