Large group of palliative care doctors call on BMA to remain opposed to assisted suicide

A large group of prominent palliative care doctors have called on the British Medical Association (BMA) to uphold their duty of care and remain opposed to assisted suicide.

The call comes as the BMA has launched a new survey of its members on the issue. The results of the BMA poll, 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.” 

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.

However, the BMA will now ask 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.”

In a letter published in The Times, over 50 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.”

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

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 process used by the College is currently subject to a legal challenge.

Meanwhile, the results of a recent poll by the Royal College of General Practitioners (RCGP) are due to be released later this month.

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.

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.

The Lord Chancellor Robert Buckland said the government had no plans to launch an inquiry into current laws preventing euthanasia.

He added: “Personally, I have grave doubts about the ability of legislation to be watertight when it comes to the potential for abuse.”

Palliative care doctors letter in full:

Sir, Today the BMA launches a consultation surveying its members’ views on physician-assisted dying. Challenging individual cases have prompted calls to change the law. However, the existing law 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 NHS is already overloaded, struggling to serve an expanding ageing population without adequate funding for palliative care.

In other jurisdictions with legalised assisted dying, the picture is disturbing, and the World Medical Association recently reiterated its opposition to doctor-assisted dying. Canada’s federal government has consulted on expanding assisted dying laws to the mentally ill, “mature minors” and individuals whose deaths are not imminent. Meanwhile, Canadian hospices are facing pressure to provide assisted death or risk losing their funding. We understand that the medical profession cannot and should not dictate the law but are concerned that the public’s trust in doctors and medical institutions will lead our patients to equate assisted dying with good end-of-life care, as in Canada. We hope that the BMA will continue to oppose the involvement of doctors and that assisted dying will not become a medical intervention in the UK.

Prof Bill Noble, Consultant in Palliative Care; Dr Jim Gilbert, Consultant in Palliative Medicine; Dr David Randall, Registrar in Renal Medicine; Dr Alexander Cary GP Trainee; Dr Dominic Whitehouse, Consultant Physician in Palliative and Respiratory Medicine; Prof Rob George, Medical Director and Consultant in Palliative Care; Dr Alison Brooks, GP; Dr Aiofe Gleeson, Consultant in Palliative Medicine; Dr Robert Twycross, Emeritus Clinical Reader in Palliative Medicine; Prof David Oliver, Professor of Palliative Medicine; Prof Simon Noble, Professor of Palliative Medicine; Prof Irene Tuffrey-Wijne, Professor of Intellectual Disability and Palliative Care; Dr Amy Proffitt, Deputy Medical Director; Dr Mark Taubert, Consultant and Lead Clinician in Palliative Medicine; Dr Marina Malthouse, Consultant in Palliative Medicine; Dr Craig Gannon, Consultant in Palliative Medicine; Dr Rosemary Anthony-Pillai, Consultant in Palliative Medicine; Dr Kevin O’Kane, Consultant in Acute Internal Medicine; Dr Melody Redman, Junior Doctor in Paediatrics; Dr Fiona McCormick, Consultant in Palliative Medicine; Dr Simon Anderson, Consultant Gastroenterologist; Dr Angela Campbell, Consultant Geriatrician; Dr Luigi Camporata, Consultant in Intensive Care Medicine; Dr Peter Diem, Consultant Geriatrician; Dr Terrence Gibson, Consultant in Acute Internal Medicine; Dr Philip Howard, Consultant Gastroenterologist; Dr Mustafa Kadam, Registrar in Acute Internal and Stroke Medicine; Dr Iain Kennedy, GP; Dr Taryn Pile, Consultant Nephrologist; Dr Sanna Khawaja, Registrar in internal Medicine; Dr Ranjababu Kulasegaram, Consultant in HIV Medicine; Dr Roshan Navin, Consultant in Acute Internal Medicine; Dr Aysha Nazir, Registrar in Emergency Medicine; Dr Laura O’Sullivan, Registrar in Acute Internal and Intensive Care; Dr Farica Patel, Registrar in Acute Internal Medicine; Dr Richard Rawlins, Retired Consultant Orthopaedic Surgeon; Dr Shabaz Roshan, Consultant Geriatrician; Dr Nadia Short, Consultant in Acute Internal Medicine; Dr Fiona Stephen, Trainee in Emergency Medicine; Dr Duncan Brown, Medical Director and Consultant in Palliative Care; Dr Ollie Minton, Clinical Lead in Palliative Medicine; Dr Claud Regnard, Honorary Consultant in Palliative Care Medicine; Dr Chris Farnham, Consultant in Palliative Medicine; Baroness Sheila Hollins, Retired Consultant Psychiatrist; Dr Ellie Smith, Consultant in Palliative Medicine and Clinical Lead for Palliative Care; Dr Sarah Cox Consultant and Lead Clinician in Palliative Medicine; Dr Idris Baker, Consultant in Palliative Medicine; Dr Seamus Coyle, Community Consultant in Palliative Care; Dr David Brooks, Consultant in Palliative Medicine; Prof Scott Murray, Emeritus Professor of Primary Palliative Care; Dr Juliet Spiller, Consultant in Palliative Medicine; Prof Marie Fallon, Professor of Palliative Medicine

Isle of Man rejects assisted suicide

Vulnerable people on the Isle of Man will continue to be protected after politicians rejected a motion calling for the introduction of assisted suicide.

