Assisted dying: why the BMA does not poll members on nuanced ethical questionsBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l593 (Published 06 February 2019) Cite this as: BMJ 2019;364:l593
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I was relieved to hear that the BMA remains opposed to assisted dying. I was beginning to wonder, after the enclosure with each February issue of the BMJ a leaflet from Healthcare Professionals for Assisted Dying. Without balancing this enclosure with the inclusion of a leaflet from an organisation with a different stance, the impression created was one of tacit support for the HPAD view. Consider the impression that would be created if a leaflet was enclosed with the BMJ giving an apologetic view for FGM, as an example of another illegal medical procedure, and then consider whether it was appropriate for the BMJ to allow this leaflet to be circulated.
Competing interests: No competing interests
The authors state that the issue of assisted dying is so "nuanced, complex, and potentially divisive" that a poll or survey is unsuitable; and that when discussing the issue at dialogue events, a binary question of approving or opposing was felt inappropriate.
If this is true, does it not automatically follow that the issue is too "nuanced, complex, and potentially divisive" for the BMA to adopt a simple binary "oppose" or "approve" position? Surely the only logically defensible position on such a topic would be a neutral one?
Competing interests: No competing interests
It is necessary to correct some errors and point out notable omissions in the piece by Dr Mowat and Dr Chisholm. Firstly, much is made of the BMA’s End-of-life care and Physician-Assisted Dying project. But far from “digging deep” into the issue of assisted dying it was made clear from the outset that assisted dying would only be examined in the limited context of its “possible impact on the doctor-patient relationship” . What we learned from the report was that both the public and doctors recognise potential positive and negative implications of changing the law, yet these speculations were not explored in depth nor scrutinised with evidence from overseas. To present this research as a seminal publication on the issue is highly misleading. What’s more, in the foreword to Volume 2 of the report, readers are warned “It is certain that campaign groups will select elements that support particular points of view”. It is somewhat ironic that the BMA itself is guilty of manipulating the findings.
It is a matter of record that the 2016 ARM debate on policy was not “informed by [the] research”. As a result of an inexplicable and avoidable quirk in the agenda, the debate on a motion calling for neutrality came before any debate or discussion of the research. What’s more, prior to the debate on the neutrality motion the ARM considered a motion claiming “it is not appropriate at this time to debate whether or not to change existing BMA policy” . If the BMA was keen to have an informed debate, why allow the possibility of denying any debate at all?
Unfortunately, the BMA also shows no willingness to learn from our colleagues around the world. Last week in the BMJ a Vice President of the Canadian Medical Association (CMA) explained how a neutral stance on assisted dying has enabled the CMA “to participate fully in the public debate [and] advocate for all its members who held divergent views on a change in the law” . For Dr Mowat and Dr Chisholm to neglect the experience of others when considering neutrality undermines the BMA’s credibility.
This piece also sends an unfortunate message to our nursing colleagues. The Royal College of Nursing has been neutral on assisted dying since 2009. Like the CMA, it has engaged constructively with legislators whenever assisted dying Bills have been before them, specifically focussing on aspects of the draft legislation that would impact on the nursing profession. Contrast this with the BMA, which, in 2014 told Parliament that “for reasons of inconsistency with BMA policy, it would be inappropriate to engage with the detailed proposals in the Assisted Dying Bill” . With this in mind one wonders how the authors can suggest that a neutral position would make it difficult for the BMA to intervene in debates. Rather, as the RCN have shown, a neutral position allows organisations to reflect the spectrum of views of members while contributing to the debate.
Equally disappointing, is the apparent disregard shown for the plight of our patients. I too believe that, “for most patients high quality palliative care can alleviate distressing symptoms associated with the dying process and allay patients’ fears”. Sadly ‘most patients’ are not all patients. What about those for whom palliative care is not enough? I cannot accept that our profession is prepared to sit on its hands and leave this small but significant minority of people to face whatever suffering awaits them. Dr Chisholm chairs the BMA’s ethics committee. I would ask him, how can this be considered ethical?
Finally the authors say that BMA will stick with its opposition until ‘we hear differently from our members’, but show no inclination to allow that listening exercise to happen. Members of the Royal College of Physicians should be congratulated that their professional body is willing, and capable, of grappling with complex issues in a way that befits the evidence-based principles of our profession. I am deeply saddened that on this issue the BMA time and time again fails not only its members, but our patients and wider society. A change in approach is desperately needed.
 BMA assisted dying: House of Lords Second Reading, July 2014
Competing interests: Former Chair, Dignity in Dying.