Palliative care doctors overwhelmingly oppose assisted suicide, new poll reveals

Seven out of ten palliative care doctors surveyed believe the British Medical Association (BMA) should remain opposed to assisted suicide, a new survey has revealed.

The largest poll to date of British medics’ views also showed that only 30% of doctors surveyed supported the BMA actively supporting attempts to change the law to allow euthanasia. Whereas 63% of doctors opposed the BMA supporting a law change or be neutral on the matter, with 40% expressing the view that the BMA should stay with it’s current position opposing a law change and 23% holding the position that is should be neutral on the matter.

When asked whether the BMA support a change in law which would permit physician-assisted suicide, 40% of doctors said it should actively support a law change, 33% said it should stick with its present policy of opposing a law change, and 21% backed a neutral stance.

However, 70% of palliative care doctors opposed a change in the medical bodies stance, whilst just 7% were in favour.

Some 44% of geriatricians were opposed to the BMA changing their stance on assisted suicide, whilst only 27% were in favour.

General Practitioners, too, seem less keen on seeing a change in the law, a result echoing the findings of their own Royal College earlier this year.

In comparison, calls for changing the BMA’s stance on assisted suicide came largely from doctors who rarely deal face-to-face with patients, such as histopathologists.

Support was also bolstered by those who have never practised medicine because they are students or do not hold a license to practice, and retired doctors.

Conscientious objection could become an issue

If the law regarding assisted suicide were to change in the future, the right to conscientiously object and opt-out of administering life-ending drugs could become an issue.

Despite doctors narrowly being in favour of a change of law, 54% of doctors revealed in the poll that they would not be willing to participate actively in the process of administering life-ending drugs. Only 26% said they would be willing, and 20% were undecided.

So, while there appears to be an appetite for allowing patients to end lives, it seems there is much less enthusiasm for providing such assistance. In Canada, the Superior Court of Justice Division Court of Ontario ruled in 2018 that if doctors are unwilling to perform legal actions, such as assisted suicide, they should find another job.

What happens next

Currently, the BMA believes that “the ongoing improvement in palliative care allows patients to die with dignity … [and] insists that physician-assisted suicide … voluntary euthanasia … [and] non-voluntary euthanasia should not be made legal in the UK.” 

The doctors’ union has had a policy opposing assisted suicide since the 1950s, but very briefly became neutral on the issue in 2005.

Since then, the BMA has been opposed to all forms of assisted suicide – a position they reaffirmed in 2016 at the organisation’s annual representative meeting.

While the BMA emphasised that the poll was not a vote and did not commit them to any change in its formal opposition to assisted suicide, it is possible doctors will call for a formal change in the medical bodies stance on assisted suicide during its next annual meeting due to take place next summer.

The results had been due for release and debate this summer, but the BMA’s annual meeting was postponed because of the coronavirus pandemic.

Duty of care

Earlier this year, as the BMA was collecting responses on its survey, a large group of prominent palliative care doctors called on the BMA to uphold their duty of care and remain opposed to assisted suicide.

In a letter published in The Times, over fifty palliative care doctors and healthcare professionals said the existing law, which prohibits any form of assisted suicide or euthanasia, “ensures that doctors continue to uphold their duty of care, avoiding the inherent risks to sick and vulnerable patients that physician assisted suicide would bring”.

The doctors also used the letter to highlight how safeguards are ignored and eligibility criteria is soon expanded in countries that allow assisted suicide. Referencing Canada, the doctors say: 

“Canada’s Federal government has consulted on expanding assisted dying laws to the mentally ill, to ‘mature minors’ and individuals whose deaths are not imminent. Meanwhile Canadian hospices are facing pressure to provide assisted death or risk losing their funding.”

‘Mendacious claims’

Commenting on the poll, Dr Gordon Macdonald, Chief Executive of Care Not Killing said

“We welcome the fact that many active medics have repeatedly rejected the mendacious claims made by those pushing for this change, namely that legalising assisted suicide and euthanasia can be done with safeguards and would not put pressure, real or perceived, on vulnerable people to end their lives prematurely.

