Assisted dying
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4075 (Published 13 June 2012) Cite this as: BMJ 2012;344:e4075
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Dear Sir / Madam
Your suggestion that the BMA should stand aside from the public debate on 'assisted dying' is remarkable. You say, in your editorial 'Legalisation is a decision for society, not doctors', that the decision whether or not to legalise these practices rests with Parliament and the public. That is, of course, true; but it does not mean that the medical profession should confine itself to considering how the law should be changed and ignore the question of whether that should happen, as you seem to be suggesting. After all, what is on the table is not just assisted dying, it is physician-assisted dying. To suggest that the BMA should have no policy on whether that should be part of clinical practice is something that I think a majority of practising doctors will find truly astonishing.
Yours sincerely
Julia Cumberlege
Baroness Cumberlege
Previous Junior Health Minister
Competing interests: No competing interests
Firstly, “neutrality” is not an option here - either we agree that we allow doctors to kill patients, or we oppose it – and we will have to live with the consequences. If we try to wash our hands of this responsibility by appealing to public opinion, we demean ourselves and our profession.
Secondly, the words “compassion” and “dignity” have been repeatedly used to justify euthanasia. Having cared for many dying patients, I know full well the suffering that many endure, and have worked day and night to provide relief of symptoms in a compassionate way. Along with thousands of other dedicated workers in this field, I have “suffered with” these people, rather than take the “easy way out” that is euthanasia. I have also observed a dignity in death that was independent of an individual’s level of functioning, even the presence of body fluids; anyone who has cared for a disabled person or indeed a “normal” new-born knows this.
Assisted dying may be about autonomy, choice, and control, but it is not about dignity or compassion.
Competing interests: No competing interests
I value the BMA’s stance on opposing assisted dying, the practice of which is indeed alien to the traditional ethos and focus of medicine.
Fiona Goodlee’s analysis of the similarities with abortion reform in 1960s is apt , but maybe incomplete : the 1967 Abortion Act was brought in for compassionate reasons – to stop the suffering from illegal abortions. However its proponents probably didn’t predict the outworking of the Act , with what is in effect abortion on demand in the first trimester and the devaluing of intrauterine disabled life i.e. the Act itself has further changed society’s viewpoint on the value of intrauterine life. I worry that if euthanasia is legalised, over time there will be the same devaluing of the lives of vulnerable people at the other end of their lives.
Competing interests: No competing interests
Of course the BMA should re-instate its position of neutrality as regards assisted dying. It is primarily about how we see , as a Society , the quality issues around death and dying . The evidence published last month on the relatively high use of deep sedation in the terminally ill in the UK suggests many doctors perhaps just wish to remain in charge and not hand over ultimate control to some of these patient as would happen with assisted dying. The objection is not to the possibility of shortening life per se – there is widespread (not universal) acceptance of the right of a patient to refuse treatment even if this may lead to an earlier death. A few years ago it was argued that assisted dying might in some way “cheapen” life in the view of wider society and lead to a mistrust of doctors. Neither of these fears seem to have been borne out by subsequent experience . The option of assisted dying for the terminally ill is about removing the fear of suffering at the very end of life that so many people dread – whether or not the patient ultimately chooses it. The main thrust of those who oppose any change in the law now concentrates on “the vulnerable” . What the BMJ should be doing is trying to have an informed debate about how those seen as vulnerable might be protected instead of just accepting the "can't be done" approach of those against this aspect of increased patient choice. Some of the arguments put forward by those arguing for the “vulnerable” are bizarre some have a clear religious basis but, for whatever reason , there is anxiety on this issue . We need to know if it is justified and whether it can be resolved. Over the last few years this mantra of threat to the vulnerable has been reiterated with monotonous regularity . The motives of those who do this ( as well as the ethics of using vulnerable groups to raise anxieties in this way) with almost no attempt to assess whether it is true , nor its implications for other aspects of care, have to be questioned. After all , a carefully drafted law could just be the best way of providing the very reassurance which the vulnerable need?
Competing interests: BMA , HPAD , Dignity in Dying
Godlee acknowledges in her editorial that 65% of doctors are opposed to a change in the law but makes much of a ‘poll of 1,000 GPs’ commissioned by the pressure group Dignity in Dying last year which allegedly showed that ‘62% supported neutrality’.
The poll is referenced to the HPAD website events page but the link from there to PJ Online can only be viewed by paid up subscribers meaning that is difficult to ascertain what question was actually asked and of whom. How convenient!
Healthcare Professionals for Assisted Dying backed by Dignity in Dying, the former Voluntary Euthanasia Society, have flooded this year’s BMA annual meeting with motions calling for doctors to take a neutral stance on assisted suicide and euthanasia.
This is a carefully orchestrated move by a small minority of doctors with extreme views aimed at neutralising medical opposition and softening up public and parliamentary opinion in advance of new pressure to change the law. HPAD has just 520 supporters, representing less than 0.25% of the medical profession.
It has been carefully engineered to coincide with two high profile cases being heard in the high court next week, plans for a new private members bill and a mass lobby of parliament by the pro-euthanasia lobby on 4 July.
The majority of doctors and the major medical royal colleges (RCGP, RCP and Association for Palliative Medicine) however remain strongly opposed to a change in the law and British parliaments have three times in last six years, twice in the House of Lords and once in Scotland, voted against the legalisation of assisted suicide.
Any change in the law on assisted suicide and euthanasia would place pressure on vulnerable sick, elderly and disabled people to end their lives for fear of being a financial or emotional burden on loved ones.
This is the very last thing we need at a time when many families and the health service itself are already under considerable financial pressure.
Doctors should see this latest move for what it is and firmly reject it.
Competing interests: I work for CMF
No-one doubts that the issue of assisted dying raises strong emotions. But the issue is too often clouded by partisan debate and insufficient examination of the international evidence; unthinkable in any other matter concerning medical practice. Fiona Godlee's editorial promoting a neutral stance by the profession is the right way forward to pursue a more dispassionate and compassionate analysis of the wide range of help that people may need at the end of their lives.
Competing interests: Member of Health Professionals for Assisted Dying
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Re: Assisted dying
The coverage on Assisted Dying in the BMJ this week, including this Editorial, certainly seem to be pushing our "Reps" to vote for assisted dying again. I am sure their will be a lively debate, but I remain opposed to such a change in our Nation's Law on this. Every case is very individual, and there are clearly such cases where the dying process has been appalling. As doctors we must keep working towards better care for the dying, and it can be good, if enough experience and effort is put into it. Let us not join those Nations & States who have taken the easy road on this. That should not be encouraged by a Medical Profession, remaining true to its roots
Competing interests: No competing interests