BMA REJECTS PHYSICIAN
The British Medical Association at a two day conference on 3rd and 4th March reached a consensus to reject moves to promote a change in the law on physician_assisted suicide. It was organised in response to a resolution of the 1998 annual representative meeting of the BMA at which the Association was asked to promote the development of a consensus on physician_assisted suicide. The Medical Ethics Committee, charged with taking this resolution forward, decided that as many people as possible should be invited to contribute to the debate, and to this end produced a discussion forum on the BMAs website and a debating pack, asking for views about consensus and where it might lie. The 200 substantial contributions were used in the planning of the conference.
The participants, nominated to attend by their local divisions, were selected to reflect a range of age, speciality and professional seniority from throughout the UK. 50 members came together in BMA House with a wide variety of views on the issue. The purpose was not to measure the degree of support for or opposition to physician_assisted suicide amongst the participants, or indeed the medical profession as a whole, but rather to identify a statement on which all could agree.
Sir Sandy Macara, immediate past chairman of BMA Council and a former chairman of the Medical Ethics Committee, presented the following definition which participants were asked to keep in mind during the two day conference:
"Consensus involves the identification of areas of broad agreement and shared values. Achieving consensus entails two processes; finding issues or perspectives that are common to all and developing them into statements with which everybody feels comfortable. Consensus acknowledges the existence of differences but focuses attention on exploring the middle ground where unanimity is most likely to be found. It involves identifying compromises which are potentially acceptable to all and which, when agreed. form a collective agreement."
The conference took the form of a series of workshops and plenary sessions with the aims of exploring areas of uncertainty and establishing common ground and consensus where possible. Two days of intense and thorough debate, looking at the issue from all sides, culminated in groups being asked to produce potential statements of consensus for discussion in the final plenary session on the second day. These were discussed, amended and finally accepted or rejected by the conference.
The final document represents an amalgamation of those statements which were accepted by all the participants. As such, it reflects more than just a majority view. It identifies where, at the end of conference, consensus lay. In general the participants held a wide spectrum of views on assisted suicide, but even those with fundamentally and diametrically opposing views found areas of which they could reach agreement.
The final document now follows:
Physician assisted suicide - Statements from a conference to promote the development of consensus 3-4th March 2000
Physician assisted suicide
Drawing together a wide range of moral viewpoints and practical considerations, the conference cannot agree to recommend a change in law to allow physician assisted suicide.
Within the profession there is a very wide range of views on physician assisted suicide (both for and against).
The conference believes that if physician assisted suicide were
to be practised:
It would alter the relationships between:
doctors and patients;
doctors and significant others; and
doctors and society.
The conference recognises the importance of:
patient autonomy; and
open communication with the patient.
In the context of the debate on physician assisted suicide, an important moral issue to be considered would be the balance between respect for the patients autonomous request and any distress and harm that may be caused to those close to the patient.
If physician assisted suicide were legally permissible doctors must not be obliged to participate.
Refusing, withdrawing or withholding medical treatment
The conference respects the autonomy of competent patients to refuse life_prolonging/sustaining medical treatment and intervention (either contemporaneously or by advance directive). Such competent refusals do not constitute physician assisted suicide.
There is a difference between respecting the competent patient s autonomous refusal of treatment and intervention, even if it results in the patient s death, and acts or omissions with the intention of causing death. The conference sees no obligation to continue treatment in which the burdens outweigh the benefits for the individual patient.
Individuals who competently choose to commit suicide are not legally prohibited from doing so. It does not follow that they have the right to be assisted to do so. In respecting the freedom of an individual to commit suicide a physician has no duty to assist them.
People/patients who are considering suicide have a moral responsibility to take account of the views and feelings of others. Aiding/abetting a suicide is currently illegal.
Care at the end of life
Physicians have a duty to educate about, promote and mobilise maximum support in maintaining quality of life for those for whom life would otherwise appear intolerable.
Patients have a right to be adequately informed about their medical conditions and treatment.
Patients should be involved in decisions pertaining to their care.
The profession recognises the need for continuing improvement in care of the dying. The conference supports the continued development and provision of high quality palliative care.
Physician assisted suicide should not be considered as an alternative to other forms of care.
In addition to the major ethical and moral issues, the conference identified the following practical problems arising from physician assisted suicide which would have to be addressed:
At the moment, it is illegal and therefore would require a change of the law to facilitate/enable implementation.
Implementation would require the distribution of drugs not normally used in general medical practice. Definition of appropriate pharmacological intervention would be required.
There is a danger of the dissemination of lethal drugs into the community.
Standard setting bodies would need to define protocols that would ensure as far as possible a reliable outcome.
In the context of physician assisted suicide, drug delivery, to be effective and reliable, would usually require the use of the parenteral route and therefore would increase medical involvement. This may be considered as moving towards, or approaching, euthanasia.
It is likely that there would be a significant number of clinicians with conscientious objections to involvement with physician assisted suicide. This may have implications in the transfer of care of patients.
Modern, effective clinical care involves many clinicians other than those medically qualified and their involvement in the process would have to be considered and structured.
Provision would have to be made for conscientious objection.
Involvement of the family and significant others, although strictly not required, would be highly advisable.
There would be considerable difficulties in identifying consistent
criteria for inclusion or, exclusion from a qualifying patient group.