“They have seen what happens in the small number of jurisdictions that have gone down this dangerous path – places like Oregon and Washington. These two US states are held up as the model to copy, but in both, a majority of those opting to end their lives cite fear of being a burden as among their key reasons, and others talk about financial concerns. While the list of conditions that qualify for the lethal cocktail of barbiturates continues to grow, some experts have warned that allowing assisted dying might also be normalising suicide in the general population. Suicide rates are, after all, a third higher in Oregon than the US average.

“In Canada, last year a Court struck down the requirement that a person be terminally ill before they qualify for euthanasia. This followed the case of Alan Nichols, a former school caretaker who was physically healthy, but struggled with depression. His life was ended by lethal injection in July. Roger Foley, meanwhile, was repeatedly offered the drugs to kill himself, while being denied the social care to live a dignified life, due to the cost.

“Closer to home, we see how laws introduced in the Netherlands or Belgium, which were supposed to be limited to mentally competent terminally ill adults, have been extended to non-mentally competent adults and children, profoundly disabled people, and even those with treatable psychiatric problems such as depression and anorexia.”

Current laws protect

Dr Macdonald concluded: “The current laws on assisted suicide and euthanasia exist to protect those who are sick, elderly, depressed or disabled from feeling obliged to end their lives. They protect those who have no voice against exploitation and coercion and those who care for them who might come under pressure to conserve scarce resources. They do not need changing.”

Assisted suicide Bill launched in Ireland

A radical Private Members’ Bill attempting to legalise assisted suicide in the Republic of Ireland has been introduced in the lower house of Ireland’s parliament.

The so-called ‘Dying with Dignity Bill’ was tabled in the Dáil Éireann by People Before Profit TD Gino Kenny on Tuesday 15 September.

Although Kenny’s party only has five members, other parties have indicated they could support the proposed law, with any vote likely to be an issue of conscience.

The ‘Dying with Dignity’ bill was first introduced by TD John Halligan in 2015 but ran out of time when the Irish government was dissolved in 2016.

Analysis by Naoise Grenham, Public Affairs Officer at Right To Life UK

There is an abundance of alarming aspects to a radical Bill which lurches far beyond the demands of the assisted suicide campaigners Dignity in Dying in the United Kingdom and the supposedly exemplary legislation of Oregon, USA, which this neighbouring campaign claims to emulate.

Most notably, Gino Kenny’s Bill allows for euthanasia in cases where “it is not possible” for the patient to administer themselves lethal drugs. 

Such actions are expressly forbidden under both the Death with Dignity Act implemented in Oregon in 1997 and the similar proposals of Dignity in Dying.

A host of other provisions illustrate the extremity of the Dying with Dignity Bill even among the radical company of Oregon and Dignity in Dying.

The Oregon law defines terminal illness as expected “within reasonable medical judgement, produce death within six months”. 

In contrast, the Bill before the Irish Parliament lacks any time limit for terminal illness, only requiring that the patient be ‘likely to die as a result of that illness or complications’ at an unspecified stage.

Whereas Oregon patients supply both written and oral requests for lethal drugs, Kenny’s Bill reduces the procedure to only a single written declaration. 

Similarly, only one witness would be needed to sign off on patient declarations under the radical Irish proposal as opposed to two witnesses under the American legislation of much longer experience. 

Unlike in Oregon, Kenny’s Bill does not stipulate that the patient be recommended to inform their next of kin of their decision.

Under the ‘Dying with Dignity’ Bill, the waiting period between a patient’s declaration to end their own life and the prescription of lethal drugs reduces from fourteen to six days in cases where death from a terminal illness is deemed likely to occur within a month. 

In contrast, the Oregon system of assisted suicide only collapses the 15-day waiting period if death from a terminal illness is likely to occur within that period.

Whereas the Death with Dignity Act in Oregon insists that any informed decision must involve consideration of “feasible alternatives, including, but not limited to, comfort care, hospice care and pain control”, Gino Kenny’s ‘Dying with Dignity’ Bill fails to detail the mandatory information for patients beyond the simple mention of “the available choices”. 

