Our move to neutrality on PAD (physician-assisted dying) in 2021 could have been the end of it for us; we could have sat comfortably on the sidelines of any debate and accepted whatever decisions others made.
But to have done so would have been to abdicate our responsibilities as a professional body, to maintain the integrity and interests of our profession and support our patients, as well as a trade union representing our members and doing our best to improve their working lives.
The problem was finding a way to speak out in support of these broad aims, without appearing to promote or pre-empt a legal change. It is a fine balancing act of representing the views of our members – whether they feel that PAD is a moral and medical necessity, or an ethical line that should not be breached – in a way that maintains our neutrality.
The task of squaring this circle fell to the association’s medical ethics committee.
The MEC is unique among BMA committees, having not only elected members but also appointed independent experts in fields such as law, ethics and theology, who generously give their time to inform our debates. We also have a dedicated staff team, each experts in their own fields, who are the driving force behind our work.
Among our members, we have those with declared positions in support of PAD and in opposition to it. This has made for lively debate and has turned out to be a great strength, as it has enabled us to form a position that has the support of all our national councils and, we trust, our wider membership.
Throughout our deliberations we kept the interests of three groups in mind: those doctors who would wish to actively participate should PAD be legalised; those who would not wish to play any part; and our patients, whether they might wish to access such a service, or alternatively feel concerned by its availability. We maintained throughout that, in discussing such matters, we were not proposing change, only specifying what would be required should a change take place.
Our first step was to contact our fellow professional associations around the globe in areas where legislation already existed, to find out what was working, and what was causing difficulties. One thing stood out: countries where the medical profession was excluded, or excluded itself, from the debates tended to have less protection for doctors than those where there was engagement. It was clear that passive neutrality was not a valid option for us.
Many debates and 18 months later, we have settled views on those areas where doctors may be most affected, and where we feel it is important for the BMA to speak out. This is available at www.bma.org.uk/pad. There is much there I hope you will want to read, but I want to pick out two particular points.
Firstly, it is vital that participation in such a service should be on an opt-in and not an opt-out basis. This would ensure no individual doctor would be required to participate if they did not wish to, and that patients could be sure they had access to trained and committed medical staff.
Furthermore, individual doctors’ ability to choose whether to participate or not must be independent of any matters of conscience. We know from our 2020 survey that some members feel PAD should be available to patients, but would not want to participate themselves. With a system based on ‘conscientious objection’ this would not be a valid reason to refuse to carry out activities directly related to assisted dying.
Secondly, in response to any proposals to change the law on assisted dying, we are absolutely clear that no doctor should be discriminated against, or face detriment, because of their views on this subject, or their decision regarding participation.
Since we began this work, public debate on this issue has increased. The impact of interventions by such people as Esther Rantzen or Prue Leith and her son Danny Kruger MP cannot be over-stated and will undoubtedly continue to fuel the debate.
Legislation has already been proposed in Scotland, Jersey, and the Isle of Man, and in England the health and social care select committee is examining the issue.
The MEC’s work over the last couple of years has put us in a good position to influence our decision makers before, not after, legislation is finalised. Indeed, we have already begun to do so.
I feel confident that, whatever your views are on this difficult subject, and whatever decisions are ultimately made by those in power, the outcome will better reflect the views of our members because of the work done by your BMA, and that can only be a good thing.
Andrew Green is deputy chair of the BMA medical ethics committee and MEC lead on physician-assisted dying