Stephen Daisley

Can doctors be ‘neutral’ on assisted dying?

Can doctors be 'neutral' on assisted dying?
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The British Medical Association (BMA) has dropped its opposition to assisted dying after a landmark vote. In doing so, it marks a journey from professional principle onto the ethical fence.

This is not the first time the BMA has declared itself neutral on the termination of post-natal human life. In 2005, the organisation voted to switch from opposition to neutrality on physician-assisted suicide but that position was overturned the following year amid charges that the policy shift had been achieved through an ‘extraordinary manoeuvre’ and ‘procedural tactics’. A decade later, in 2016, the body again rejected adoption of a neutral stance following a consultation with 500 association members and the general public.

By 2019, the BBC was quoting the BMA’s outlook as:

‘(T)he ethics of clinical practice, as the principal purpose of medicine is to improve patients' quality of life, not to foreshorten it’.

A parliamentary briefing prepared by the BMA in 2020 said ‘UK law should not be changed to permit assisted dying in any form (including assisted dying with involvement from doctors)’ and gave as its principal reason:

‘Medical involvement in assisted dying could fundamentally alter the ethos within which medical care is provided. The principal purpose of medicine is to improve patients’ quality of life, not to foreshorten life. A number of doctors have concerns that the trust found in the unique relationship between doctors and patients might be jeopardised if doctors were permitted to play a role in ending patients’ lives.’

The position paper also warned that ‘(a)ssisted dying could have a negative impact on the doctor-patient relationship’ and ‘cause some to fear doctors and medical settings’, particularly elderly and disabled people ‘or those who see themselves as a burden’.

The document added that a change in the law ‘could put vulnerable people at risk of harm, by altering society’s attitudes towards the elderly or disabled’ or making these groups feel ‘under pressure’ to consider ending their lives. Instead, the BMA wanted to see ‘high quality palliative care services’ consistently and widely available and better public information campaigns to draw attention to these options.

On Tuesday, by a vote of 49 per cent to 48 per cent, the body adopted ‘a position of neutrality on assisted dying including physician-assisted dying’. The resolution, which seeks refuge in reflecting ‘the diversity of opinion’ among the BMA membership, doesn’t merely reverse the association’s stance (for the third time in less than two decades) but undermines its authority to speak on medical ethics. Did ‘the ethics of clinical practice’ and ‘the principal purpose of medicine’ change some time between 2019 and yesterday?

Such a transformation would have to be substantial to justify the BMA’s decision that it is now disinterested on a policy that, just a year ago, it said could ‘fundamentally alter the ethos’ of clinical provision, cause vulnerable patients to ‘fear doctors and medical settings’ and put said patients ‘at risk of harm’. What changed? Are we to believe that doctor-assisted suicide may no longer upturn the basic ethos of medical provision, inspire fear in patients or put the vulnerable in harm’s way? Or are we to conclude that the BMA has become neutral on such outcomes?

A more honest resolution would have acknowledged that, like all membership organisations, the BMA is buffeted by the headwinds of member preference, factional politics, and institutional expression of changing mores among professional elites and the general public.

No one could have censured the BMA for its candour, but candour wasn’t an option for it would have required an admission that the association’s ethical enunciations do not carry the timeless, unimpeachable authority we are determined to associate with the medical profession. Roger Scruton wrote in The Meaning of Conservatism that ‘(e)very doctor…in so far as his identity stems from his profession, pursues an ideal of professional conduct and professional achievement’. In its assertion of professional authority on assisted suicide, it is that very value which the BMA has undermined.

The BMA’s changing position emerges from an ideal in which neither the state nor society may try to interrupt the ability of the individual to direct his or her own life. The right to kill yourself – free of legal or other consequence for you or anyone who assists you – is the ultimate expression of this worldview.

However, it is possible — even necessary — for liberals, political, religious and otherwise, to uphold the centrality of individual rights and personal self-governance while guarding the inviolability (or, in Christian terms, sanctity) of life as a fundamental building block of human freedom.

Even the Catholic Church recognises that ‘discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate’. As such, a liberal so-minded might accept a role for patient-requested or physician-directed do-not-resuscitate orders in certain circumstances — just as he or she might defer to individual choice on bodily harm, mutilation or clinical alteration — but draw the line at self-destruction. If the life of the individual is not inviolable, then nor are the rights that life confers.