Perhaps most strikingly, the ‘Dying with Dignity’ Bill makes no reference to the possibility of psychological or psychiatric evaluation in case of potentially impaired judgement on the part of the patient. This represents a disturbing distinction with Oregon where the physicians are obliged to refer such patients for counselling.

‘Wrong in principle’

The latest proposal to allow assisted suicide has been criticised by palliative care doctors, geriatricians, politicians and pro-life campaigners.

Columnist and head of the Dublin-based Ioana Institute, David Quinn, condemned the Bill for being both “wrong in principle” and for having “incredibly far-reaching” proposals which go further than other countries that allow assisted suicide.

“For example, the definition of ‘terminal illness’ is so broad it could include dementia. It does not require that a person be within a set period of death such as six months. Therefore, the person could be in the early stages of a terminal illness with years of life remaining and still ask a doctor for a lethal drug. They only have to make the request once,” he told Crux.

No proper protection for conscience rights

In addition to David’s concerns, the bill would force healthcare professionals who have a conscientious objection to assisted suicide to make “arrangements for the transfer of care of the qualifying person”, a form of participation that goes against an individual’s conscience rights.

This is especially worrying for the hospice movement, which cares for patients near the end of their lives and is philosophically opposed to euthanasia.

In stark contrast, the archetypal Death with Dignity Act in Oregon does not require healthcare professionals to transfer such patients but only to transfer their records once the patients have themselves located a new provider.

‘A better option’

Professor Anthony O’Brien, a Clinical Professor of Palliative Medicine at University College Cork with over 35 years of experience in hospice care, has spoken out against the Bill, telling The Irish Times:

“I have met very many patients who in desperation asked to have their life ended, believing that they had no other option. With good palliative care, the overwhelming majority had occasion to change their minds. With suicide, there is no going back.

“Surely a compassionate society can be more creative in its response to human suffering than premature, self-inflicted death. Good care is always a better option.”

‘Regressive step’

Hope Ireland, a coalition of healthcare professionals and disability rights advocates, says the introduction of assisted suicide and euthanasia is a “regressive step for vulnerable people – particularly the elderly and those with disabilities”.

In their briefing document, which was sent to all of Ireland’s TDs, they highlight how the operation of similar laws in other countries have shown the consequences of legalisation are “catastrophic” for older people and people with disabilities.

For example, they state:  “In 2019, a woman with dementia who revoked her consent to be euthanised had to be held down by her family whilst the doctor ended her life. A Dutch court approved this practice, and acquitted the doctor of any wrongdoing.”

Negative culture change

Peadar Tóibín, the leader of the pro-life Aontú party, has warned that in countries that have introduced physician-assisted suicide or euthanasia, “pressure starts to grow on older people and people with severe disabilities.”

So much so that countries such as Canada, Netherlands and Belgium have seen the number avail of assisted suicide radically increase,” he told News Letter.

“These countries initially introduced assisted suicide for a small number of really difficult cases but have now seen the numbers increase nine and ten-fold. Requests for euthanasia are extremely rare before it’s made legal but radically increase when the culture changes,” Tóibín continued.

He also said the bill could “radically change” the direction of the medical profession from the saving of life to ending it.

“We urge the government to assist people with living. To invest the necessary resources to ensure that people who are faced with difficult death have all the supports that they need to make for final journey as comfortable and pain free as humanly possible. We need to improve our palliative care and our health service but euthanasia is not the solution to the failings in our health system,” he said.

Large turnout of MPs and Peers hear about dangers of assisted suicide

A large number of MPs and Peers attended a parliamentary event, this week, on the dangers of assisted suicide and the grim reality its legalisation would bring to the UK.

Politicians from across the political spectrum heard speeches from internationally renowned Dutch ethicist Prof. Theo Boer and Mr Wesley Smith, who has been recognised as “one of America’s premier public intellectuals on bioethics” by the National Journal.

