“Whether you agree with assisted dying or not, whether you decide to participate or not, we will be at the table to protect your rights and interests. Legalisation of AD is a societal prerogative. It is a done deal. But we still have an opportunity to help shape what it will look like in practice.”
Dr Jeff Blackmer (Canadian Medical Association) [1]
Once a year 400 British Medical Association (BMA) representatives meet to debate the medical, political and ethical issues of the day and vote on them. This year end of life care and physician assisted dying (PAD) were high on the agenda, after the BMA had spent time and money producing a three volume report on them. But having declared that this work was intended to inform debate, they unaccountably scheduled the motions to make policy on PAD on the day before the full scale discussion.
First up was a wrecking motion intended to halt the debate all together which was only narrowly defeated, indicating that the mood in the hall was not well disposed to even discussing PAD. The substantive motion, proposing that the BMA should move to a neutral position, was the usual bipolar discourse which generated more heat than light, with the mangling of statistics and unashamed shroud waving. Hyperbole was rampant, one burly speaker claiming he had been “openly intimidated” by supporters of assisted dying politely distributing leaflets outside the venue. The chair misunderstood a neutral position as meaning doctors would have no voice, and the motion was lost by 198 votes to 113 (with many abstentions which went unrecorded).
On the following day there was a mediated discussion based on the BMA report. Doctors were asked to imagine a scenario where assisted dying was legal and to discuss how they would respond to it—exactly the situation faced by the Canadian Medical Association (CMA) in February 2015. [2] The convenor Michael Burke ruthlessly cut diatribes and demanded that those who wished to speak stick to the point—how would we contribute when faced with inevitable legislation?
When relieved of the responsibility of deciding whether we wanted PAD and asked to consider the challenges of participating in it the discussion improved dramatically. Questions of how and where and by whom arose. The debate suggested the same as personal conversations—that many don’t oppose PAD itself, rather their opposition reflects concerns about the practicalities—could I opt out, what about my small practice, how much paperwork would it involve? One speaker who said she would have nothing to do with PAD was challenged by Burke—would you just show your patient the door? The audience reaction implied that they took a dim view of that possibility.
The discussion suggested that when the time came—as it surely will—doctors will rise to the challenge. As happened in Canada they would put their patients’ needs before their own beliefs, and get on with it, would use their clinical expertise to find the solutions which will protect patients and the profession. But as long as there is no legislation for AD in the UK the debate will remain binary, with each side entrenched, recycling the same facts and fears. I believe that if the vote on neutrality had been taken after that thoughtful debate it would have been a closer result.
The question of physician assisted dying is akin to the fight for votes for women a hundred years ago. It will keep coming back (as Mark Porter himself admitted) and it will do so until it is accepted, because society wants it and it is the right thing to do. To pretend otherwise is to be Canute faced by the incoming tide. The BMA will have an important role to play when that happens, and could learn from the excellent work undertaken by the Canadian Medical Association since their legislation was proposed. It would be better to position ourselves now for that role by adopting a neutral position. A neutral position would not mean—as Mark Porter suggested in his uncharacteristically muddled summing up—that we had no voice but rather that we could use our voice to protect the interests of our patients and the profession. It is our opposition that silences us.
Those who wanted to stifle the debate on PAD asked repeatedly—nothing has changed, why discuss this? But they are wrong. 84 million people in North America are now covered by legislation, other jurisdictions are looking at it. The Australian Medical Association is surveying all its members (something the BMA has never done). [3] Most importantly the great majority of our patients want legislation—82%, including 79% of religious people and 86% of disabled people. [4] We should not turn our backs on them. The law in the UK is not working—some end of life suffering cannot be relieved, [5] two people a month travel to Dignitas, [6] and 300 dying people take their own lives every year. [7] As coverage of these tragic cases continues the public in the UK will be looking across at Canada and the US and asking us—if they can make it work why can’t we?
Jacky Davis is a consultant radiologist, campaigner for the NHS (founder member of Keep our NHS Public), co author of the books NHS For Sale and NHS SOS, and a member of the BMA council. She is also chair of Healthcare Professionals for Assisted Dying. She has written this blog in a personal capacity. You can follow her on Twitter @DrJackyDavis.
Competing interests: I have read and understood the BMJ policy on declaration of interests and I hereby declare the following interest: I’m a member of Healthcare Professionals for Assisted Dying (HPAD).
[1], [2] A Canadian Approach To Assisted Dying: CMA Member Dialogue
[3] Review of the AMA’s policy on assisted dying – an update.
[5] The limits of palliative care.
[6] “One person a fortnight” travels to Dignitas from Britain to end their lives.
[7] More than 300 terminally ill people a year committing suicide.