On 21 June the British Medical Association, at its Annual Representative Meeting, rejected a Motion that its policy of opposition to legalisation of physician-assisted suicide (PAS) should be changed to one of neutrality. That’s hardly surprising. An opinion survey of 1,000 GPs last year revealed that only one in seven of them would be prepared to consider a request for PAS.
So what is this lobbying of doctors all about? After all, this is not the first time the BMA has refused to be talked into neutrality on this issue. The reason is simple: the campaigners for legalisation have little hope of commending their proposals to Parliament unless they can persuade the medical profession to drop its opposition. There is no serious prospect of the medical professional bodies supporting legalisation, but a vote for neutrality could have been spun as ‘doctors no longer oppose assisted dying’. The BMA has spotted the trap.
Some argue that legalisation is a matter for society, not for the medical profession. It is for Parliament to say, on behalf of society as a whole, whether any law should be enacted or changed. But what the lobbyists are proposing is not just assisted suicide but physician-assisted suicide. If doctors are expected to engage in such practices, the medical profession must be allowed to express a view about it. To demand that it should be neutral on an issue that goes to the heart of clinical practice is to seek to muzzle it.
Many doctors are worried about the principle of PAS. They believe it is difficult to reconcile with the ‘do no harm’ principle that underpins everything they do. Others are concerned about their ability to make judgements which go way beyond the medical field – judgements about, for example, how well-considered, settled and voluntary is a request for PAS. In these days of the multi-partner GP practice and fewer home visits, many doctors know little of their patients’ lives beyond the consulting room or the hospital ward.
While there are certainly doctors who are supportive of legalising PAS, the majority are not. They know that predicting life expectancy is often little better than guesswork, that diagnostic errors occur and that no doctor can assess what goes on in families behind closed doors. They know that elder abuse is not uncommon and that, though the vast majority of families are loving and caring, some are not – but they can be hard to identify.
They also know that terminal illness makes patients highly vulnerable. A terminal diagnosis can knock people sideways, as they struggle to come to terms with their mortality and worry about the impact of their illness on those around them. They are not the self-assured and strong-willed individuals who step out the pages of the ‘assisted dying’ bills we see.
It is for such reasons that Parliament, both at Westminster and at Holyrood, has repeatedly rejected legalisation, most recently in 2015. Yet despite this another private member’s bill, identical to the one which was rejected by the House of Commons last September, has been tabled in the House of Lords. It really is time that the ‘assisted dying’ lobby sat down and, instead of trundling out the same bills and motions year after year, asked itself why it is failing to gain traction with Parliament and the medical profession.