Yesterday, members of the island’s Parliament voted unanimously to simply ‘note the debate’ rather than back further parliamentary work on the issue.

A number of members spoke out against the motion including the Chief Minister, Howard Quyale.

Ahead of the vote, a number of healthcare professionals on the island expressed overwhelming opposition.

The Isle of Man Medical Society revealed that 85 percent of working doctors would not support assisted suicide.  

The Society’s President, Dr Jonathan Wilmot, and executive committee chairman Dr May Shiu Chan said doctors feared that vulnerable people would be put under pressure to die.

“They were concerned that it would not in reality be a voluntary or free choice” the group said, adding, “vulnerable people would feel an obligation to opt for it to decrease the burden on relatives or that others may believe it was best for them and seek to influence their choice”.

The Association of Palliative Medicine of Great Britain and Ireland have also stated their official position is to oppose any plan to introduce assisted suicide.

Dr David Randall, spokesman for the Our Duty of Care campaign said changing the law could put “vulnerable people at risk of suffering real or imagine pressure from others to end their lives prematurely”.

The Isle of Man rejected a call to introduce assisted suicide by 17 votes to 5 in 2015.  

Responding to the debate, CARE’s Communications Manager, James Mildred said: “Legalising assisted suicide would be a retrograde step for the Isle of Man. Not only would it put pressure on vulnerable people, but it would also fundamentally harm the vital doctor patient relationship.”

Alistair Thompson, a spokesman for the Care Not Killing Alliance, told Manx Radio that the so-called safeguards are often circumvented, that the doctors carrying out assessments do not believe they are adequate.

He noted that “half the people choosing to end their lives fear becoming a burden on their families”.

Government rejects call for a review into assisted suicide, after strong opposition from MPs

Strong opposition from MPs has resulted in the Government rejecting calls for a review on assisted suicide despite the best efforts from large pressure groups in favour of assisted suicide.

This follows the news that an attempt to introduce assisted suicide to the Isle of Man has failed

MPs received thousands of emails from constituents ahead of the debate urging them to attend and speak in opposition to the assisted suicide lobby’s campaign.

A large turnout of MPs, including Sir Desmond Swayne, Sir John Hayes, Fiona Bruce, Dr Lisa Cameron, Andrew Selous and Martin Vickers spoke strongly against assisted suicide in the debate. 

Fiona Bruce, Chair of the All-Party Parliamentary Pro-Life Group, said disability groups are “extremely concerned” about what has happened in other countries that have introduced assisted suicide legislation. 

She noted that in the US State of Oregon the majority of those applying for assisted suicide now cite “fear of being a burden” as their major end-of-life concern. Adding that “far fewer cite pain concerns.” 

In Canada, “under the 2016 law that has allowed terminally ill people to request assisted suicide and euthanasia, safeguards have been ignored, removed and extended to non-terminally ill people such as those with depression.”

“In July a depressed but otherwise healthy man was killed by lethal injection, despite not being terminally ill. Another man who suffers from a neurological disease actually recorded hospital staff offering him a medically assisted death, despite repeated statements that he did not want to die. 

“Only this week, on Tuesday, there was an article in The Times about three Belgian doctors on trial in relation to the euthanasia of someone reported to have a personality disorder and autism. The family believes that she was depressed but that she did not, as required by Belgian law, have a serious and incurable disorder.”

In these cases, she said: “The point to note is that, regardless of the wording of eligibility criteria in legislation, in practice safeguards are often discarded, and vulnerable and depressed people are assisted to end their lives.”

“Rather than assisting vulnerable people to commit suicide, or administering euthanasia, we should be looking to improve palliative care provision and mental health treatment… Marie Curie estimates that 25% of cancer patients do not currently get the palliative care that they need.”

Rounding off her speech, she exclaimed: “The UK is a pioneer in palliative medicine and a world leader in palliative care. Let us keep it that way!”

A large number of MPs mirrored Fiona’s call for improved mental-health and palliative care, over the introduction of an extreme assisted suicide law, in a renewed effort to assist people to live. 

Dr Lisa Cameron, Chair of the All-Party Parliamentary Group for Disability, said: “Often, when people face debilitating illness or very difficult life events, suicide may come to their minds. Does she agree that at such times, we should provide better mental health support, psychological support and counselling to enable people to come to terms with their feelings and look much more positively towards their abilities and the contribution they make?” 

Expressing his concerns about a potential review into the law on assisted suicide, Jim Shannon argued: “The answer is not legalising assisted suicide. The answer is to help, to support and to be compassionate towards families. Does she acknowledge the good work that is done by many charities, particularly Macmillan, whose compassion and love make the unimaginable a little bit more bearable?”

