Royal College of Physicians clarifies it does not support assisted suicide

In a move welcomed by pro-life groups, The Royal College of Physicians (RCP) has released a statement on its website clarifying that it does not support a change in the law on assisted suicide.

The RCP, which represents more than 35,000 doctors, dropped its long-standing opposition to assisted dying in favour of neutrality following a controversial survey of its members last year.

In a highly contentious move criticised by over 1,500 doctors, the RCP’s Council said ahead of the vote that the College would go neutral unless 60% of its members voted either in favour or against assisted suicide.

The resulting survey revealed 43.4% said the organisation should be opposed to a change in the law to allow assisted dying, while nearly a third (31.6%) said it should support a change in the law and a quarter (25%) said it should be neutral.

Despite continued opposition to assisted suicide being the most favoured position among those surveyed, the RCP adopted a neutral position to assisted suicide.

The change in stance and the irregular framing of the poll prompted a legal challenge.

Professor John Saunders, a Fellow of the RCP and the former chair of its Ethics Committee labelled the survey as a “sham with a rigged outcome”.

Peer and Former Paralympian Baroness Grey-Thompson had warned that the RCP’s survey was: ‘A travesty of a consultation and… it risks bringing the college into disrepute as professional body’.

Now, in a statement on its website this week, the RCP has clarified that it does not support a change to the law.

“Neutrality was defined as neither supporting nor opposing a change in the law, to try to represent the breadth of views within its membership,” it said.

“Regrettably, this position has been interpreted by some as suggesting that the College is either indifferent to legal change or is supportive of a change in the law.

“So that there can be no doubt, the RCP clarifies that it does not support a change in the law to permit assisted dying at the present time.”

The clarification was welcomed by Dr Gordon Macdonald, Chief Executive of Care Not Killing.

He said: “This extensive and unusually frank statement from the UK’s oldest medical organisation, rightly puts a sword to the lie that RCP supports a change in the law – it does not. 

“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. This is not an imagined risk.

“As we have seen in places like Oregon and Washington, a majority of those ending their lives cite the fear of being a burden on their families and carers as a reason for the decision to end their life.”

Earlier this year, The Royal College of General Practitioners (RCGP) announced it will continue to oppose a change in law on assisted suicide following a consultation of its members.  

The RCGP’s consultation, conducted independently by Savanta ComRes, was sent to almost 50,000 members, who were asked whether RCGP should change its current position of opposing a change in the law on assisted dying.

Just under half (47%) of those surveyed said the College should not change its position, while 40% said it should support a law change providing there is a regulatory framework and appropriate safeguarding processes in place. 11% of respondents said the RCGPs should be neutral, while 2% abstained.

The British Medical Association (BMA) recently polled its member’s views on assisted suicide. The results of the first-ever BMA survey on assisted dying, which closed on 27 February, were due to be discussed at this year’s annual representatives meeting in June and could see the professional body changing its current policy on assisted suicide.

However, due to the coronavirus crisis all BMA events have been cancelled for the foreseeable future meaning any announcement is likely to be postponed.

Activists have been attempting to introduce assisted suicide legislation to the UK through the courts, through parliament and through pressuring medical bodies but continue to face obstacles.

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 330 to 118 voting 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.

Additionally, the Lord Chancellor Robert Buckland QC has recently confirmed the Government has “no plans” to introduce assisted suicide legislation, saying: “Personally, I have grave doubts about the ability of legislation to be watertight when it comes to the potential for abuse.”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. In fact, when asked questions that drill down into the merits of the debate, the percentage of those in support drops dramatically.

Assisted suicide will save NHS money and provide organs, researchers argue

Legalising assisted suicide would save the NHS money and potentially release higher quality organs for transplant argue researchers at the University of Strathclyde, raising ethical concerns.

The highly controversial paper by Dr David Shaw, an ethicist at the Universities of Basel and Maastricht, and Professor Alec Morton, a health economist and analyst, has been criticised by palliative care and pro-life groups. 

