The BMA should adopt neutrality on assisted dying
This week the British Medical Journal published an editorial arguing that a change in UK law to permit assisted dying is “almost inevitable” in the face of a long-term societal shift towards favouring patient choice and autonomy. Fiona Godlee, the author of the editorial, observed that the transition to legalisation could take some time and suggests that in the meantime the British Medical Association (BMA), and the Royal Colleges should heed the calls of pro-assisted dying medical professionals and ‘move their position from opposition to neutrality.’ This is to reflect the diversity of views among doctors ‘and to encourage open debate.’
The BMA currently justifies its current stance of opposition on the basis that BMA policy is ‘made through the Association’s democratic processes’ and that the majority of doctors are currently ‘firmly opposed to assisted suicide and to doctors taking a role in any form of assisted dying.’ However, while this stance of ‘firm opposition’ may reflect the majority voice, it certainly does not represent all doctors’ views. In fact, surveys of the medical profession by Professor Clive Seale find that more than a third of doctors (35 per cent) think that a doctor should ‘probably’ or ‘definitely’ be able to assist the suicide of a terminally ill patient. Even more tellingly, other large-scale surveys have found that approximately 25 per cent of doctors would themselves be willing to assist a terminally ill patient’s suicide.
With these facts established, it is clear that a stance of ‘firm opposition’ by the BMA risks making the third of doctors who are in favour of assisted dying feel stigmatised or ignored by their professional body. This can only polarise the debate within the medical profession and encourage more pro-assisted dying doctors to join the active campaign for change by organisations such as Healthcare Professionals for Assisted Dying – something that key opinion formers within the BMA would clearly like to avoid.
In contrast to the BMA’s current policy position opposing assisted dying, the Royal College of Nursing (RCN) has held a position of neutrality since July 2009. This decision to change its position followed an RCN consultation that found 49 per cent of participating nurses supported the legalisation of assisted dying and only 40 per cent opposed. This also reflects the current Government’s stance, which recognises that assisted dying is primarily an ethical debate, therefore statutory decisions about assisted dying should be left up to individual MPs’ consciences rather than being an appropriate subject for policy formulation.
By so-far failing to adopt a position of neutrality, which would enable individual doctors to openly debate their views without fear of professional condemnation, the BMA is lagging behind both the Royal College of Nursing and parliament, not to mention the views of the general public. If the BMA decides to adopt a neutral position on assisted dying at its next policymaking meeting later this month, this will be an important step forward, towards supporting a more mature and transparent professional debate. If doctors with moderate views on assisted dying do not feel that they have to ‘take sides’, this could allow a more nuanced discussion to develop; surely this is a more attractive prospect for the BMA than a polarising debate that drives doctors further and further apart.