The case for neutrality on assisted dying

 

The British Medical Association and some other professional healthcare bodies are publicly opposed to legislation to permit assisted dying for terminally ill mentally competent adults. HPAD believes that the proper stance of our professional bodies is one of studied neutrality.

At the heart of the case for neutrality is that the decriminalisation of assisted dying should be a matter for society as a whole to decide, and no particular group within it should have a disproportionate influence on this decision. The view of society is clear-cut: successive surveys have shown that it is supported by over 80% of the general population[1], including 70% of those with religious beliefs[2]. This is not an unthinking or ill-informed response: support for assisted suicide for people who have severe illnesses but are not terminally ill is much lower – at about 40%1.

Healthcare professional organisations committed to shaking off the paternalism of the past should not use their influence to impose the beliefs of some of their members on patients: it is inconsistent with the idea of ‘patient-centred care’ and the principle of ‘no decision about me without me’.

The publicly stated opposition of the BMA and some royal colleges to assisted dying also ignores the division of opinion within the professions. The most reliable information suggests that between 30% and 40% of doctors are in favour of decriminalisation[3],[4] and that a third would like the option of an assisted death for themselves[5]. What is more, two thirds of doctors in a survey conducted in October 2011 agreed that the medical bodies should take a neutral position on assisted dying[6]. These voices have been silenced: to put it bluntly, they are not represented by their representative bodies.

Neutrality is not indifference. It would not prevent our representative bodies participating in public debates on assisted dying, quite the contrary: it would enable them to participate constructively. From a neutral position our professional organisations can contribute their expertise to debates on matters such as safeguards, prognosis and vulnerability – something it is difficult to do from a position of principled opposition. Their expertise may lead them to criticize a badly formulated assisted dying law and this would be entirely justifiable. Opposing (or indeed advocating) assisted dying on principle is not.

The case for neutrality does not imply that medical organisations should never hold a position on controversial matters or that individual members should not express their views on assisted dying. As responsible citizens, individual doctors are, of course, entitled to express their views about the ethical and clinical case for, and the potential social impact of, a change in the law. Medical bodies are right to take a position issues such as their own working conditions, the health service, and public health. However, they should not pass judgements about the morality of the decisions their patients make regarding their own care. In the case of assisted dying, they should restrict their role to advising on safeguards and the other issues noted in the previous paragraph.

Given the overwhelming support for assisted dying in society as a whole and given also that there are healthcare professionals of good will, different faiths, and expertise in palliative care, with passionate views on both sides of the debate, we believe that the proper stance of healthcare professional bodies is one of neutrality.

 

 

[1] Clery E, McLean S, Phillips M. (2007) Quickening death: the euthanasia debate. In: Parks A, Curtice J, Thomson K, Phillips M, Johnson M, eds. British social attitudes. The 23rd report—perspectives on a changing society. Sage. 35-54.

 

[2] McAndrew S. (2010) Religious faith and contemporary attitudes. In: Park A, Curtice J, Thomson K, Phillips A, Clery E, Butt S, eds. British social attitudes: 2009-2010. The 26th Report. Sage. 87-113.

 

[3] Seale C. (2009) Legalisation of euthanasia or physician-assisted suicide: survey of doctors’ attitudes. Palliat Med. 23:205-12.

 

[4] Lee W, Price A, Rayner L, Hotopf M. (2009) Survey of doctors’ opinions of the legalisation of physician assisted suicide. BMC Med Ethics. 10:2.

 

[5] http://www.dignityindying.org.uk/news/general/n329-only-1-in-3-doctors-wouldnt-want-the-option-of-assisted-dying-to-be-available-to-them-at-the-end-of-their-lives.html

 

[6] http://www.hpad.org.uk/download_file/view/57/