The pair say they do not intend their arguments to be used as the basis on which to change present legislation but claim that permitting assisted suicide would substantially benefit both the small population that seeks it and the larger general population.

Additionally, lead author, Dr Shaw, has dismissed criticisms from individuals – who have suggested it is callous to consider assisted suicide from the perspective of resource management – by labelling this criticism as “misplaced”.

He adds: “We are simply arguing that the economic costs of denying assisted dying should not be ignored; they should not be the key driver of any legal change, but it would be irresponsible not to consider them.”

The researchers argue that up to £74m could be saved if just one-third of the costs involved in caring for those with cancer were cut by vulnerable cancer patients opting for an assisted suicide.

In the paper, the authors write: “Organ donation could also benefit because there are several reasons why donation, after assisted dying, is better from a clinical and economic perspective.

“First, if patients are denied assisted dying, organ function will gradually deteriorate until they die naturally, meaning that transplantation is less likely to be successful. Second, patients who choose assisted dying have to go through a lengthy process, and organ donation can be easily integrated into that process…”

This year it was revealed that the legalisation of assisted suicide in Canada has led to a surge in organ donations and the open solicitation of those considering medically assisted death. In one case, a chronically ill man was denied healthcare at his home and instead offered an assisted suicide. 

Dr Moira McQueen, executive director of the Canadian Catholic Bioethics Institute, told CNA such practices appear “rather horrifying.”

Given that a person who is approved for euthanasia may not be terminally ill, McQueen added it is not out of the realm of possibility that a primary physician “might well suggest organ donation as, if not an incentive, a kind of ‘consolation’ for the person’s own loss of life.”

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

A new Assisted Dying Bill by Lord Falconer has recently received its first reading in the House of Lords. Due to the busy parliamentary timetable, it is unlikely that this bill will be debated further, but it demonstrates the clear intent from the pro-assisted suicide lobby to try and change the law.  

Dr Gordon Macdonald, chief executive of Care Not Killing, which resists any change in the law, said: “This report is highly disturbing. It highlights the dangers of legalising euthanasia. Very quickly the argument moves from that of personal autonomy to doctors and nurses making value judgments about the quality of other people’s lives while seeking to save money and tackle so-called ‘bed blocking’ in health services.” 

A spokesperson for Right To Life, Catherine Robinson said:

“You can learn a lot from paying close attention to countries and other places where assisted suicide and euthanasia has been legalised. Recent evidence from the United States demonstrates how the so-called ‘right to die’ could become the ‘duty to die’. Feelings of being a burden were cited in 55% of Oregon and 56% of Washington assisted-suicide requests in 2017.

“This is especially the case when families and health budgets are placed under financial pressure, which makes the Canadian study which found that the legalisation of assisted suicide could save the health care system up to $138 million per year so alarming. 

“Legalising assisted dying would likely lead to pressure on vulnerable people to choose the quicker, cheaper option of death over palliative care.

“This is further compounded when one considers how the legalisation of assisted dying has led to a surge in organ donations and the open solicitation of those considering medical assistance in dying (known as MAiD) in the country. 

“Rather than assist vulnerable people to end their lives, we should be looking to improve the UK’s palliative care provision and affirm their right to life.”

Euthanasia-on-demand could be legalised in Canada and Germany, while Spain and Portugal debate legalising assisted suicide

Assisted suicide advocates are seeking to legalise the practice in Spain and Portugal while expanding the availability in Canada and Germany.

Euthanasia-on-demand could become available in Canada and Germany for the majority of the general population, showcasing how, once introduced in law, assisted suicide regimes often expand significantly either through the courts or parliament.

Canada

The Canadian Government has tabled a bill that, if approved, would expand the country’s assisted suicide regime to include people without a terminal illness.

The legislation comes after the Quebec Superior Court ruled last year that a safeguard requiring patients to prove their natural death was “reasonably foreseeable” was unconstitutional.

According to Reuters, the bill will now “remove the requirement for a person’s natural death to be reasonably foreseeable in order to be eligible for medical assistance in dying,” opening up assisted suicide to those who aren’t terminally ill.

