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‘Few Canadian doctors foresaw that “going neutral” would guarantee the arrival of euthanasia, or that promises of a shot in the arm for palliative care would be forgotten. Even fewer realised they would have no option but to cooperate with providing death on demand. It has become all too easy to end patients’ lives. Learn from our mistakes.’

Dr Will Johnson, Family Physician and Professor (Vancouver, Canada)
BMJ 2019;364:l412

This webpage represents a group of doctors who believe that the medical Royal Colleges and BMA should maintain opposition to assisted suicide. Thank you for visiting.

We appreciate that deciding which way to vote in the recent BMA poll will have been difficult for many, as we seek to respect the wishes of individual patients while protecting the safety and wellbeing of the whole of society. There are many strong personal reasons that may lead us to support or oppose assisted suicide as individuals, but the collective voice of doctors should not be neutralised. This poll was not about the rights and wrongs of assisted suicide, but whether it should become a new duty for doctors.

In Canada, the move to medical neutrality fuelled a dramatic and ongoing shift in the culture and practice of medicine – as this video illustrates:

Controversial?

But isn’t neutrality on assisted suicide a reasonable position for medical bodies to take, on a controversial issue that divides its members?

As this blog points out, neutrality actually abdicates the professional responsibility to speak up for vulnerable patient groups and lead the debate on an area of massive professional relevance to doctors. Parliament and the general public would perceive a move to neutrality on assisted suicide as doctors dropping opposition to, or even providing tacit support for, a change in the law.

If assisted suicide is legalised, it will mean profound changes in how we all practise medicine. For example, clinical guidelines for many terminal or chronic illnesses will likely require doctors to ask patients whether they would wish to have assistance in taking their own lives at an early stage of planning treatment. This would represent a fundamental change in how we deliver care, and Parliament and the public rightly look to medical bodies like the RCGP and BMA for guidance on issues like this. If you oppose legal changes that would make doctors responsible for assisting suicide, please vote to maintain opposition so that the BMA can continue to represent doctors’ concerns – going ‘neutral’ implies that we don’t care about the issues raised.

‘During almost 30 years as a GP, I can think of only a handful of patients who asked me to help them die, and over time they all changed their minds once the real issues that prompted the requests were explored and help was given in the areas that made them feel so desperate.’
Dr Trevor Stammers
FRCGP, London
'As a palliative care physician I know there are a few patients who may indeed want out of this life, but many more patients fear death and fear the actions and motivations of those with power over them.'
Dr Rosemarie Anthony-Pillai
Palliative Care Consultant and ex member of Royal College of Physicians Clinical Ethics in Medicine Committee
‘”Prohibition” to “optional” is a huge shift and is definitely not ethically neutral. Medical ethics involves declining some kinds of patient requests for the good of wider society. This is such a case.’
Dr Naomi Beer
MRCGP, East London
'It is not possible to be neutral about an activity that a clinician is involved in administering. Neutrality implies that we have nothing to say one way or the other as to where our professional duties lie in the care of society’s potentially most vulnerable people.'
Dr Amy Proffitt
Consultant in Palliative Medicine

Assisted suicide: five reasons for concern

PATIENT SAFETY

We believe that if the law is changed to license doctors to assist death, no amount of clinical safeguards can protect vulnerable patients from potential harm.

Maintaining the safety of all our patients is rightly a foremost priority in clinical practice.

Although most families act entirely in the best interests of loved ones, sadly the charity Action on Elder Abuse estimates that as many as a million older people are vulnerable to abuse, and in 2016-7 there were 2,856 convictions for crimes against the elderly.

In 2018, it was revealed that over 450 patients had their lives prematurely ended by medical intervention at Gosport Memorial Hospital on the Isle of Wight.
If doctors are licensed to legally administer lethal doses of medications, detecting criminality and abuse towards vulnerable patients will become even harder than it is at present. Laws need to default to safety.

In 2018, it was revealed that over 450 patients had their lives prematurely ended by medical intervention at Gosport Memorial Hospital on the Isle of Wight.

If doctors are licensed to legally administer lethal doses of medications, detecting criminality and abuse towards vulnerable patients will become even harder than it is at present. Laws need to default to safety.

DUTY OF CARE

Because of the long medical tradition of rejecting interventions designed to cause death, it remains vital that whatever society may decide about assisted suicide, doctors do not administer lethal doses of medication.

Modern medicine traces its roots back to ancient Greece, where doctors in the Hippocratic tradition distinguished themselves from charlatans by taking an oath never to administer poison.

Assisting suicide has been prohibited by all international codes of medical ethics since then, including being forcefully repudiated by the World Medical Association in September 2019.

It is opposed by all national medical associations globally except those in Canada and the Netherlands. Meanwhile, in the UK, it is opposed by most key institutions, including the BMA. If society wishes to legislate for assisted suicide, doctors should not be involved in providing it.

