Assisted dying: BMA surveys its members for first time
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m459 (Published 06 February 2020) Cite this as: BMJ 2020;368:m459
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Dear Editor,
As the widow of an MND patient, I would beg you to consider assisted dying as an acceptable option for patients diagnosed with terminal and untreatable conditions such as MND. Modern medicine cannot offer anything in the way of valid treatment for this appalling disease, just one single drug which may extend life for 3 months though do nothing for the symptoms.
Social care and otherwise does not provide adequate care for MND nor presumably other such conditions - my experience only relates to the lack of care available for him as an MND patient. If you have money you can pay fir extra carers, night-time nurses, extra equipment at a relevant time, not months too late.
Why should people who are genuinely incurable and of sound mind not be given the option by a trusted medic to end their suffering earlier than letting nature take its course? Because, be honest, that is all modern medicine is able to do - still - for such conditions.
Yours in hope
Nikki Davey
Competing interests: No competing interests
Dear Editor
I find it disturbing that Gordon Macdonald has such a lot to say about voluntary assisted dying/physician assisted dying. Yet, has no proof to back some of his comments.
If he researched the guidelines that are being requested for the UK he would find that being a "burden" wouldn't qualify. Another reason the UK should follow the strict Swiss guidelines.
The model as used by Dignitas in Switzerland for 70+ years, has a clean record of voluntary assisted dying, The person requesting v a d has to see at least two independent psychiatrists to prove they are of sound mind. They are asked on the day of v a d whether they are aware of what will happen. Any hesitation in response and the procedure is halted. At no point is a doctor present. All procedures of a patients voluntary assisted death are recorded and handed to the Swiss police as proof everything is done within the law.
It is estimated that up to August 2015, 300 British people had travelled to Switzerland to end their life. Why should people who are terminally ill or incurably suffering in the UK have to travel to another country?
Palliative care, as proven does not work in all cases. Nurses & doctors who work with terminally ill patients agree that 1mg more of the strongest pain relief for some would be a fatal overdose.
Let those people who are terminally ill & incurably suffering have the right to choose. For those who don't want it, that is their right to choose!
Competing interests: No competing interests
Dear Editor,
I disagree with Dr. Elliott. I think it's right that campaigners on either side of the assisted dying debate have the opportunity to voice their arguments. The BMJ is not the civil service so the idea of a "Purdah" is surely misplaced. As medical bodies give this issue more serious consideration than ever before we should be encouraging open debate, not seeking to suppress it. Dr. Elliott may not have seen that the BMJ has recently carried an advert from the group "Our Duty of Care", a group that is opposed to assisted dying. Readers may be interested know that "Our Duty of Care" had a similar advert removed from Facebook last week for breaching its rules of transparency.
I am also not persuaded by Dr. Macdonald's argument that the BMA's historic opposition to assisted dying is in itself a reason to maintain it. I am glad that those who fought for social progress in other areas of life - abolitionism, women's suffrage, equal marriage - were not so enamoured with the past that they surrendered their visions of a better future. Positive developments in medicine have also come about through challenging accepted norms, not deferring to them.
The UK's ban on assisted dying has inflicted great pain on dying people and their families. People still suffer despite having access to the very best care, we abandon those who seek a peaceful death in Switzerland and criminalise loved ones, and many more people try to exercise control alone, behind closed doors, without our help and support.
Doctors may disagree on what the law should look like, but I hope we can agree that we should no longer lend our support to a status quo that fails so many of our patients.
Competing interests: No competing interests
Dear Editor
I was annoyed and perplexed to find a full page advert by Healthcare Professionals for Assisted Dying proposing that B.M.A. members support a neutral stance on the forthcoming poll on physician assisted dying. As the poll has now opened I would have expected that the B.M.J. would not allow any advertising from lobby groups until the poll has closed. As in our political polls I would suggest a period of purdah and hope that this will now occur.
Competing interests: No competing interests
Dear Editor
I refer to the rather one-sided article recently published (BMJ, 8th February) about the BMA poll on assisted suicide and euthanasia.
The article failed to mention that from 1950 until 2005 the BMA was opposed to euthanasia. It only adopted a position of neutrality for one year in 2005, a position which was reversed in 2006.
The BMA’s longstanding opposition to euthanasia reflects the overwhelming view internationally that assisted suicide and euthanasia are not an appropriate part of medicine. This view was reaffirmed in October last year by the World Medical Association (WMA) at its 70th General Assembly in Georgia. The WMA published a declaration committing it, “to the principles of medical ethics and that utmost respect has to be maintained for human life”.