Disability advocates, including the Council of Canadians with Disabilities, have said the court’s decision sent the message that “having a disability is a fate worse than death”.

A recent report by the Special Rapporteur on the rights of persons with disabilities in Canada highlighted very troubling concerns about the impact Canada’s assisted suicide laws are having on people with disabilities.

According to the report, “The Special Rapporteur is extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective. She has learned that there is no protocol in place to demonstrate that persons with disabilities deemed eligible for assistive dying have been provided with viable alternatives.”

The report goes on to say: “moreover, she [the special rapporteur] has received worrisome information about persons with disabilities in institutions being pressurised to seek medical assistance in dying and of practitioners not formally reporting cases involving persons with disabilities.”

During her visit, the Special Rapporteur said people with disabilities told her “they are being offered the ‘choice’ between a nursing home and medical assistance in dying”.

More than 13,000 Canadians have been given a medically-assisted suicide since it was legalised in September 2016, according to the data from the justice department.

Ethical concerns were raised earlier this year when it was revealed the legalisation of assisted suicide in the country had resulted in a surge of organ donations and the open solicitation of those considering medically assisted death.

In Ontario, a hospital has faced criticism for advertising euthanasia in an urgent care waiting room.

An alarming study has found that the legalisation of assisted suicide could save the Canadian health care system up to $138 million per year.

According to the Alzheimer’s Society of Canada, over 500,000 Canadians live with dementia, with 25,000 new cases diagnosed each year.  It currently costs more than $10 billion per year to care for those in Canada’s health system.  

Germany

A five-year-old law banning professional assisted suicide in Germany has been declared unconstitutional by the country’s top court.

In 2015, Germany’s parliament voted to amend paragraph 217 of the country’s criminal code to add in safeguards preventing groups or individuals creating a form of business that profited from assisted suicide.

However, in its ruling on Wednesday, the Federal Constitutional Court declared Germany’s constitution includes a right to a self-determined death which encompasses the freedom to take one’s own life and use assistance provided voluntarily by third parties.

The Government must now draw up new laws to reflect the legality of assisted suicide in the country.

The German Medical Association opposed any relaxing of Paragraph 217, warning it could open the door to euthanasia, where doctors take an active role in helping a patient die – for example through lethal injection.

The head of Germany’s Palliative Medicine Society, Heiner Melching, said that overturning the ban on professional assisted suicide could also open the door to “self-styled euthanasia assistants”.

The court stressed however that legislators still had “a broad spectrum” of options to regulate assisted suicide, for instance through mandatory waiting periods or through introducing other safeguards in law.

Portugal

Last week, Portugal’s parliament moved closer to legalising assisted suicide and euthanasia after voting in favour of five “right-to-die” bills. 

The details of the bill will now be discussed in detail and amended by the parliament’s constitutional affairs committee, after which it will be subject to a final vote.

President Marcelo Rebelo de Sousa can veto any new law passed by the Government, but the country’s parliament can override his veto by voting a second time for approval.

Francisco Guimaraes, a 21-year-old protestor, told Reuters that he believes “life is an inviolable asset, human life has an inviolable value, consecrated by our Portuguese constitution.”

“We must care for life until it comes to its natural end,” he added.

Spain

The lower chamber of Spain’s parliament, the Congress of Deputies, has voted in favour of considering a bill that would legalise assisted suicide and euthanasia in cases of “clearly debilitating diseases without a cure, without a solution and which cause significant suffering.”

The bill will now go to the upper chamber of Spain’s parliament, the Senate, for a final vote with assisted suicide activists hoping it will be approved by June.

Rocio Monasterio, the leader of the Madrid branch of the Spanish political party Vox, told Reuters her party would mount “fierce” resistance to the bill, which she said would allow people whose life was no longer considered useful to be “eliminated”.

A spokesperson for Right To Life UK, Catherine Robinson said:

“You can learn a lot from paying close attention to countries and other places where assisted suicide and euthanasia has been legalised. What we often see is that death soon starts to appear as an all-too-acceptable solution to all sorts of conditions and, alarmingly, emotional situations.

