Why the British Medical Association is (currently) wrong on assisted dying.

They list the following reasons for their opposition and I thought I’d take this time to respond (underneath each point), drawing on evidence from Oregon where assisted dying for terminally ill adults with mental capacity has been safely practiced since 1997.

Permitting assisted dying for some could put vulnerable people at risk of harm.

• Research evidence from Oregon demonstrates that groups of potentially vulnerable patients are not negatively impacted on by assisted dying.
• As in Oregon, Dignity in Dying only campaigns for assisted dying for terminally ill adults with mental capacity, not non-dying disabled people or those with a chronic or long-term illness.
• Any legislation would include checks to ensure that people were not being coerced into making a decision and that those without mental capacity (e.g. those with dementia) could not access assisted dying.
• The provision of upfront safeguards would do more to prevent abuse than the current law that effectively turns a blind eye to dying Britons travelling abroad to die or taking their lives at home, sometimes with the assistance of loved ones.

Such a change would be contrary to the ethics of clinical practice, as the principal purpose of medicine is to improve patients’ quality of life, not to foreshorten it.

• This statement is contradictory to existing medical practice – research by Professor Clive Seale found that in 7.4% of reported doctors took decisions “where they had to some degree intended to hasten death”. These decisions, not regulated by up-front safeguards, would have been taken in the patient’s best interest.
• Assisted dying for terminally ill patients can improve the quality of a person’s final months by providing a level of control as they prepare to die. Even if the individual does not end up having assistance to die – they know that they can and take great comfort from this. We know from Oregon that around 40% of those who request, and are eligible for assisted dying, do not die this way.
• It is up to these terminally ill, eligible patients to decide whether they want to foreshorten their lives or not. From the perspective of the general public, 80% of whom support assisted dying, it is the right of terminally ill people to control the end of their lives. Providing this choice improves the quality of end of life and foreshortening is not a failure of the medical professional.

Legalising assisted dying could weaken society’s prohibition on killing and undermine the safeguards against non-voluntary euthanasia. Society could embark on a ‘slippery slope’ with undesirable consequences.

• There is no evidence from Oregon that non-voluntary euthanasia has risen, or that doctors have viewed the legalisation of assisted dying as permission to conduct illegal practices. Indeed, the Netherlands (where voluntary euthanasia for terminal and chronic people has been practiced since 2002) has seen a decrease in non-voluntary euthanasia since 2002.
• Oregon has not widened its law since 1997 and there has been no pressure to do so. To say that introducing an assisted dying law could lead to other laws being eroded is based on fear, rather than evidence.

For most patients, effective and high quality palliative care can alleviate distressing symptoms associated with the dying process and allay patients’ fears.

• For most terminally ill patients palliative care is adequate. However, palliative care is not a panacea and there will always be some dying people for whom it does not provide alleviation for their emotional and physical distress. In Oregon nearly 100% of patients who have an assisted death are enrolled in hospice care. Palliative care is doing a good job – however it is not a magic wand.

Only a minority of people want to end their lives. The rules for the majority should not be changed to accommodate a small group.

• This statement appears to suggest that the BMA has a utilitarian approach to treating suffering. Each and every patient is important. We calculate that around 1,000 terminally ill people would have an assisted death each year. This is a small but significant number and these people’s suffering should not be discounted. Furthermore, many more people would take comfort from knowing the option is there.
• Legalising assisted dying would change the rules for the majority. It would give us all the chance to discuss how we might want to die with healthcare professionals, rather than the current system of hiding away and not allowing upfront discussions.

On a final note, many doctors (around 40%) actually support a change in the law and a recent poll found that even more (62%) agree that medical bodies like the BMA should be neutral on the subject. These doctors simply aren’t represented by the BMA’s current stance.