With the RCP preparing to poll its members about its stance on assisted dying, Dr Amy Proffitt, executive secretary of the Association for Palliative Medicine (APM), argues the case for opposing medical involvement.
The RCP's questions go to the heart of medicine. Should the law change to permit doctors to assist in the suicide of their patients? If so, this is a fundamental and irreversible shift in medicine’s philosophy and practice. The core issue in this survey is not whether assisting suicide is ever right or wrong, but whether this is a medical duty.
The profession’s view is central to this political debate because it is about a doctor’s involvement. It is not possible to be neutral about an activity that a clinician is involved in administering. Neutrality implies that we have nothing to say one way or the other as to where our professional duties lie in the care of society’s potentially most vulnerable people.
Your vote and the RCP’s position have social and political consequences. In other legislatures where medical organisations became neutral, doctors are the ones implementing assisted suicide and carry full responsibility, including when things go wrong.
In law, ‘assisted dying’ is assisted suicide. It is not about use of high doses of analgesia and similar medication to relieve distress. It concerns doctors having legal responsibility for assessing eligibility, declining or approving a request and providing drugs to patients with the deliberate intent to cause their deaths. This is usually a massive dose of barbiturates (ie 9-10 grams) with or without other drugs.
[...] would I myself be willing to supply or administer a massive dose of sedative +/- a muscle relaxant to patients with the deliberate intent of bringing about their death?
There is a core question. Walk a mile in the shoes of a physician whose patient requests assisted suicide or death and ask yourself:
‘If the law were changed, would I myself be willing to supply or administer (Canada’s law includes this) a massive dose of sedative +/- a muscle relaxant to patients with the deliberate intent of bringing about their death?’
As colleagues and physicians, I would ask you to consider the following before you respond:
If legislation involving doctors is given a ‘green light’ those responsible for and concerned about some of the most vulnerable and sick in society will carry the responsibility for a fundamental change in clinical practice. Neutrality will be misread as support for a change in the law. If the College is to have a default position, it should be the existing - and safe one - opposing medical involvement in assisting peoples’ suicides.
Dr Amy Proffitt is executive secretary of the Association for Palliative Medicine (APM), and a consultant in Palliative Medicine at Barts health. The APM is developing developing a web resource in which you can find further reading and links to both sides of the argument.