“Every year there is a significant increase in the number of people being euthanised or helped to commit suicide by their doctors. This is compounded by the fact that once assisted suicide has been legalised for one category of people, it is often only a matter of time before it is extended to others, whether it is imposed through the courts or Government.

“In Belgium and the Netherlands doctors now routinely end the lives of patients suffering from psychiatric illness, with no underlying physical illness. 

“Recently, The Telegraph and the Daily Mail reported that a Dutch family held down their mother as she fought against being euthanized by her doctor.

“Cases like these aren’t one off rarities but are becoming commonplace and have even prompted Theo Boer, a medical ethicist at the University of Groningen, to issue a warning to countries considering legalising assisted suicide and euthanasia.

“‘Look closely at the Netherlands because this is where your country may be 20 years from now,’ he said.

“Furthermore, evidence from Canada demonstrates how a so-called ‘right to die’ can become a ‘duty to die’. Feelings of being a burden were cited in 55% of Oregon and 56% of Washington assisted-suicide requests in 2017.

“This is especially the case when families and health budgets are under financial pressure, which makes the Canadian study which found that the legalisation of assisted suicide could save the health care system more than $138 million per year so alarming.

“Legalising assisted suicide would likely lead to pressure on vulnerable people to choose the quicker, cheaper option of death over palliative care.”

Royal College of GPs will remain opposed to assisted suicide

The Royal College of General Practitioners (RCGP) will continue to oppose a change in law on assisted suicide, following a consultation of its members.   

The RCGP’s consultation, conducted independently by Savanta ComRes, was sent to almost 50,000 members, who were asked whether RCGP should change its current position of opposing a change in the law on assisted dying.

Just under half (47%) of those surveyed said the College should not change its position, while 40% said it should support a law change providing there is a regulatory framework and appropriate safeguarding processes in place.

11% of respondents said the RCGPs should be neutral, while 2% abstained.

The RCGP Council agreed that the survey results did not support a change in the RCGP’s existing position on assisted suicide.

Professor Martin Marshall, Chair of the Royal College of GPs, said: “Assisted dying is a controversial topic and this was reflected in the responses to our consultation. However, the highest proportion of respondents said that the College should continue to oppose a change in the law on assisted dying…

“The role of the College now is to ensure that patients receive the best possible palliative and end of life care, and to this end we are working with Marie Curie and others to support this.”

In a victory for pro-life campaigners, the RGCP declared it will not review the College`s position on assisted suicide for at least five years unless there are significant developments on the issue.

The medical body last consulted members on the issue in 2013, when the majority said the college should remain opposed.

Currently, no professional medical body supports changing the law on assisted suicide, which is illegal in the UK.

However, activists have been attempting to introduce assisted suicide legislation to the UK through the courts, medical bodies and parliament.

The British Medical Association (BMA) is currently surveying its member’s views on assisted suicide.  The results of the BMA survey, which closes on 27 February, will be discussed at this year’s annual conference in June and could see the professional body changing its current policy on assisted suicide.

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.” 

However, the BMA is now asking its 160,000 members:

“whether they believe the BMA should support, oppose, or take a neutral stance on a change in the law to permit doctors to prescribe drugs for eligible patients to end their own life … [and] about a stance to a change in the law to permit doctors to administer drugs with the intention of ending an eligible patient’s life.”

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.

In a letter published in The Times, a large group of prominent palliative care doctors have called on the BMA to uphold their duty of care and remain opposed to assisted suicide.

The Royal College of Physicians dropped its long-standing opposition to assisted dying in favour of neutrality following a 2019 membership survey, despite continued opposition to assisted suicide being the most favoured position among those surveyed. The change in stance from the college is currently the subject of a legal challenge.

In November, 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 330 to 118 voting against introducing assisted suicide in 2015. 

Just last month, 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.

Additionally, the Lord Chancellor Robert Buckland QC has recently confirmed the Government has “no plans” to introduce assisted suicide legislation, saying: “Personally, I have grave doubts about the ability of legislation to be watertight when it comes to the potential for abuse.”

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