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End-of-life care and physician-assisted dying

The BMA works to support doctors, our members, with the practical and ethical challenges they face every day in their clinical practice.

Supporting patients at the end of life is one such challenge.

In order to effectively support doctors in providing the best possible care to patients, we wanted to understand these challenges.

We realised however, that in order to do this, we also needed to listen to patients’ views. We wanted to understand how the lived experiences and perceptions of our members and the public met the paper vision. We wanted to know what works well, what works less well, and why that is.

At the same time, we recognised that physician-assisted dying had been receiving close scrutiny in the media, popular culture, and UK parliaments.

The issues relating to physician-assisted dying are complex and nuanced, and merit careful consideration.

We wanted to explore some of these issues in greater depth to inform our own internal discussion and debate.

For all these reasons, in November 2014 we launched a major project to explore the public’s and doctors’ attitudes on some aspects of end-of-life care and physician-assisted dying.

  • About the project

    We commissioned social research experts TNS BMRB to design and conduct a series of 21 dialogue events across the UK, hearing from over 500 doctors and members of the public on the following issues:

    • How the perceptions, and reality, of end-of-life care compare to models of good practice;
    • The challenges of providing good care at the end of life; and
    • The possible impact on the doctor-patient relationship if physician-assisted dying were to be legalised. 

    Dialogue events: at a glance

    Map summarising ELCPAD events and programme of engagement

     (click to enlarge)

  • BMA policy on end-of-life care and physician-assisted dying

    The BMA has longstanding policy advocating for all patients to have access to the highest-quality end-of-life care, and policy opposing assisted dying in all its forms.

    The project was not intended to alter or influence our current policy, but to help facilitate a full and informed debate on the issue.

    A debate on the BMA’s policy on assisted dying was held at ARM 2016 where, after insightful and considered discussion on whether the BMA should continue to be opposed to assisted dying or move to a position of neutrality, our policy of opposition was upheld. In addition, a special session was held on the project as a whole.

    Representatives discussed their own personal experiences of providing end-of-life care before passing motions calling for specific improvements to be made to end-of-life care, based on recommendations made in volume 3 of the report.

    In this session, debate focused on some of the more complex and detailed questions doctors would face if physician-assisted dying were legalised.

    No conclusions or decisions on these questions were reached but, rather, this marks the beginning of a discussion with our members on the complexities of an issue which will continue to be of vital interest to the medical profession.

    Read more about current BMA policy on this issue

  • Volume 1: Setting the scene

    Cover of Report Volume 1

    Before we could explore the public’s and doctors’ experiences and perceptions of end-of-life care, we had to know what was theoretically available.

    In order to facilitate informed debate on some of the issues relating to physician-assisted dying, we also needed to provide factual information about the current legal and political context around assisted dying in the UK and internationally.

    Volume 1 pulls all of this information together to set the scene against which the qualitative research was conducted.

    It outlines evidence on the provision of end-of-life care in the UK; the practical challenges in delivering that; the debate on assisted dying in the UK; and the international evidence available on assisted dying.

    Download Volume 1: Setting the scene

    Update to Volume 1

  • Volume 2: Public dialogue research

    Report Volume 2 Cover

    Volume 2: Public dialogue research

    Volume 2 is the report on the findings from the project events, written by TNS BMRB.

    It outlines the research design, details the discussions and outcomes from all of the events, and offers some key insights on some of the findings.

    This project was one of the most significant pieces of qualitative research initiated by the BMA, and this volume of the report will support greater understanding and discussion of the issues within our own membership and beyond.

    Download Volume 2: Public dialogue research

  • Volume 3: Reflections and recommendations

    Report Volume 3 cover

    Volume 3: Reflections and recommendations

    The third and final volume of the project report details the BMA’s reflections and recommendations on all that has emerged from the research contained in Volumes 1 and 2.

    It was clear from our work that although there are many examples of excellent end-of-life care across the UK, there is still significant variability in quality of care. In this volume, we make various recommendations aimed at addressing the current shortfall in end-of-life care provisions.

    Read the key recommendations from the project

    We also offer some initial reflections on the findings about physician-assisted dying and the potential impact legalisation might have on the doctor-patient relationship.

    As the main aim of this component of the project was to gather information for our own internal debate and discussion, we do not make any recommendations about assisted dying or what role doctors should play in this.

    This volume sets the agenda for our future work and policy development in these areas, and we hope that it will serve as a basis for discussion and action, among both members and stakeholders.

    Download volume 3: Reflections and recommendations

  • Next steps

    The outcomes and recommendations from this project will not only help inform our own decisions, deliberations and lobbying on these topics, but also contribute to the broader public debate, now and into the future.

    We will be lobbying governments and healthcare providers on the changes that can be made to end-of-life care provision so that high quality end-of-life care is available throughout the UK.

    We will also continue to support our members in providing high-quality end-of-life care to patients and will continue to monitor developments relating to physician-assisted dying and lobby on the BMA’s position, where appropriate.

    Join the conversation on our dedicated forum on Connecting doctors