The event, which took place on World Suicide Prevention Day (Thursday 10 September), was hosted by the All-Party Parliamentary Pro-Life Group and chaired by Fiona Bruce MP.

Ahead of main speeches, the pro-life Conservative MP said: “at this particular time of global pandemic it’s all the more critical that we reassure people that every life is intrinsically valuable.”

‘Default way to die’

In his speech, Dutch ethicist Professor Theo Boer explained how he has experienced the expansion of assisted dying in the Netherlands since it was introduced in 2002.

Prof. Boer was a former advocate of legal euthanasia but changed his mind after seeing its continued expansion both in the Netherlands and other countries and the negative consequences of it.

He revealed that for many people he has witnessed assisted dying become “a default way to die”.

Fear-mongering

Mr Smith said that activists and pressure groups often use fear, in particular fear-mongering on the difficulties of death, to push through their agenda.

He added that people “very rarely” commit assisted suicide because of pain, but do so for existential reasons. These reasons may include being worried about losing their dignity and a fear of being a burden to their families and loved ones.

“I can’t think of anything more cruel than letting somebody who’s having a terrible awful time getting through the night because of existential anguish feel that their deaths have a greater value than their lives,” Mr Smith said.

He added that assisted suicide violates human rights by creating a two-tier system of valuing lives which says to some people ‘Yes your suicide is worth preventing’, but says to others ‘yours isn’t’.

Suicide crisis exacerbated

Both Prof. Boer and Mr Smith believe that the “suicide crisis” in the West is “exacerbated” by allowing assisted dying, despite claims to the contrary from activists and pressure groups.

Prof. Boer highlighted how the number of suicides in the Netherlands has risen by 35% over the past decade, coinciding with a 150% rise in the number of people seeking assisted dying, while the rate has decreased in neighbouring countries which don’t allow assisted dying.

He stated that in Germany, where euthanasia is not possible, the suicide rate has decreased over the past ten years.

Prof. Boer added: “the signal that is being sent to a society is that death is the solution to any form of unbearable and irremediable suffering”.

He further indicated that assisted dying tends to develop from being a last resort to prevent a terrible death into being a last resort to prevent a terrible life.

No medical, legal or political support for assisted suicide

Large pressure groups in favour of assisted suicide and activists have been attempting to force assisted suicide on the UK through the courts, medical bodies and parliament.

However, despite their best efforts, they continue to face obstacles and their efforts have so far been futile.

Not a single doctors group or major disability rights organisation in the UK supports changing the law, including the British Medical Association (BMA), the Royal College of General Practitioners, the Royal College of Physicians, the British Geriatric Society and the Association for Palliative Medicine.

Last year, the High Court rejected to hold a judicial review of the current law on assisted suicide, with judges stating the court was “not an appropriate forum for the discussion of the sanctity of life”. The Court of Appeal rejected an attempt to challenge this decision last month.

Similarly, in 2018, the Court of Appeal ruled that Parliament was a “better forum” than the courts for determining the issue of legalising assisted suicide.

Parliament has consistently rejected attempts by the assisted suicide lobby to introduce assisted suicide, with MPs voting 330 to 118 against introducing assisted suicide in 2015. 

In January, strong opposition from MPs resulted in the Government rejecting a call for review on assisted suicide, despite the best efforts from large pressure groups in favour of assisted suicide.

The Lord Chancellor, Robert Buckland QC, has reaffirmed this stance on two occasions this year.  

In February, Mr Buckland QC, stated the Government has “no plans” to introduce assisted suicide legislation.

In a letter to Dr Gordon Macdonald, the CEO of anti-euthanasia group Care Not Killing, Mr Buckland said: “Personally, I have grave doubts about the ability of legislation to be watertight when it comes to the potential for abuse.”

He added: “My predecessor was… supportive of a call for evidence but no call was initiated before he left office, nor… does the Government currently have any plans to initiate a call for evidence. This remains my position.”

Mr Buckland QC reaffirmed the Government’s stance in April, during a remote meeting of the Joint Committee on Human Rights.

