Most UK doctors support assisted dying, a new poll shows: the BMA’s opposition does not represent membersBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k301 (Published 07 February 2018) Cite this as: BMJ 2018;360:k301
Last year, the consultant neurologist David Nicholl wrote in The BMJ about the change in his views on assisted dying.1 He explained that he had moved from being “utterly opposed” to being an ardent supporter after the assisted death of a close friend in Belgium. He argued that patients with a terminal illness should be allowed “a death with dignity on their own terms” and wondered why the views of the UK medical profession on the subject were reportedly so out of step with those of their patients, 82% of whom support legislation for assisted dying.2
The BMA has long been opposed to assisted dying, and its view is often quoted in parliamentary debate as representing that of doctors.3 BMA policy is made at its annual representatives meeting (ARM), where delegates vote after listening to debates. Thus BMA policy is the result of a debate attended by around 400 delegates. Nicholl thought that doctors’ views should be sought outside the ARM, and he approached doctors.net.uk with a view to conducting an online poll.
Doctors’ diverse views
The poll, which ran for 10 days last October, asked whether doctors agreed that assisted dying should be made legal in defined circumstances.4 In all, 733 people participated—more than double the 313 who voted on BMA policy at the 2016 ARM—and 55% agreed or strongly agreed with the proposition. Forty three per cent were against assisted dying and 2% had no opinion. Not implacable opposition, therefore, but a clear range of views with most respondents in favour of a change in the law. The sample was small, but the results chime with a 2015 medeConnect poll of 1000 GPs, which found that 56% thought that medical bodies such as the BMA and the Royal College of General Practitioners should adopt a position of neutrality on assisted dying.5
The current disconnect between BMA policy and the views of doctors and patients undermines the BMA’s credibility, and its continuing opposition excludes it from the public debate. In a briefing to the House of Lords in 2014, the BMA said, “For reasons of inconsistency with BMA policy it would be inappropriate to engage with the detailed proposals in the Assisted Dying Bill.”6 Its stance of outright opposition means that constructive engagement is impossible. Doctors who support legal reform, now in the majority according to the latest poll, are left without a voice.
Assisted dying does not represent a leap into a dangerous unknown. Other jurisdictions have proved that it is possible to change the law, and doctors have shown that such laws can work hand in hand with excellent palliative care. Assisted dying already works safely for the 58 million Americans who have access to it. This month marks the 20th anniversary of the introduction of legislation in Oregon. Predictions of systemic abuse and inevitable broadening of eligibility criteria have not come true. The Oregon Hospice Association now supports assisted dying as one of the many choices available for patients approaching the end of life.7 In Australia, the state of Victoria has adopted legislation for assisted dying.
A decision for society
The spread of legislation for assisted dying means the subject will keep returning in the UK. Recently, Noel Conway, a patient with terminal motor neurone disease, brought a judicial review challenging the current law on assisted dying. He has now been granted permission to appeal an earlier decision by the High Court which rejected his case. Last year I wrote a piece on why the BMA should move to a neutral position,8 a stance that would allow for constructive engagement while acknowledging the range of views of the membership. The case for a change in policy is now stronger than ever. This latest poll throws down the gauntlet to the BMA: if it does not accept the result it must challenge it with its own ballot of the membership. If it accepts the result it cannot, in good conscience, continue to oppose assisted dying.
Ultimately legalisation for assisted dying will be a decision for UK society. The job of the BMA will be to contribute to the debate, not find itself sidelined because of its implacable opposition. Its members, and our patients, deserve better.
UK healthcare organisations’ stances on assisted dying
Association for Palliative Medicine
Royal College of General Practitioners
Royal College of Physicians of London
Royal College of Surgeons of England
General Medical Council
General Pharmaceutical 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 of Edinburgh
Royal Society of Medicine
Royal College of Nursing
Royal College of Nursing Scotland
Royal College of Psychiatrists
Royal Pharmaceutical Society
The RCP surveyed its members the following year.11 Most respondents favoured the college taking a neutral or supportive stance for legal reform, but the college remains opposed.
We invited the BMA to respond but it had not done so at the time of publication.
Provenance and peer review: Commissioned; not externally peer reviewed.
Competing interests: I have read and understood the BMJ policy on declaration of interests and declare the following: I am a member of BMA council, a board member of Dignity in Dying, and chair of Healthcare Professionals for Assisted Dying.