Assisted dying: Association for Palliative Medicine responds

As the world’s largest association representing doctors in palliative medicine, we (current officers of the Association for Palliative Medicine (APM)) are saddened and dismayed by the recent blog and opinion article in The BMJ.12 Anonymous pieces are the most difficult to respond to, as often the motives for the original piece are not obvious.

The Royal College of Physicians’ recent independent and anonymous poll about assisted dying confirms that, in line with the APM survey of 2014, 4% of palliative care physicians are in favour, 16% are undecided, and 80% remain opposed to medicine’s involvement in ending patients’ lives. It is no surprise that palliative medicine, for which care of the dying is core business, has a spread of views but also a clear and consistent perspective of medicine’s role.

To support our membership in making their personal decisions on such an important matter, we developed a web resource in January 2019 to give them balanced, comprehensive access to the literature, media, and other evidence from both sides of the argument, alongside APM members’ historical position of opposition to a change in the law. We were careful to seek and incorporate all perspectives, made that clear on our public facing web resource, and sought alternative views actively. We have never instructed our members how to vote in the Royal College of Physicians’ survey, only that they should express their opinion to make sure that individual members’ views were represented.

The anonymous piece published in The BMJ states that some members fear “being criticised, ostracised, or, worst of all, having their careers threatened.” This is simply wrong: the continued respect and authority that Sam Ahmedzai, a public and prominent proponent of assisted suicide, enjoys in our specialty is testimony to that.

Debate is active and live on this matter, and quite rightly so, but to say that debate and disagreement correlates with ostracism or threat is nonsensical.

We are all trying to find the wise way forward. Opinions stand or fall on their merit. Amy Proffitt’s personal view (separate from the APM) about the Royal College of Physicians’ coherence of neutrality over doctors’ involvement in ending life had no more or less power than Ahmedzai’s narrative of his shifting position in favour of it.34

As we have developed our resource discussing a doctor’s place in ending peoples’ lives, the APM has been grateful for the views of prominent members, such as Richard Scheffer, who promotes physician assisted dying, along with those on our executive in the past two years who have supported physicians being involved in ending life. It has been extremely helpful in developing a balanced resource.

It is a common mistake to confuse a view on the rights and wrongs of assisted suicide with whether doctors should be involved. They are entirely distinct, and society shall ultimately be given the right to decide, without the direct involvement of doctors.

Finally, we have had no suggestion from any communications or APM meetings that our membership has an issue with our position.