The headline figures don’t tell the whole story in the BMA assisted suicide poll

While there have been what seems like an unending succession of polls of British doctors about euthanasia and assisted suicide, that run by the British Medical Association (BMA) early in 2020 can lay claim to being one of the most thorough and significant. With over 29,000 respondents across all areas of medicine and at every career stage, it is the most wide-ranging and in-depth survey of medical opinion on the topic in the UK.

The results published on Thursday are sobering, especially for those of us who oppose the idea of legalising the ending of patients’ lives. The headline figures show that 40 per cent of respondents wanted the BMA to actively support attempts to change the law to legalise assisted suicide, 33 per cent favoured opposition, and 21 per cent felt the BMA should adopt a neutral position.

On the face of it, that is quite a stark shift in opinion across the broad swathe of British medics represented by the BMA.

But dig down into the data a bit more, and the picture is more complex than supporters of so-called ‘assisted dying’ would have us believe. Firstly, the stronger support in the poll was for the legalisation of assisted suicide (where the patient would self-administer lethal drugs that are prescribed by and overseen by a doctor or a nurse). Results for euthanasia (where a clinician would directly administer the lethal drugs) showed predictable opposition.

Furthermore, 54 per cent said that they would not be willing to participate actively in the process of administering life-ending drugs, should assisted suicide be legalised. Twenty-six per cent said they would be willing, and 20 per cent were undecided So while there appears to be an appetite for allowing patients to access assistance in ending their lives, it seems there is much less enthusiasm for providing such assistance This could be problematic should the law change, as the situation in Canada grimly illustrates. The right to op-out on conscience grounds could easily be eroded by law and practice.

Dig deeper by specialty and, like previous polls, there is a marked difference in support for a change in the BMA’s stance and for legalisation between disciplines. Those working in acute medicine, whose patients often die suddenly, or are discharged to other, long-term specialties when their care becomes less acute and more complex, are most in favour. Between 48 and 53 per cent were in favour of change among professions such as trauma, obstetrics and gynaecology, and intensive care. Similarly high figures are found among those who seldom deal face-to-face with patients, such as histopathologists. But among palliative care physicians, geriatricians and oncologists, there was much stronger opposition.

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.

And when it comes to career stage, students and retirees were much more in favour of law change than those in current clinical practice.

In short, it seems that the idea, rather than the reality of assisted suicide is in favour among a significant minority of doctors. However, that support falls away among those who actually deal day-to-day with those nearing the end of their lives, and even more so when the responsibility for making the decision and supplying the lethal drugs is on the cards.

The decision on its final position will be taken by the BMA’s Annual Representative Meeting (ARM) in June 2021. Many are pushing for the BMA to shift to a neutral position at that meeting. However, the evidence from other jurisdictions is that this would not only hasten legalisation but also limit the freedom of conscience of doctors who do not wish to participate. And when that happens, we also start to see the incremental extension of assisted suicide and euthanasia to an ever-widening range of patient groups, including those with limited or no mental capacity to give consent, such as the comatose, those with dementia, children and infants.

The BMA has always resisted the call to make policy by membership survey. We hope that sober reflection on these poll results between now and next June will lead the ARM to be mindful of the implications of their decision. They should remember that the majority of medical bodies around the world remain strongly opposed to legalising assisted dying of any kind because of such examples. Just last year, the World Medical Association (WMA), at its 70th General Assembly, reiterated its firm opposition to euthanasia and physician-assisted suicide.

The impact that changing its current stance of opposition could have on the many elderly and disabled people who will feel a real or perceived pressure to ask for their lives to be shortened cannot be underestimated.