This article appears in the May 2004 edition of the Catholic Medical Quarterly
Assisted Dying for the Terminally Ill Bill
Second Reading 10 March - Summary of the BMA Views
The Bill seeks to legalise assisted suicide and also purports to make provision for terminally ill individuals to receive pain-relieving medication. In respect of the first part of that aim, the BMA has consistently opposed euthanasia and physician assisted suicide for the following reasons
- Legalising physician assisted suicide would fundamentally alter the ethos of medicine;
- Arguments for such legislation are generally based on arguments about competent individuals' rights to choose the manner of their demise. Although the BMA respects the concept of individual autonomy, it argues that there are limits to what patients can choose when their choice will inevitably impact on other people and on society at large;
- Legalising assisted suicide would affect patients' ability to trust their doctors and to trust medical advice;
- In particular, it could determine the trust that vulnerable, elderly, disabled or very ill patients have in the health care system;
- If assisted suicide were to be an available option, there would inevitably be pressure from all seriously ill people to consider it even if they would not otherwise entertain such an idea;
- Health professionals explaining all options for the management of terminal illness would have to include mention of assisted suicide. Patients might choose it for the wrong reasons. They might feel obliged to choose that option if they feel themselves to be burdensome to others or concerned, for example, about the financial implications for their families of a long terminal illness;
- It would also weaken society's prohibition on intentional killing and could weaken safeguards against non-voluntary euthanasia of people who are both seriously ill and mentally impaired.
In 2000, the BMA held a two day conference to promote the development of consensus on physician assisted suicide. Overwhelmingly, BMA members, from a wide range of moral viewpoints, agreed that they could not recommend a change in the law to allow voluntary euthanasia and physician assisted suicide. Part of the reason for this consensus concerned the high risks if assisted suicide came to be accepted as a viable option for people not specifically mentioned in this Bill but who would inevitably be affected by it: vulnerable, dependent or very impressionable sick people.
Although views in society differ about the legitimate or appropriate uses of medical skills, the primary goal of medicine is still seen as promoting welfare, protecting the vulnerable and giving all patients as good a quality of life as is possible. In the BMA's view, permitting euthanasia or physician assisted suicide would irrevocably undermine this primary goal of medicine, impacting on how doctors relate to their own role and to their patients. The BMA recognises that patients are not only benefited by physical and clinical improvements but are also benefited by having their own values respected and being enabled to achieve their personal goals. Nevertheless, we believe that in the case of euthanasia and assisted suicide, benefit for an individual, in terms of having their wishes respected, is only achievable at too high a cost in terms of potential harm to society at large.
The Bill's second proposition is that there needs to be legal provision for pain relief. In the BMA's view, this plays on unjustified public fears about the possibility of intolerable or unrelieved pain at the end of life. In fact, the law and ethical position are already clear on the right of patients to receive the most effective pain relief available. This right - and doctors' ability to prescribe appropriately - is not compromised by the fact that effective medication might have the side effect of shortening some patients' lifespan. Control of pain, or other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of care in terminal illness is achievement of the best quality of whatever life remains for patients and their families.