BMA Changes to Neutral Position on Assisted Dying After Members Vote

Becky McCall

September 14, 2021

A landmark shift to a position of neutrality with respect to permitting physician-assisted dying (PAD) was the outcome of a vote on the issue made during the British Medical Association’s (BMA) annual representative meeting (ARM) today.

The Association has long opposed assisted dying, while other medical bodies including the Royal College of Physicians and Royal College of Nursing have adopted neutral positions in 2019 and 2009 respectively.  

However, the vote was almost equally split between those in favour and those against with the former winning by just four votes: 149 (49%) out of the 302 votes, cast in favour of the BMA adopting a neutral stance, and 145 (48%) against; eight representatives abstained.

A position of neutrality means that the BMA will not take a view on whether or not the law should be changed. However, the BMA points out that neutrality "does not mean that we will be silent on this issue".

Historic Debate

In response to the outcome, Dr Jacky Davis, consultant radiologist and Chair of Healthcare Professionals for Assisted Dying, remarked that: "The BMA should be commended for listening to its members and for adopting a position which now represents the range of views on assisted dying among doctors fairly and accurately." 

The BMA has opposed making assisted dying legal since 2006, and this opposition by medics has largely blocked any movement on the issue in parliament. 

However, it is due to be debated as a Private Member’s bill in October and with the BMA’s new-found position of neutrality, Dr Davis emphasised that it would ensure the BMA a seat at the table in what is an ‘historic debate’. "It will enable our profession to contribute constructively to future legislation to help ensure it works for doctors, works for dying people, and works for society as a whole."

In response to the outcome, Baroness Ilora Finlay of Llandaff, who actively debates against PAD and euthanasia stressed that, "any change in legislation poses serious risks to the medical profession".

She pointed out that today’s vote was not in support of doctors being involved in assisted dying; it was only a vote on whether the BMA should represent the views of all members including those who are not licensed to practice. "In today’s debate the majority of speakers were clear that any move to assisted dying must not involve doctors; they cannot be gatekeepers on assisted suicide or euthanasia, nor providing patients with lethal drugs.

"Throughout the ARM, it has been stressed that the profession is on its knees.  Doctors cannot take this on," she added.

Precursor to the Assisted Dying Bill Due for Parliamentary Debate

Earlier this year, a Private Member’s bill to change the law was brought to the House of Lords by Baroness Molly Meacher of Spitalfields. A second reading is due on October 22.

Baroness Meacher spoke to Medscape News UK following today’s outcome. She commended the BMA for allowing all views to be heard. She asserted that the BMA’s decision to adopt a neutral position on assisted dying signified "a move away from polarisation, towards a fair and honest debate based on the facts".

"Doctors rightly have a stake in these discussions, and it is imperative that their views and interests are represented accurately to law-makers, while ensuring that the voices of their patients remain at the very heart of the conversation" she said.

The bill proposes that under the assisted dying rules, doctors would be required to prescribe the necessary drugs and an eligible patient would self-administer. To be eligible, the patient would need to be over 18 years, terminally ill with 6 months or less to live and fully mentally competent, and be judged as making a clear, settled decision of their own volition. Two independent doctors and a High Court judge must be satisfied that an individual meets these requirements. A prescription for life-ending medication would then be granted, which the individual could take at a time and place of their choosing.

"As well as safeguarding patients, my Bill also importantly protects doctors who may conscientiously object to being involved. This respects freedom of choice and thought, just as the BMA’s new stance does. I look forward to working alongside the BMA as my Assisted Dying Bill progresses," said Baroness Meacher. 

In opposition, Baroness Finlay will argue against changing the law on PAD and euthanasia in next month’s Parliamentary debate, with reference to evidence from abroad where assisted dying has been permitted by law for up to 23 years in some countries. "These practises rapidly escalate and expand, and in these places palliative care does not continue to develop as it should."
 

Palliative Care Largely Resists a Change in Position

Baroness Finlay spoke at today’s debate and shared her thoughts with Medscape News UK following the outcome. She emphasised the long-held stance that, "assisted suicide and euthanasia are not compatible with good palliative care".

"Doctors enter medicine, wanting to improve the quality of life of patients, treat the treatable and provide care when disease is irreversible. They do not want to do harm and it's worth remembering that a court ruling has been clear that you cannot consent to something that will do you harm."

Reinforcing her point, she referred to Canada, which introduced laws to permit assisted dying in 2016, and has found that doctors leave palliative care because "it is fundamentally incompatible with ending patients’ lives prematurely".

Among the many speakers in the debate, was Dr Dominic Whitehouse, consultant physician in palliative and respiratory medicine, and registrar for the Catholic Medical Association. He said that: "Good care negates the need for assisted dying. Working with the most complex end of life patients every day, there is not one patient we have been unable to help, some with the most severe and distressing symptoms imaginable." 

He pointed out that some seek assisted dying but they are "all comforted by being listened to, having their fears explored and their symptoms explained all with symptom relief and focus on dignity".

Speaking in support of the motion, anaesthetist, Dr Nick Flatt, BMA representative from the UK Consultants Conference, compared the situation around assisted dying to that of abortion. "Assisted dying polarises opinions. The BMA survey shows that doctors are divided on this. To be blunt, we are not opposed to another situation where doctors’ actions kill a human, that is termination of pregnancy, … the BMA supports the Abortion Act. It is inconsistent that we oppose the ending of a life where a patient makes an active informed choice but support another where the victim has no say at all…" 
 

2020 BMA Survey of Members

Today’s BMA debate follows on from the results of a survey by the BMA last year that found 61% of members want the association to drop its opposition to law change. "In the face of those results, maintaining its current stance is untenable. It silences doctors in this important debate," said Baroness Meacher. "Adopting a stance of engaged neutrality would respect the diversity of thought, ending polarisation and allowing a more constructive, fair and open debate as my bill progresses."
 
The 2020 survey asked BMA membership for their views on law change on PAD, including whether the BMA should change its position on doctors prescribing (not administering) lethal drugs, to which 40% offered support, 21% were neutral, 33% were opposed and 6% undecided.

Asked whether they personally support or oppose a change in the law, results showed that 50% supported a law change, 39% opposed and 11% were undecided. 

A third question asked if doctors would participate in prescribing drugs to end life. Here, only 36% said they would, 45% would not, and 19% were undecided.

The survey also found that more doctors were against actually administering the drugs than prescribing – only 30% supported this. The key motion of today’s BMA debate was for the BMA ‘to represent the diversity of opinion demonstrated in the survey of its membership, the British Medical Association should move to a position of neutrality on assisted dying including physician assisted dying’.

Medscape News UK asked Baroness Finlay what the difference was between assisted dying (prescribing lethal drugs) and euthanasia (administering lethal drugs) to the patient, she said: "Assisted Dying sanitises it and gives it the air of medical benevolence. But what is it if the doctor puts in an IV line and connects the patient to a drip pump and the patient triggers the infusion with an eye movement or instruction – what is that?"

Letter in Support of the Motion From Leading Medics

In a letter to The Guardian today, organised by the UK Assisted Dying Coalition, a handful of leading figures in medicine asserted their position that the BMA must change its stance on PAD. Signatories including neurosurgeon, Dr Henry Marsh, and former Deputy Chief Medical Officer, NHS England, Dr Graham Winyard.

They make clear that, "In an era when modern medicine can extend the length of an individual’s life but not necessarily its quality, we believe that those with terminal or incurable conditions deserve a choice about how, where and when they die." 

"As medical professionals, we believe that it is our first responsibility to preserve life. But that does not mean we should prolong it at any cost," they write. 
 

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