The British Medical Association (BMA) is currently consulting its members on the issue of assisted suicide and what the position of the BMA on the issue should be. The poll will close on 27 February. Depending on the outcome, it could mean that the BMA, which is the UK’s official trade union for doctors, would drop its opposition to all forms of euthanasia and assisted suicide which it has held since 2006. In this piece, we set out some of the key arguments why the BMA should remain opposed to all forms of assisted suicide.
1. The right to die will become a duty to die
The duty of the law is to protect life. This sacred principle would be altered if assisted suicide ever became law. Some of the most vulnerable people in our society are the elderly and the sick. If the law is changed, they will come under huge pressure and the right to die will become the duty to die. Figures from Washington State and Oregon show that in 2018, under each State’s Death with Dignity Act, 51% and 54%[1],[2]respectively said they were concerned they would be a burden on family, friends/caregivers if they continued to live.
2. No law can be made completely safe for vulnerable people
It is striking that in previous debates around changing the current law on assisted suicide, former Lord Chancellor Lord Falconer, in speaking about his own assisted dying Bill said: “I don’t think you can ever have a system that is completely watertight.”[3]This is backed up by evidence from other countries. Regardless of the intent of those crafting assisted killing laws, eligibility and criteria will doubtless change over time. As Prof. Theo Boer, a former leading Dutch euthanasia watchdog member has warned, it would be naive to assume the UK would be immune to this[4].
3. Doctors do not want a law change
The Association of Palliative Medicine, representing 1,200 palliative medicine doctors, medics most familiar with death and dying, strongly “oppose any change in the law to licence doctors to supply or administer lethal drugs to a patient to enable them to take their own lives.”[5] No major medical professional body supports changing the law to introduce assisted suicide of any kind. This includes: the BMA, the Geriatric Society, the Association of Palliative Medicine, the Royal College of General Practitioners. Of course, some will argue the Royal College of Physicians shifting to neutral last year suggests otherwise. Strikingly, the poll the College conducted is subject to an ongoing legal review,[6] in part because following a poll which showed the most favoured option was remaining opposed, the College still changed to neutral.
4. Public support is not clear cut
The campaign group Dignity in Dying, formerly known as the Voluntary Euthanasia Society often like to claim widespread public support for changing the law. But this claim is disingenuous at best and an outright lie at worst. If you explore the views of the public more deeply, initial support for assisted suicide fades away, when consideration is given to how the law would work in practice. A poll of 2,055 British adults saw a figure of 73% initial support for assisted suicide fall to 43% for and 43% against[7].
5. Evidence from overseas should lead to a rejection of law change
Canada’s law changed in June 2016 to enable Canadian patients to receive medically assisted suicide under conditions where death has become “reasonably foreseeable”. Since then, conscientious objection for doctors has been significantly undermined, the “reasonably foreseeable natural death requirement has been deemed too restrictive, and a consultation is currently underway to consider changes to the law including questions on opening access to assisted suicide to under-18s, those with solely psychological conditions and the use of advance requests for those who may lack the capacity to consent at a later date. At least 7,949 people have died under Canada’s laws.
In Oregon there has been a 522% increase in the number of people choosing assisted suicide per annum since the law was introduced. In January 2020, the law changed so that the 15 day waiting period will no longer apply if the doctor estimates that the patient will not live for 15 days after making the initial request. Given the difficulties associated with determining prognoses, this is especially troubling. In both Oregon and Washington there has been an increase in medical conditions considered as falling within the scope of the law compared to the original five terminal conditions in Oregon.
In Belgium and the Netherlands,where the law allows both euthanasia and assisted suicide, the original criteria have been expanded to include children.
Conclusion
There is no logical end point once you legalise some form of assisted suicide. The autonomy of individuals who desire a change in the law must be balanced against the need to protect vulnerable people from harm. The current law performs this balancing act well, if not perfectly. The alternative is potentially tragic in that we legalise a dangerous change in the law and end up putting the most vulnerable under terrible pressure.
If you are a member of the BMA, you can respond to the poll on assisted suicide by clicking here.
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References
[1]Washington State Death with Dignity Act Report 2018, Table 2, page 11
[2]Oregon" class="redactor-autoparser-object">https://www.doh.wa.gov/Portals... State Death with Dignity Act Report 2018, Table 1 page 12
https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf
[3] “Assisted death plan is risky, admits Falconer who says no system could be 'completely watertight'”, Daily Mail, 6 January 2012
[4] “Don’t make our mistake: As assisted suicide bill goes to Lords, Dutch watchdog who once backed euthanasia warns UK of ‘slippery slope’ to mass deaths”, Daily Mail, 9 July 2014 https://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html
[5] Association for Palliative Medicine Position Statement, Association for Palliative Medicine of Great Britain and Ireland, June 2019 https://apmonline.org/wp-content/uploads/2019/07/apm-pas-position-statement-june-2019-final.pdf
[6] Judgment given 22 October 2019 in High Court, Chancery Division, Randall & Others v Charity Commission, The Attorney General (Re Royal College of Physicians), See Press Release https://drive.google.com/file/d/1jwnjM96Arbx7hUDHuVzXKbKfHF_qH7-M/view
[7] http://comres.co.uk/wp-content/themes/comres/poll/Care_Assisted_Suicide_Poll_July_2014_(with_summary_table).pdf
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Why the BMA should remain opposed to assisted suicide