The Royal College of Physicians (RCP) should be congratulated for dropping its longstanding opposition to assisted dying and adopting a position of neutrality, as announced this week following a poll of members. This is the only way for it to accurately represent the range of views among its members and engage constructively in assisted dying debates, learning from the extensive evidence of safe practice in the USA, Canada and Australia.
However, we should not have to congratulate a medical body for simply catching up with the views of its membership. Polls have consistently shown that doctors are cautiously divided on this issue, with a survey last month finding a majority (55%) would support their medical organisations taking a neutral stance and a significant number (43%) would want the option of an assisted death for themselves if they became terminally ill.
Placing the unwavering support of the British public (which has consistently stood at around 80%) to one side, why do medical bodies lag behind their members on this issue?
One possible explanation is the network of well-mobilised, anti-choice organisations which have tried to silence the RCP in recent weeks. Having campaigned strenuously for decades against what we fortunately now accept as vital personal freedoms such as abortion and LGBT rights, these groups have recognised assisted dying as the next frontier of liberal reform.
Their attempts to gag the RCP from releasing the results of their survey, which were thankfully thrown out by the High Court on Thursday, are just a glimpse into the lengths they are willing to go to impose their agendas on others. This week openDemocracy revealed the worrying ties these groups have to well-funded, evangelical Christian organisations in the USA, including one branded as an ‘anti-LGBT hate group’ by the Southern Poverty Law Center.
Another explanation might be the undue influence of a small number of palliative care doctors. It is important we listen to the voices of those who care for dying people. However, when members of the Association for Palliative Medicine (APM) who are sympathetic to assisted dying feel they must write anonymously in the British Medical Journal because the culture of fear and intimidation within their profession is so strong, this must lead to a re-examination of the weight we place upon the fear-based arguments the APM makes against changing the law. There are many palliative care doctors who do wish their patients were permitted a greater degree of choice and control at the end of their lives. Also, we know it is nurses who deliver the bulk of care people receive in their final weeks and days of life and their College has been neutral on this issue since 2009.
This decision from the Royal College of Physicians follows in the footsteps of medical bodies around the world, and marks the way for the other UK medical colleges and the British Medical Association to engage with their members in a similarly open and constructive manner. When medical bodies adopt a neutral stance it allows individuals to voice their support or concern without undue pressure to conform to other colleagues’ views or being intimidated into silence.
While it is essential that healthcare professionals engage fully and properly in this debate, as we rightly move away from a culture of medical paternalism it is the voices of people with real, lived experience of terminal illness which should be paramount. Doctors and lawmakers in the US, Australia and Canada have rightly put the views of patients and the public first and concluded that providing assisted dying is perfectly compatible with a doctor’s prime purpose, which is to relieve suffering. The same will inevitably happen here in the UK, and this move from the RCP is a welcome removal of a block towards it.
Sarah Wootton is the chief executive of Dignity in Dying