This article appears in the Aug 2006 edition of the Catholic Medical Quarterly
Was the BMA Policy on Assisted Dying Dictated by a Christian Lobby?
The policy of the British Medical Association is decided at its Annual Representatives Meeting (ARM), held this year in Belfast. At the 2005 meeting the longstanding BMA policy of opposition to euthanasia and physician assisted suicide was changed to one of neutrality. The proceedings of this debate were questioned, but despite this the vote was portrayed ,as the medical profession moving towards supporting euthanasia.
Following this, 'a pressure group called Care not Killing was established with support from faith groups including the Catholic Bishops of England and Wales, the Christian Medical Fellowship and the Islamic Doctors Association, and also from such secular organisations as the British Council on Disability and the Association of Palliative Medicine. The Royal College of GPs and the Royal College of Physicians consulted their members on the issue and moved from their previous positions of neutrality to opposition. Motions calling for a reversal of last year's decision were submitted for the 2006 ARM and the scene was set for a show down in Belfast.
The debate on the last morning of the meeting was on a motion affirming that ongoing improvements in palliative care allow patients to die with dignity, and opposing the legalisation of physician assisted suicide, voluntary euthanasia and involuntary euthanasia of those not competent to decide. The motion also requested a ballot of BMA members on this issue. The debate was tense with some passionate and well reasoned speeches on both sides. Those who opposed the motion argued either that, given the division in society on the issue, the BMA should be neutral, or that doctors should always respect the wishes of their patients even to the point of taking the lives of those who are terminally ill and in unbearable suffering. Those who supported the motion argued that, while patient autonomy is good, it must be limited in order to protect dying people from pressure to end their lives because they perceive themselves to a burden. They also highlighted the risk of patients making wrong decisions because of an incorrect diagnosis or prognosis or because of depression or temporarily poor symptom control. The votes were decisive with 2:1 voting against voluntary euthanasia and PAS, although, disturbingly, 6% of delegates voted to support legalisation of non voluntary euthanasia. Given the clarity of these votes the call for a ballot of all BMA members was not supported.
The immediate response of the pre-euthanasia lobby was to blame religion. Dr Evan Harris MP accused the Christian Medical Fellowship of secretly dictating BMA policy, manipulating the medical profession and "targeting individual doctors for pressure and abuse". The National Secular Society claimed that doctors had "ditched" their neutral stance under "Christian pressure", and Dignity in Dying (formerly the Voluntary Euthanasia Society) blamed the "religious lobby"and complained that the BMA must now engage on a "doctrinaire basis instead of a neutral and professional one". These responses seem odd since none of the arguments supporting the motion had been made from any religious text, teaching or tradition. Although the CMF was accused of "packing" the meeting, in fact out of the 520 delegates to the ARM only 13 were members of the CMF and none of them spoke in the debate.
It would be easy to dismiss this reaction as prejudice and sour grapes, but perhaps the pro-euthanasia lobby has a point. This issue raises profound questions about the value and meaning of life, questions which are at the heart of the religious search. An open letter from the leaders of British Buddhists, Christians, Hindus, Jews, Muslims and Sikhs stated: "We hold all human life to be sacred and worthy of the utmost respect and note with concern that repeated attempts are being made to persuade Parliament to change the law on international killing so as to allow assisted suicide and voluntary euthanasia for those who are terminally ill'." Many in our society who would reject the notion of sacredness of human life would nevertheless recognise the validity of the questions raised by this religious perspective: Are our lives a gift with inherent value or just a given fact? Are we our own property to dispose of as we alone see fit? Do we have duties to others which may over-ride our own desires? What is our understanding of human nature if our suffering has no meaning and the care we give and receive is ultimately pointless? What would be the effects of legalising intentional killing on the perpetrator, the medical profession and society?
Perhaps the BMA debate demonstrates that we can and should debate the clinical and legal implications of euthanasia and assisted suicide rationally, but that in the end the conclusions that individuals come to may well be based on their faith in the meaningfulness or meaninglessness of existence.
Open letter to all Members of Parliament and the House of Lords, from leaders of British faith communities 7 October 2005.
Dr. Phil McCarthy is a GP from the Westbury on Trym Practice.