 

THE MESSAGE THIS WOULD SEND

Patients with frailty, terminal illness, cognitive impairment or significant multi-morbidity are at particular risk of having a low view of their own value and importance to others. If we change the law to allow assisted suicide, we acquiesce with the view that some lives don’t deserve full legal protection.

Currently, the 1961 Suicide Act prohibits actively encouraging or assisting someone else to commit suicide, because as a society we recognise that all lives matter.

Patients with terminal illnesses are particularly vulnerable to depression and suicidal ideation, but with proper support can be helped to move to a better place and view the future with hope.

We must continue to support a law that says that all patients matter equally; and that society doesn’t agree that any lives would be better off ended.

Respecting Colleagues

As a profession, we need to stand with our colleagues in palliative and geriatric medicine who are deeply concerned about the implications of assisted suicide for their clinical practice and the patients they look after and avoid dividing teams on this deeply personal issue.

The Association of Palliative Medicine polled its members in 2015 on their views on assisted suicide. 82% were personally opposed to legal change, and 73% felt that legalisation would adversely affect palliative care services.

The British Society of Geriatrics is also formally opposed to the legalisation of assisted suicide, believing that “the best way for physicians to help these vulnerable people is to maximise their independence and health, rather than assisting with their expressed wish to die.”

There are many within the profession who are deeply opposed to assisted suicide, and its legalisation would create divisions within teams and the risk that individuals may feel pressurised or even bullied into acting against their consciences.

THE RISK OF INCREMENTAL EXTENSION

If legalised, there is a significant risk that clinical indications for assisted suicide would be broadened far wider than currently intended, perhaps even for patients suffering from mental ill health or simply old age.

Whilst some campaigners for assisted suicide state they want to see assisted suicide legalised only for patients with a prognosis of 6 months or less, others go further, such as My Death My Decision, and those supporting disabled man Paul Lamb in his current court application.

Indeed, it would be difficult to argue that restricting assisted suicide to the terminally ill is not discriminatory. We have seen this pattern of incremental extension most recently in Canada as individuals and groups lobby for assisted dying to be made available to people with an ever-wider range of conditions. Only a complete prohibition on medical involvement in assisted suicide will protect the wider population we serve.

On 30 March 2020, the President of the Royal College of Physicians informed members and fellows that a lengthy legal challenge to the College’s move to neutrality in 2019 had been resolved.

‘So that there can be no doubt, the RCP clarifies that it does not support a change in the law to permit assisted dying at the present time.’

The College’s statement notes that:

‘The majority of doctors would be unwilling to participate actively in assisted dying if the law were changed to permit it, with only 25% indicating a willingness to do so.’

Welcoming the new statement, the claimants – Drs David Randall, Kathryn Myers, Dermot Kearney and Adrian Treloar – said:

‘We are pleased that the RCP Council have reflected on ways in which the neutral position on assisted dying adopted by the RCP last year has been misrepresented by some outside the College to imply an indifference to the issues raised, or support for a change in the law. We, as individuals, have profound concerns about the safety and impact on society of any change in the law in this regard. We therefore endorse the statement that makes it clear that the RCP does not support such legislation.’

This followed the 21 February 2020 announcement that the Royal College of General Practitioners would remain opposed after its own consultation found opposition was the most favoured stance.

Positioning statement

Why we oppose assisted suicide:

  • OPPOSE does not mean we want people to suffer at the end of life, we continue
    • To uphold the rights patients already have to say ‘no’ to treatment, 
    • To insist that patients have proper symptom control, and 
    • To maintain patient’s rights to change their minds about their preferences in care, even to the point of death.
  • OPPOSE protects the profession, so:
    • No-one will be forced to act against their principles
    • The UK’s world-leading experts in Palliative Care are listened to.
  • OPPOSE allows patients to feel confident that
    • Doctors will not attempt to hasten death under any circumstance.
    • They will be cared for in the best way possible until their natural death
    • That clinical need always out-weighs money in deciding what is best for the patient.

We support:

  • High quality palliative care that supports disabled people, the terminally ill and their families
  • Access to mental health services to tackle depression and demoralisation that can occur after diagnosis
  • Financial help to ensure patients do not feel that they are a burden
  • Further research into how patients can best be looked after.

Get involved

If you are a doctor or medical student and would like to be kept up to date with the campaign and possibly get involved with future projects, please fill in the form below.

About us

The ‘Our duty of care’ campaign is run by practising doctors who are deeply concerned about the risks to patients and clinical services if assisted suicide is legalised. We initially formed in early 2019 to oppose the Royal College of Physicians’ move to neutrality on assisted suicide, which is currently subject to legal challenge.  

We have been partly supported, both financially and logistically, by Care Not Killing, an alliance of individuals and organisations opposed to a change in the law on assisted suicide.

To contact us please email info@ourdutyofcare.org.uk