His fellow DUP colleague, Ian Paisley, continued this point by saying: “We should be asking the positive, strong question: how much palliative care and support can we give people at the greatest point of need?”

He added: “We parliamentarians should be prepared to offer hope to people, not to say, as others have said, ‘You’re now a burden. It’s time to shuffle off this mortal coil.’” 

Baroness Finlay has introduced an Access to Palliative Care and Treatment of Children Bill to the House of Lords. This bill aims to highlight the necessity of speciality training for palliative care; to ensure that children, babies, and those with learning disabilities receive palliative care; and, the responsibility of Clinical Commissioning Groups to identify, fund support and provide services to those with palliative care needs.

Other concerns raised by MPs included the change it would bring in the relationship between a doctor and a patient. 

Martin Vickers MP said the relationship between a doctor and patient is one the UK should treasure. “Rather than opening the door to assisting us to die, patients—all of us—need to have confidence that our medical professionals are striving to keep us in good health and alive,” he added.

Extending this point, Sir Desmond Swayne MP noted the large number of assisted suicide deaths in the Netherlands and asked wether we are prepared to “fundamentally change the nature of the medical profession, when the clinician who brings healing is also the clinician who brings death?”

Another argument made by MPs was the valuation of life, and how legalising assisted suicide would fundamentally change how we value life as a society. Making this point was Sir John Hayes MP who said: “Although life, as I have described it, is momentary, each moment is precious. The life of profoundly disabled people is precious, and the life of those weak, wizened, sick and infirm people is precious.”

Highlighting how the valuation of life would change, Andrew Selous MP said: “We need to be very careful to ensure that old and sick people do not feel a pressure to end their lives, perhaps from their children, who might want to inherit their assets and to whom they may feel they are being a burden.”

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

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. 

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.

Three doctors on trial in Belgian euthanasia case draws attention to risks of assisted suicide laws

Three Belgian doctors are on trial this week accused of unlawfully poisoning a woman in the country’s first criminal case concerning euthanasia.

Tine Nys died surrounded by her family on 27 April 2010.

Her sisters, Lotte and Sophie, are adamant she was not incurably ill as Belgian law requires, but suffering from the heartache of a broken relationship.

Prosecutors argue that the 38-year-old had falsely claimed to be autistic in order to be approved for euthanasia, and had only been diagnosed with Asperger’s just two months before her death, but never received treatment for the condition.

They say the three doctors, whose names have not been made public never established her “suffering” as ‘incurable’, which is a requirement to be approved for euthanasia in Belgium.

Assisted suicide and euthanasia were first legalised in Belgium in 2002 for adults experiencing a “constant and unbearable physical or mental suffering that cannot be alleviated.”

In 2014, the law was amended to include children experiencing constant and unbearable suffering which cannot be eased, and which will cause death in the short term”.

Since then individuals have been euthanised for depression, blindness and deafness, gender-identity and anorexia.

Prosecutors will then read the indictment on Friday before the three doctors, whose names are required for the euthanasia procedure are given a chance to speak next Monday. If the three are found guilty they could be sentenced to a lifetime in prison. They include the doctor who administered the lethal injection, Tine’s former general practitioner and a psychiatrist.

Tine’s sisters revealed the botched manner and lack of compassion from the doctor who administered Tine’s lethal injection.

Speaking to Flemish TV in 2016, they said: “He likened her death to that of a pet that is in pain and is having a shot.

“He also asked our father to hold the needle in her arm because he had forgotten to bring plasters. When she had died he asked our parents if they wanted to listen through the stethoscope to check her heart had actually stopped beating.”

In Belgium, there is now a renewed push for euthanasia to be available for those who are healthy but have decided they have a “fulfilled life”

The President of Belgium’s Liberal Party, Gwendolyn Rutten, told the Brussels Times: “We must be able to choose the right to die not only when we are suffering in an intolerable way but also when our lives are fulfilled and we request to do it explicitly, freely, independently and firmly.”

In 2018 there was a total of 2,357 reported assisted suicides, up from 2,309 in the previous year. Since 2010, there has been a 247% increase in just 8 years.

The country is currently considering euthanising a physically healthy 23-year-old over a mental health problem.

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

“While this case may be unprecedented, it not only highlights the lack of compassion in countries with assisted suicide and euthanasia laws but also draws attention to the risks and dangers of legalising assisted suicide and euthanasia.

“Tine Nys was a physically healthy woman with her future ahead of her. She should have been offered care and support to alleviate her short-term suffering.

“Assisted suicide clears the way for despair and hopelessness. Where hardship and suffering is, assisted suicide is allowed to take the place of care and compassion as a response”

The UK has rejected numerous attempts to legalise assisted suicide since the turn of the millennium. The most recent assisted suicide bill, in 2015, was defeated by 330 votes to 118, a majority of 212 votes.