BMA on end of life decisions

1. BMA on end of life decisions Medical Ethics: Euthanasia

2. British Medical Association • The BMA represents doctors throughout the UK who hold a wide range of views on the issue of assisted dying. • It is important to understand their views because doctors would be most affected by any changes to the UK laws regarding euthanasia or assisted suicide. • While the BMA fully acknowledges this broad spectrum of opinion within its membership, the consensus since 2006 has remained that the law should not be changed to permit assisted dying or doctors’ involvement in assisted dying.

3. The BMA has clear policy on the issue of euthanasia, agreed in 2006. • The BMA: • believes that the ongoing improvement in palliative care allows patients to die with dignity  • insists that physician-assisted suicide should not be made legal in the UK • insists that voluntary euthanasia should not be made legal in the UK • insists that non-voluntary euthanasia should not be made legal in the UK • insists that if euthanasia were legalised there should be a clear demarcation between those doctors who would be involved in it and those who would not.

4. BMA policy firmly opposes assisted dying for the following key reasons: • Permitting assisted dying for some could put vulnerable people at risk of harm.  • Such a change would be contrary to the ethics of clinical practice, as the principal purpose of medicine is to improve patients’ quality of life, not to foreshorten it.  • Legalising assisted dying could weaken society’s prohibition on killing and undermine the safeguards against non-voluntary euthanasia. Society could embark on a ‘slippery slope’ with undesirable consequences.  • For most patients, effective and high quality palliative care can effectively alleviate distressing symptoms associated with the dying process and allay patients’ fears.  • Only a minority of people want to end their lives. The rules for the majority should not be changed to accommodate a small group.

5. The BMA has considerable sympathy with individuals facing the effects of terminal illnesses and other incurable conditions but is concerned that giving them a legal right to end their lives with physician assistance, even where that assistance is limited to assessment, verification or prescribing, could alter the ethos within which medical care is provided.

6. Further information on the BMA view can be found at: • http://bma.org.uk/practical-support-at-work/ethics/bma-policy-assisted-dying

7. BMA guidelines on withdrawing treatment • Medical treatment can legally and ethically be withdrawn when it is unable to benefit the patient. • It should be withdrawn when it is not in the patient's best interest or if the patient has refused it. • In practice, however, this is, a profoundly difficult decision. • This was illustrated in 1993 in the case of Tony Bland. In a persistent vegetative state (PVS) with no awareness of the world and no hope of recovery, Bland was not terminally ill but withdrawal of artificial nutrition would inevitably result in his death.

8. BMA argument for withdrawing treatment • Medicine aims to restore or maintain patients' health by maximising benefit and minimising harm. • When medical treatment ceases to provide a net benefit to the patient, this primary goal of medicine cannot be realised and the justification for intervening is gone. • Unless some other justification can be demonstrated, most people would accept that treatment should not be prolonged.

9. GMC: General Medical Council • Are the independent regulator for doctors in the UK. • Their legal purpose is to protect, promote and maintain the health and safety of the public by making sure that doctors meet the standards for good medical practice.

10. GMC: General Medical Council • If clinically assisted nutrition or hydration is necessary to keep a patient alive, the duty of care will normally require the doctor to provide it, if a patient with capacity wishes to receive it.16 • Clinically assisted nutrition or hydration may be withheld or withdrawn if the patient does not wish to receive it; or if the patient is dying and the care goals change to palliative care and relief of suffering; or if the patient lacks capacity to decide and it is considered that providing clinically assisted nutrition or hydration would not be in their best interests.17 • In the case of patients in a permanent vegetative state (PVS), clinically assisted nutrition or hydration constitutes medical treatment and may be lawfully withdrawn in certain circumstances.18  However, in practice, a court declaration should be obtained.19

11. GMC: General Medical Council • New guidance for doctors, Treatment and care towards the end of life: good practice in decision making, came into effect on 1 July 2010.