Intended for healthcare professionals


Assisted dying: Guernsey rejects proposal to move towards legalisation

BMJ 2018; 361 doi: (Published 21 May 2018) Cite this as: BMJ 2018;361:k2236

Re: Assisted dying: Guernsey rejects proposal to move towards legalisation

I was disappointed by the result in Guernsey as I think legalised physician assisted dying is an inevitability in the British Isles. The sooner we find a way to give dying people this option, the sooner we can minimise the risk of their suffering in their final weeks and months. Delaying the inevitable is in my mind a lily-livered tactic that future generations will rightly condemn us for.

Deputy Gavin St Pier captured my views on this issue in his opening remarks in the debate: “It is often said that this is an immensely complex moral, ethical, and legal issue. But at its heart is a very simple principle—that of autonomy and the right to self determination.”

Doctors should examine these words carefully and consider their implications. In October 2017 the World Medical Association updated the Declaration of Geneva’s Physician’s Pledge with the line: “I will respect the autonomy and dignity of my patient.” The Pledge was also re-ordered so that lines concerning patients’ rights appear first, this was to “highlight the importance of patient self-determination as one of the key cornerstones of medical ethics” [1].

Assisted dying would be completely in keeping with these revisions and the rest of the Physician’s Pledge, which is why doctors in jurisdictions where it is legal find no conflict between being involved in assisted dying and their consciences. The timely evolution of the Physician’s Pledge is no coincidence. I see assisted dying as the end-point of the journey towards person-centred end-of-life care, which is why few would argue that the demand for law change will go away. Of course there are doctors who would not want to participate in an assisted dying law and their views should be respected. But as a whole our profession has no right to stand in the way of society’s attempts to dismantle an antiquated culture of medical paternalism.

I watched the debate unfold in Guernsey with interest and feel the BMA has been shamed by it - its monolithic opposition to law change has been exposed as undemocratic and unconstructive. For the BMA to be cited as one of the lead agitators against the proposals [2], in the face of overwhelming public support, casts the medical profession in a negative light and I believe this will lead to resentment and a lack of trust between patients and their doctors. We deserve a voice in debates on contentious healthcare issues, yet many doctors who are sympathetic to the notion of terminally ill people being given control over the manner and timing of their deaths are being silenced by the BMA’s current approach. A neutral stance is the only logical one the BMA can adopt to remedy such stridency.

The Royal College of Physicians made it clear to movers of the proposals in Guernsey that while it opposes assisted dying it would be willing to play a role in developing safeguarded legislation should the vote pass, a view echoed by the GMC [3]. The RCP and the RCGP are also due to revisit this issue by canvassing the views of their members, something the BMA has thus far failed to do. Clearly some of our professional organisations are moving in the right direction and there is a real risk the BMA will be left behind.

Finally, I would challenge this article’s generous description of Living and Dying Well as “a body that explores the complexities surrounding the debate on assisted dying and other end-of-life issues”. Living and Dying Well was co-founded by Baroness Ilora Finlay and Lord Alex Carlile in 2010, the same year the latter stepped down as a director of Care Not Killing, an umbrella organisation home to many pro-life campaign groups whose raison d'être, as the unsubtle name implies, is to fundamentally oppose any change to the current legal framework in this area [4]. Rather than existing to “explore” these issues, Living and Dying Well is a pressure group operating in and outside of Westminster with a clear goal of preventing the legalisation of assisted dying. It has received core funding support from the Catholic Church to do so, notably to ramp up its campaign to defeat the Assisted Dying Bill put before the House of Commons in 2015 [5]. Baroness Finlay herself has received a grant from the Catholic Church to lobby against law change in New Zealand [6] and last year spoke about assisted dying at an end-of-life care event at the Vatican (incidentally, the BMA’s treasurer, Andrew Dearden, chaired one of the sessions) [7].

I would therefore urge Baroness Finlay to be more transparent about her intentions in this debate and to refrain from reiterating her former role as President of the BMA, which, in my mind, is little more than an attempt to apply a gloss of medical expertise to what appear to be absolutist personal beliefs. I am reminded of the recent BMJ piece on declaring religion as a competing interest [8]. Judging by the responses to that article there is no consensus on whether or not such declarations are appropriate when expressing a personal view. However, at the very least, in the interest of clarity, Baroness Finlay should declare that she speaks on behalf of an organisation that has received sponsorship from a Church eager to denounce assisted dying as an absurd and reprehensible “sin against God” [9].


Competing interests: Member of Healthcare Professionals for Assisted Dying

25 May 2018
Dr Richard Clubb
GP, retired