BMJ backs assisted suicide

One of the world’s leading medical journals has endorsed the legalisation of assisted suicide. An editorial of the BMJ (formerly the British Medical Journal), says, “Lord Falconer’s Assisted Dying Bill is expected to receive its second reading in the House of Lords this month. The BMJ hopes that this bill will eventually become law… Let us hope that our timid lawmakers will rise to the challenge.”

The authors, Fiona Godlee, the editor-in-chief, Tony Delamothe, the UK editor; and Rosamund Snow, the patient editor, have given fresh comfort to the supporters of an assisted suicide bill which has failed several times before in the British Parliament.

Apart from reassuring readers that there are few dangers in legalisation, they base their argument four-square on the widely-accepted principle of autonomy.

“People should be able to exercise choice over their lives, which should include how and when they die, when death is imminent. In recent decades, respect for autonomy has emerged as the cardinal principle in medical ethics and underpins developments in informed consent, patient confidentiality, and advance directives. Recognition of an individual’s right to determine his or her best interests lies at the heart of efforts to advance patient partnership. It would be perverse to suspend our advocacy at the moment a person’s days were numbered.”

A strong influence in framing their argument is the experience of Oregon, where assisted suicide is legal – and unproblematic, in their view. Extrapolating Oregon’s figures to England and Wales, the BMJ editors contend that legalisation would hardly affect the working lives of British doctors:

“… each year about one patient per general practice of 9300 patients would discuss the issue of assisted dying; each general practice would issue one prescription for life ending medication every five or six years, and every eight to nine years one patient per general practice would take life ending medication.”

The editorial was immediately disavowed by the publisher of the BMJ, the British Medical Association. Dr Mark Porter, chairman of the BMA council, said: “There are strongly held views within the medical profession on both sides of this complex and emotive issue. ‘The BMA remains firmly opposed to legalising assisted dying. This issue has been regularly debated at the BMA’s policy forming annual conference and recent calls for a change in the law have persistently been rejected.”

As one would expect, there were a number of responses to the editorial. A palliative care physician questioned whether it would be right to frustrate the autonomy of patients who were not terminally ill who wanted to commit suicide. A psychiatrist wrote that legalisation would corrupt the profession and hurt public trust. “Instead of killing patients, why not try talking to them?”

Kevin Yuill, a history professor and the author of Assisted Suicide: The Liberal, Humanist Case Against Legalization, argued that assisted suicide is a moral issue which does not depend on opinion polls. “The UK abolished the death penalty in 1998 (rightly, in my mind) because we recognised that it is wrong, even for the best possible reasons, for the state to take a life. Make no mistake: the Falconer Bill will reinstate the death penalty for those who do not think their lives are worth living.”

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