We risk our careers if we discuss assisted dying, say UK palliative care consultants

We are five consultants; between us we have 94 years of consultant level experience in palliative medicine. We share concerns about the way that our specialty’s medical colleges represent assisted dying in the media, including in this journal.

The Royal College of Physicians (RCP), after a recent survey of its members and fellows, adopted a neutral position on assisted dying. Since the survey was announced, there has been an outpouring of strong opinions in the media from the officers and members of the Association for Palliative Medicine (APM).12 Most criticised the RCP for not following the APM’s absolute opposition to a change in UK law to allow some forms of assisted dying. Fortunately, The BMJ has restored some balance by publishing articles from Canadian physicians who have experience of providing assisted dying.34

Critics suggest that taking a neutral stance is opening the door to an irreversible breakdown of medical standards and public trust; is a dereliction of thousands of years of Hippocratic practices; and—worst of all—that it would lead directly to doctors being asked to “kill” patients. In our view, these assertions are indefensible and morally repugnant interpretations of a reasonable attempt by the college to survey its membership and, importantly, to use neutrality to facilitate discussion about the topic.

We are unaware of any evidence that other jurisdictions that have legalised forms of assisted dying have seen a loss of faith in the medical profession by the public. There is also no evidence that assisted dying is inconsistent with modern evidence based medicine. Most importantly, the assertion that doctors in the UK might be called on to “kill” patients is blatant scaremongering.

We would like to open another side to this discussion. As consultants in palliative medicine, we undoubtedly see the same spectrum of patients and their carers as those at the APM. We have no reason to suspect that our colleagues are any less sympathetic, compassionate, or proficient in our art, as we are. We, however, disagree that assisted dying is inherently a bad thing, and we believe it is our professional responsibility to have an open discussion regarding the subject. It’s important to do this since many of the dying people for whom we care have expressed a wish that assisted dying be an option that they could access.

We would like to tackle the charge that legalising assisted dying would lead to doctors being asked—possibly even forced by unspecified insidious means—to “kill” patients. We believe that our colleagues, for whom we have enormous respect, have failed to read and understand the terms of recent attempts to bring assisted dying to the UK, and are confusing “assisted dying” with “voluntary euthanasia.” An example is the Falconer Commission which made it very clear that the act of dying would be at the competent patient’s repeated request, facilitated by a doctor writing a prescription, for a lethal “draught” that would have to be taken by the conscious patient by his or her own hand.5 We challenge that this could be construed as “killing.”

The authors of this letter have tried in different ways to engender an open and fair discussion about the subject with our specialist colleagues, in the hospices, hospitals, and community settings in which we practise our craft. We note that the last time a British palliative medicine doctor wrote about changing his viewpoint on assisted dying, he was subjected to intense criticism and ostracism by his peers.6

All of us have been stifled from talking about this topic. We believe that there are many more colleagues—especially trainees and early career consultants—who do not share the views of the officers of the APM, but we suspect they are inhibited from openly sharing their own views. Whenever a related situation arises—such as the RCP’s survey, or when a patient’s request for assisted dying is brought before British courts—the APM emails its members with the clear and unequivocal direction that they are to oppose these developments. There is no concession to the possibility that other doctors practising high quality, ethical specialist palliative medicine may hold a different opinion—or simply want to hear different views.

We hope readers understand why we decided to write with anonymity, at least until there is a climate of open and fair discussion in our specialty where doctors do not fear being criticised, ostracised, or—worst of all—having their careers threatened. We commend the RCP’s move to bring more open discussion to the medical community, but hope that our specialty does not continue to deny its own members that freedom.