It continues, “Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide”.
And concludes:
“No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end…”
This final part of statement is particularly important as in Canada and the Netherlands we have seen health care professionals, who conscientiously object to assisted dying, being pressured to make referrals for euthanasia.
There are other concerns too.
In the Netherlands, the fastest growing category of euthanasia deaths is that of patients with psychiatric conditions. There was a 600% increase in such cases in the years from 2012 to 2017.
In the US, the National Council on Disability published a major review of what is happening in the minority of states that have changed the law to allow assisted suicide. It concluded that safeguards were ineffective and that oversight of abuse and mistakes was absent. These states included Oregon and Washington where a majority of those ending their lives do so because of fear of being a burden.
This is why despite the constant and emotive campaigning by a small number of vocal pressure groups, doctors around the world continue to strongly oppose assisted suicide and euthanasia.
We hope this principled opposition will continue in the UK.
Competing interests: No competing interests
Re: Assisted dying: BMA surveys its members for first time: Why BMA Should Not Support Assisted Dying and Must NOT Remain Neutral. l.
Dear BMA Survey and BMJ Editors
Thank you for writing to me about the current Survey.
Something appears to continuously block my response to you on line. Is the fault technical?
I am BMA LIFE-MEMBER (6142830, Life-Fellow 001837). I do not know how many other BMA Members/Fellows are having difficulty accessing your Survey on line even when they click the right buttons.
In any case, I have spelt out in earlier BMJ communications my reasons for rejecting Physician Assisted Dying. I have been BMA Member since January 1959 (61 years long). I think BMA should NOT remain Neutral over such a vital question.
"Since 2006 the BMA has opposed assisted dying in all its forms" writes the BMJ on 8 February 2020.
Yet in today's survey members are asked "whether they believe the BMA should support, oppose, or take a neutral stance on a change in the law to permit doctors to prescribe drugs for eligible patients to end their own life". I oppose a change in the law whatever meaning is attached to the phrase "eligible patients". But my on line opinion on this matter fails to get through.
Who, on earth, is entitled to decide which patients are "eligible" to be demised?
Physician Assisted Dying should NOT be a BMA Policy. See the several reasons I have given previously in BMJ posts:
1. Most religious followers support assisted suicide for the dying: Survey flawed through inadequate definition of "religious" and "terminally ill" www.bmj.com/content/346/bmj.f2855/rr/645095
2. "Nine out of 10 palliative care experts would choose Liverpool care pathway for themselves": Majority expert choice does not mean best choice www.bmj.com/content/346/bmj.f1303/rr/634791
3. Doctor cleared of asking nurse to give fatal dose to dying patient: More honest nurses, please 17 September BMJ 2009; 339: b3812 http://www.bmj.com/cgi/eletters/339/sep15_3/b3812#220512
4. Is talking about God to be banned from clinical care? BMJ Rapid Response 2 June 2011 http://www.bmj.com/content/342/bmj.d3275/reply#bmj_el_261475
5. Personal Answer to The Question "Do you believe in God?" 20 January 2018 BMJ Response https://www.bmj.com/content/319/7214/929.2/rr-0
6. So You Know Where I am coming from (SYKWIACF) Prefaces My Religious Belief. BMJ Rapid Response June 1 2018 https://www.bmj.com/content/361/bmj.k1558/rr-4
As my present contribution to the Survey is not getting through on line, please record me as against change in the law.
BMA should NOT be neutral on this vital matter, in my opinion.
Professor F I D Konotey-Ahulu FGA MD(Lond) FRCP(Lond) FRCP(Glasg) DTMH(L'pool) DSc (Hon UCC) DSc(Hon UH)
Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana and Former Consultant Physician Genetic Counsellor in Haemoglobinopathy Korle Bu Teaching Hospital and 9 Harley Street, London W1G 9AL. Website: www.sicklecell.md
Competing Interest: I declare that I believe The historical LORD JESUS CHRIST who said "Before Abraham was I AM" (St John chapter 8 verse 52) and who in John 11 verses 25 & 26 pronounced the reality of life after death!
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Competing interests: I declare that I believe The historical LORD JESUS CHRIST who said "Before Abraham was I AM" (St John chapter 8 verse 52) and who in John 11 verses 25 & 26 pronounced the reality of life after death!