Tim Dieppe comments on the controversial process the RCP used to change their stance on assisted suicide.
The Royal College of Physicians (RCP) announced last month that it would drop its formal stance of opposition to assisted suicide and adopt a neutral stance on the subject. The process by which the stance was changed, however, was highly controversial. The chairman of the RCP’s ethics committee and two other members of the committee have now resigned in protest over the decision. This puts further pressure on the RCP to review its change of stance on assisted dying.
Change of stance announced ahead of poll
The RCP announced in January its intention to move to a neutral stance on assisted suicide ahead of polling its members on the subject. It stated that its policy stance would change to neutral unless 60% – initially two thirds – of respondents to its survey were against legalising assisted suicide. The decision, made prior to polling members, requiring a supermajority to reverse a change of stance is highly controversial. One could argue by the same logic that a supermajority ought to have been required simply to change the stance from formal opposition to assisted suicide.
The previous poll of RCP members five years ago found that a majority did not support a change in the law. Some 58.4% said they would not be prepared to ‘participate actively’ in assisted dying were it legalised.
The latest poll results came out in March. Members were given three options on what the RCP’s position should be on assisted dying. 43.4% were opposed, 31.6% were in favour, and 25% were neutral. The largest portion of physicians therefore thought that the RCP’s stance should remain opposed to assisted dying.
What is most interesting is the breakdown of the responses by speciality. Of those involved in Palliative Medicine, 80.9% were opposed to assisted dying. These are the physicians closest to those at the end of life, and the physicians who would be most affected by a change in the law.
Members were also asked whether they support a change in the law to permit assisted dying. 49.1% said ‘no’, 40.5% ‘yes’, and 10.4% were undecided. Again, of the Palliative Medicine physicians, 84.3% were opposed to a change in the law.
The final question was whether if the law was changed members would be prepared to participate actively in assisted dying. Here 55.1% said ‘no’, 24.6% said ‘yes’, and 20.3% said ‘Don’t know’. 84.4% of Palliative Medicine respondents said they would not participate actively in assisted dying were it to be legalised.
The poll results show continued strong opposition to legalising assisted dying amongst members of the RCP, with opposition strongest amongst those in Palliative Medicine. In spite of this, the formal stance of the RCP has changed to a neutral stance on whether the law should be changed.
The Telegraph reported that Professor Weale has resigned as chair of the RCP ethics council over its change of stance on assisted dying. He said that the way that the survey had been set up presented “considerable problems of procedural unfairness.” He also explained that the ethics committee advice was that the RCP should remain opposed to a change in the law on euthanasia. “There is simply no point in the committee offering reasoned positions if they are ignored by the council,” he wrote. “There seems to be no chain of coherent reasoning leading to the council’s own position,” he said.
A group of doctors has mounted a legal challenge to the RCP over the way the decision was made to change their stance on this issue. A crowdfunding campaign has raised over £23,000 towards the legal costs. They argue that requiring a supermajority to reverse a proposed change in stance is without precedent in matters of this kind. The resignation of the chair and two other members of the ethics committee will considerably strengthen their case.
Most medical bodies opposed
The vast majority of medical bodies are opposed to assisted suicide because of the way in which legalisation of assisted suicide would fundamentally change the doctor/patient relationship. This opposition is reflected most strongly in the views of palliative care physicians expressed in the RCP poll. If bodies like the RCP drop their opposition to assisted dying, this would add to the political pressure to change the law on euthanasia.
We hope that the resignations and legal challenge cause the RCP to think again about the way in which they have changed their position on this vital issue.