Prime Minister changes stance on assisted suicide

The current Prime Minister, Boris Johnson, previously supported introducing assisted suicide to the UK.

However, he apparently had a change of heart after meeting with Lord Falconer, who has twice failed in bringing forward a Bill to introduce assisted suicide to the UK.

During the meeting with Falconer, it became clear to Johnson that supposed safeguards around assisted suicide simply weren’t effective in practice. 

Ironically, he left the meeting, which had been set-up to get him more involved with campaigning for assisted suicide, more aware of the practical issues with allowing assisted suicide.

He then went on to to vote against an assisted suicide bill brought forward by Labour MP Rob Marris in 2015. 

This was a landslide victory for campaigners opposed to the Bill, with 330 MPs voting against the Bill and only 118 in support. 

Ahead of voting against the Bill, Boris Johnson said: “The Bill may seem compassionate but I have serious concerns about it working in practice. I cannot support it.”

In line with his new views, Boris Johnson unveiled an additional £25 million funding for hospices in a bid to ease end-of-life care last year. 

Deeply flawed polling

Assisted suicide pressure groups cite a poll that shows there is widespread support for legislation of assisted suicide, yet experts have heavily criticised the polling as deeply flawed.

Additionally, when asked questions that drill down into the merits of the debate, the percentage of those in support drops dramatically.

Healthy over 75s targeted in Dutch assisted suicide law expansion

A Dutch MP has tabled a controversial Bill that would allow healthy people to have an assisted suicide if they feel their life is ‘complete’.

Pia Dijkstra, Foreign Minister for the four-party coalition Government and medical ethics lead for coalition party D66, submitted the proposed bill last week.

It would allow healthy individuals over 75-years-old who have “a strong death wish” for at least two months to seek the assistance of an ‘end-of-life supervisor’ to die.

The Bill will now go to the Raad van State judicial advisory committee for review – a process which will take three to six months – before being scheduled for a debate and vote.

It will then need to win a majority vote in the House of Representatives before being passed to the Senate for a debate and vote.

‘Completely unacceptable’

According to Dutch News, the proposals are likely to stoke conflict in the Government, with two of the coalitions four parties being radically opposed to any further expansion of assisted suicide legislation.  

The Christian Union party finds the proposal completely unacceptable and says its timing, during the coronavirus pandemic, is insensitive.

The party leader, Gert-Jan Segers, said: “I find it extraordinarily painful that at a time when old people feel extra vulnerable, D66 submits a proposal that we know will cause many of them increased insecurity and worry.”

Christian Union Party member Carla Dik-Faber added: “D66 chooses against all advice to come up with a law that is literally life-threatening… Instead of a plan to address the concerns, the worrying and needs that the elderly may suffer from, says D66: here you have a pill. I find that very, very bitter.”

Outlining his opposition to the proposals, CDA leader and health minister, Hugo de Jonge, made an appeal to tackle issues of loneliness and social problems faced by the elderly.

In a parliamentary briefing he said: “It is our task to make every effort to ensure that these people find the meaning of life and meaning in life again.”

Outlining their opposition to similar proposals in 2017, the KNMG Royal Dutch Medical Association believe it could have the undesirable effect of stigmatising the aged population.

The medical association said that the government should invest in measures to make sure the elderly do not feel their lives are pointless, over the option of an early death.

Euthanasia on the increase

The Netherlands’ only euthanasia clinic recently revealed that it had seen a 22% increase in requests from people seeking assistance to end their lives last year compared to 2018.

Last month, a Dutch doctor, who was cleared of murder for euthanising a vulnerable woman with dementia, waived her anonymity to declare she did the “right thing”, even though her patient said “no” three times.

In an interview with Dutch current affairs programme Nieuwsuur, Marinou Arends attempted to justify her actions saying they were “for the best”.

Her comments come after a 2019 district court ruling in the Hague stating that doctors in the Netherlands can no longer be prosecuted for carrying out euthanasia on dementia patients who have previously given written consent.

Previously, those with dementia would need to reconfirm their earlier request.