The Royal College's sham 'consultation' could threaten the very ethos of our profession
Assisted suicide is back in the news: Britain’s Royal College of Physicians has decided to survey its membership on the question. But this time there’s a catch.
The last time the RCP consulted its members, in 2014, the majority of doctors said that they opposed an “assisted dying” law (as it is euphemistically called). But this time, the RCP has decided to declare itself “neutral” on the question – unless a supermajority of 60 per cent is opposed. (Tellingly, the threshold was originally two-thirds but was hurriedly reduced.)
The decision, which has been engineered by campaign groups supportive of assisted suicide, has prompted alarm amongst doctors and parliamentarians. Earlier this month, a letter appeared in The Times from doctors and academics, signalling their alarm at the way in which the consultation has been handled.
Baroness Grey-Thompson, the campaigner and former Paralympian, wrote in the Times last month: “That a venerable institution like the RCP should have allowed itself to be pushed into fixing the rules – there is no other word for it – for a consultation on a subject that lies at the heart of medicine is deeply worrying.”
Physician-assisted suicide is, of course, a divisive and emotive issue. Onlookers may be inclined to think that a position of neutrality is a good compromise. But it could have serious consequences.
When parliamentarians debate whether assisted suicide should be legalised, they look to the views of doctors for their views. So far the relevant medical colleges in this debate (including the RCP, the Royal College of General Practitioners and the British Medical Association) have declared their opposition to assisted suicide. The Royal College of Physicians (Edinburgh) and the Royal College of Physicians & Surgeons (Glasgow) also remain clearly opposed. This stance sends a clear message to our lawmakers that the majority of doctors do not think assisted suicide has any place in medicine.
Should the RCP adopt an official stance of neutrality, it is likely to be seen – and the campaigners know this – as doctors shrugging their shoulders at a major change to the criminal law; a change in which they would be expected to play a key role.
After all, how can doctors be “neutral” on whether assisting patients’ suicides should be part of clinical care? It is a fundamental question concerning what a doctor’s duty of care means. Doctors play a key role in suicide prevention. Should they now be asked to prevent some suicides and facilitate others?
Under current law, our NHS and entire health and social care infrastructure is designed to assist people to live. Its ethos rests on the principle that doctors value the lives of their patients. We are meant to use all their expertise and knowledge to ensure each person’s dignity is respected and their quality of life improved. There are suicide prevention strategies in place to send the message that taking one’s life is not something to be encouraged or assisted.
Doctors cannot afford to be neutral on this. If physician-assisted suicide were ever to be permitted under UK law, we would be expected to judge who does – or does not – qualify (a task which goes way beyond our knowledge as doctors) and to prescribe the lethal drugs which would end patients’ lives.
Given that most of us don’t want any part in this, vulnerable patients would be forced to “shop around” for compliant doctors, who may know very little about them beyond their case notes. We all know the demands which are placed on our time. Will doctors really be able to spot signs of subtle coercion from family members, especially given the limited consultation time available?
We can only hope that the RCP will review this sham consultation and think again. In the meantime, if you are a doctor and eligible to vote, please make it clear that doctors should not be in the business of assisting sick and vulnerable individuals with suicide.
Kevin O’Kane FRCP is Consultant in Acute Internal Medicine at St Thomas’s Hospital and Senior Lecturer in Medicine at King’s College London