Can doctors really be neutral on assisted dying?

The BMA’s decision to adopt a position of neutrality on the vexed question of ‘assisted dying’ was taken following a vote at the Annual Representative Meeting in which support for a change in the law outweighed, by the narrowest of margins (149 to 145), opposition to legal change.  While neutrality may on the face of it appear to be a reasonable position to adopt in such circumstances, there are other factors to be taken into account.

The recent BMA survey of membership opinion showed that support for legal change was strongest among those (such as, for example, practitioners in obstetrics and gynaecology and medical students) who had little contact with and experience of treating terminally ill patients, while opposition was strongest among those (for example, in palliative care, geriatric medicine and oncology) working in specialisations involving day-to-day contact with such patients.

Support for a change in the law is one thing.  But that leaves open the question of whether, if the law were to be changed, doctors should be charged with making the decisions on who should and should not receive lethal drugs with which to end their lives.  The recent BMA survey showed clearly that, if the law were to be changed, a majority of doctors would not be willing to participate in its implementation.  This is hardly surprising.  The decisions involved cover not only issues such as diagnosis and prognosis but also social issues, such as the settled nature of a request for lethal drugs or the presence of family or other pressures, on which most doctors are not qualified to make valid judgements.

Both these factors and the extremely narrow result of the recent BMA vote make it difficult for supporters of legal change to argue that there has been anything remotely resembling a serious shift in medical opinion.  Legalisation of ‘assisted dying’ has always been a contentious issue, among doctors as well as among others, and opinion has always been divided.  In 2003 the BMA voted for neutrality but reverted to opposition in 2005.  It is in any case difficult to see how a profession dedicated to the healing of the sick, that is founded on the principle of ‘first do no harm’ and that has a key role on suicide prevention can be seriously neutral over the question of whether doctors should be licensed by law to supply lethal drugs.