Assisted dying – a summary of the BMA’s position
July 2006
At the BMA’s annual conference in Belfast on 29 June 2006, doctors voted by an overwhelming majority against legalising physician assisted suicide and euthanasia. The current policy is therefore that the BMA:
(i) believes that the ongoing improvement in palliative care allows patients to die with dignity;
(ii) insists that physician-assisted suicide should not be made legal in the UK;
(iii) insists that voluntary euthanasia should not be made legal in the UK;
(iv) insists that non-voluntary euthanasia should not be made legal in the UK; and,
(v) insists that if euthanasia were legalised, there should be a clear demarcation between those doctors who would be involved in it and those who would not.
Background to the BMA’s position
There have been various attempts in the past few years to change the law and legalise assisted dying. In 2005, the BMA considered the merits of allowing Parliament and society at large to decide this controversial matter and took a neutral stance. In 2006 however, BMA members voting at the annual meeting made clear that the majority oppose such legislation. Therefore the BMA has dropped its neutral stance and opposes all forms of assisted dying.
Although views in society differ about the legitimate or appropriate uses of medical skills, the primary goal of medicine is still seen as promoting welfare, protecting the vulnerable and giving all patients as good a quality of life as is possible. It is sometimes argued that promoting patients’ welfare should include deliberately shortening their lives when terminally ill patients request that or when individuals’ suffering cannot be fully alleviated. The BMA’s policy, however, is that assisting patients to die prematurely is not part of the moral ethos or the primary goal of medicine and, if allowed, could impact detrimentally on how doctors relate to their own role and to their patients.
Arguments for legislation of assisted dying are generally based on arguments about competent individuals’ rights to choose the manner of their demise or about cases where medicine is unable to control distressing terminal symptoms. Although the BMA respects the concept of individual autonomy, it argues that there are limits to what patients can choose if their choice will inevitably impact on other people. Also, as the BMA’s policy implies, access to the best quality palliative care is vital if terminal suffering is to be properly managed.
Arguments against legalisation focus on practical and moral points. If assisted dying were an option, there would be pressure for all seriously ill people to consider it even if they would not otherwise entertain such an idea. Health professionals explaining options for the management of terminal illness would have to include assisted dying. Patients might feel obliged to choose it for the wrong reasons, such as if they were worried about being a burden or concerned about the financial implications of a long terminal illness.
The concept of assisted dying risks undermining patients’ ability to trust their doctors and the health care system. In particular, it could generate immense anxiety for vulnerable, elderly, disabled or very ill patients. It could also weaken society’s prohibition on intentional killing and undermine safeguards against non-voluntary euthanasia of people who are both seriously ill and mentally impaired. For such reasons, the BMA opposes it.
Palliative care
If public anxiety about the management of terminal conditions is to be addressed, an urgent and continuing matter of concern remains the uneven availability of good quality palliative care for patients who want it.
In 2005, the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill was critical of the gaps in palliative care provision. Such services were said to be inadequately resourced and unevenly spread. BMA members have echoed this point.
Earlier in 2006, in its white paper, Our health, our care, our say, the Government acknowledged that additional investment is needed to improve end-of-life care. (paragraph 4.102) It pledged to double investment in palliative care services and improve coordination between hospices, community-based palliative care professionals and other care providers. For many patients with terminal conditions and for their families, this is an issue of increasing urgency.
Good effective palliative care must be more widely available throughout the UK.
For further information, please contact the Parliamentary Unit:
Email: parliamentaryunit@bma.org.uk