BMA shapes debate on assisted dying
‘Constructive engagement’ as bill examined in detail
As a Westminster committee scrutinises the detail of the assisted dying bill, the BMA continues to shape the debate, cementing its position as a thought-leader on the issue.
It remains neutral on the question of whether or not assisted dying should be legalised.
However, the association remains committed to engaging with the debate, says BMA medical ethics committee chair Andrew Green, to protect the rights of all doctors and patients, whatever their stance on the issue.
Dr Green was one of the first medical experts to provide evidence last week to MPs considering Labour MP for Spen Valley Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill.
Next week, as the Public Bill Committee on the Terminally Ill Adults (End of Life) Bill moves into line-by-line scrutiny of the bill, the BMA will provide briefings to MPs on clauses being considered and amendments tabled that relate to issues the association has identified.
Dr Green has been encouraged by the BMA’s continued ‘constructive engagement’ in the debate and the invitation to participate in last week’s hearings.
‘We’ve done so much work on assisted dying over years and have reached a very settled position, so I think we’re seen as a key player providing helpful input,’ he says. ‘I was very thankful we were heard early in the debate last week, alongside the chief medical officer and the GMC.
‘It’s also been good to see Ms Leadbeater speaking openly about reflecting our recommendations in the wording of her bill, and to see others giving evidence citing our positions and amplifying them.’
‘Opt-in’ clause
Several BMA positions are already in the bill in its current form. These include:
- The ‘opt-in’ model: only doctors who choose to participate are able to do so
- The right of a doctor to refuse to carry out activities directly related to assisted dying for any reason, not just conscientious objection
- Statutory protection from discrimination for doctors, whether they decide to participate in assisted dying or not.
The BMA will continue to push for greater clarity in some clauses. It will lobby for some other, new provisions to be added, such as ‘safe-access zones’ to protect ‘staff and patients from harassment and/or abuse’.
Many of these issues arose in questions asked of Dr Green at the committee last week.
Avoiding a gag clause, which would prevent doctors from initiating discussions about assisted dying, was one of the issues the BMA successfully convinced Kim Leadbeater of before her bill was published. The BMA also insists doctors should be under no obligation to raise the subject.
At the committee hearing on 28 January, Dr Green reiterated: ‘Assisted dying must not become just another tick-box thing doctors mention to patients. That must not happen.’
Yet he stressed the importance of protecting a ‘safe space’ for ‘difficult discussions’ between patient and doctor. ‘Please do not pass legislation that makes it harder for doctors to understand their patients,’ he said. Ms Leadbeater has underlined the importance of the BMA's advice on this matter and reflected its position in amendments she tabled this week.
There was also more scrutiny of the principle that doctors should ‘opt in’ to involvement in assisted dying – a BMA position, which it believes should be made more explicit in the bill. Dr Green stressed that the right to refuse to participate, which the BMA pushed for, should apply to every aspect of assisted dying, including providing assessments of capacity or prognoses of life expectancy to determine a patient’s eligibility.
Referral concerns
Dr Green also expressed concern with the bill’s wording, which would require non-participating doctors to ‘refer’ patients to another doctor who was willing to participate.
He proposed there be an ‘official information service’ where terminally ill patients could be ‘signposted’ to explore the full range of options available, including palliative care.
‘The bill is currently quite light on detail on where eligible [or potentially eligible] people might get this information,’ says BMA senior public affairs adviser Holly Weldin.
The bill makes no provision for how assisted-dying services might be delivered. The BMA believes they should be separate services. ‘It should not be any part of any doctor’s normal job to provide assisted dying,’ Dr Green told MPs.
The BMA has not taken a view on whether this service should be part of the NHS or not – but wants the bill to state more explicitly that opt-in doctors would need to be specially trained.
Dr Green answered questions on a wide range of other issues too, from capacity and coercion to legal oversight and funding, and the implications for doctors of legislation in different jurisdictions in the UK progressing at different speeds.
The BMA has also contributed to debates in Scotland, including on Scottish Liberal Democrats MSP for Orkney Islands Liam McArthur’s assisted-dying bill, and in crown dependencies such as Jersey and the Isle of Man where the legislative process is at a later stage. The Manx Parliament, for example, has shifted from an ‘opt-out’ to an ‘opt-in’ system, following BMA intervention.
‘This issue is something that strikes at the very heart of the way we perceive ourselves, not only professionally as doctors but also as people. So it's completely understandable that people have feelings that are intense. All of our key asks – such as having an ‘opt-in’ model and the need for specialised training and support for those who choose to provide the service – are specifically designed to protect the interests of all doctors whatever their personal views and intentions. And at the very heart of it all is a concern for our patients,' said Dr Green.
The BMA's established views have been approved by all four BMA councils, representing its membership across the whole of the UK.
The Westminster bill’s committee stage is likely to continue into Spring, given the earliest possible date it can report back to the Commons is 25 April.
- For more information on the BMA’s work on assisted dying, visit bma.org.uk/pad
