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If you disagree with the RCGP's assisted dying decision, make your voice heard

Professor Sir Sam Everington

The blanket ban on assisted dying dates all the way back to the 1961 Suicide Act, yet there is increasing pressure for a review of the status quo.

Over 80% of the public support an assisted dying law that would give terminally ill, mentally competent adults the option of an assisted death. While previous attempts to change the law have been rejected, a Westminster Hall debate earlier this year highlighted the growing appetite MPs now have for the Ministry of Justice to launch an independent inquiry into how the current law is functioning.

I approach this debate from numerous perspectives.

As an individual, aware of my own mortality, I know I’d personally find comfort in having the option to die on my own terms, should I find the final weeks of a terminal illness intolerable.

As a barrister, I recognise the legal fudge the current law presents and just how inadequate this is for dying people and their families. How cruel and irrational is it that we allow people to travel overseas for an assisted death if that is their wish, but we threaten their grieving loved ones with prosecution if they have provided any assistance? It’s notable that 18 police and crime commissioners have raised concerns about how the current law impacts dying people, their families and the police officers who have the unenviable task of investigating these compassionate acts.

But it’s from my perspective as a GP that I find the UK’s ban on assisted dying most troubling. Throughout my career, I’ve seen first hand the suffering many people are forced to endure, even when they have access to the very best care.

I’m acutely aware of the disproportionate influence my profession has had in this debate.

When MPs last considered legislation in 2015, the united opposition of the BMA, RCGP and Royal College of Physicians was cited by many as a reason why they didn’t feel able to support the Bill in front of them. If doctors are unwilling to do this, they argued, how could it work in practice?

With the RCGP reaffirming its opposition to law change this week, it may appear that little has changed in the last five years. But nothing could be further from the truth.

The decision of the College’s Council was based on a survey of the College’s membership. The results show the majority of respondents wanted the College to change its policy. This reveals a dramatic shift in views since the RCGP’s previous consultation in 2013, when 77% of GPs who responded were content for the College to oppose law change. Now, less than half agree with this position, and 51% feel the College should either support or be neutral on assisted dying.

I feel ashamed of the part we are playing in inflicting further suffering on some of our patients

The fact that the will of the RCGP membership has been so ignored is completely unacceptable. It raises serious questions about the process through which this decision was made and more about broadly the RCGP’s standing as a credible, representative body. Our professional bodies need to be strong, evidence-based and trustworthy. The RCGP maintaining opposition without a mandate to do so embodies the very worst characteristics of ‘doctor knows best’ paternalism.

I asked the College for an explanation for ignoring 51% of its members surveyed. They have responded by saying ‘an exceptionally rigorous process was followed’. When asked for a copy of the full results, including responses to the additional questions and the weighted data, they told me they have agreed not to share it with members, but couldn’t provide a justification for this. I hasten to add that members paid for this survey with our membership fees. It’s illogical and unscientific not to release the full results; the antithesis of the values a College such as ours should stand for.

It seems to me the decision to remain opposed to assisted dying despite such a dramatic shift in opinion was not based on the wishes of the majority of members (or the vast majority of patients) but on expediency and politics. Surely otherwise the College would robustly defend their decision in the media and to their members, and would have no concerns about sharing the data, as is normal practice in good, transparent science. But the RCGP has remained mysteriously silent since the decision was announced, other than disseminating a written press statement.

I must admit that this reminds me of the establishment’s response when my colleague Professor Aneez Esmail and I exposed race discrimination throughout the medical profession some years ago – a purposeful political silence.

It’s also tragic that the doctors’ organisation that represents those who practice family medicine are not in the vanguard for this crucial family issue. Other Colleges are showing not just leadership, but are much closer to the public will.

Last year, the Royal College of Physicians dropped its opposition to law change based on a survey of its members, one that revealed a similar split in views to the RCGP survey. The RCP joined most other Royal Colleges, including those representing anaesthetists, nurses, oncologists, pathologists and psychiatrists, who don’t campaign for or against a change in the law. In a welcome development, the BMA is surveying its members on assisted dying for the first time in its 187-year history, with the results informing a debate on its longstanding policy of opposition in the summer. We await the results of that survey, which is open until 27th February.

A balanced, neutral position is the reasonable compromise that medical bodies can arrive at. Neutrality shows leadership, allows for constructive engagement and respects conflicting views. Neutrality also sends a much needed message of solidarity to our patients; I hate to think how the RCGP’s endorsement of the current law will be perceived by those who are currently bearing the brunt of its failures.

With public demand unwavering and the mood in Parliament shifting, the RCGP appears to have set up camp on the wrong side of history. Yet while this is a debate for wider society, the expertise of doctors will be needed in order to craft safeguarded, workable legislation in the coming years.

Of course the UK has much to learn from the increasing number of jurisdictions around the world that have already legislated to give people choice at the end of life, including nine US States, two Australian states and, pending a referendum later this year, New Zealand. But as a GP, I want my professional body to pride itself on its ability to speak out in the best interests of its patients. This week’s backwards - some would say cowardly - decision will instead leave the RCGP out in the cold.

I recognise that I’m privileged to be able to view this debate from different personal and professional perspectives. As an individual in society, I implore Parliament to make progress. As a barrister, I know the law we have is untenable. As a GP, I cannot help but feel ashamed of the part we are playing in inflicting further suffering on some of our patients.

Professor Sir Sam Everington OBE is chair of London’s 32 CCGs, a GP in Tower Hamlets, and a barrister. He is writing in a personal capacity.

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Readers' comments (18)

  • Clarification: I sent this article to Pulse as a personal opinion with just my name attached. This article represents my personal opinion and not the opinion of my CCG or any other body I sit on or represent. Best wishes, Sam Everington.

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  • Excellent article.
    Shame on the RCGP for ignoring the views of its members.
    It seems the views of some of our 'leaders' are stuck in the dark ages and they clearly feel it is acceptable to adopt a paternalistic stance on this issue.
    So we are left with a situation whereby those with severe irreversible illness fortunate enough to be able to afford transport costs to Switzerland can choose the time and manner of their own death and the less well off, with similar illness, are left to die 'naturally'

    A deeply shameful state of affairs.

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  • Thank you Sam for your excellent article.
    I have to admit to having profound cognitive dissonance with this issue (and indeed I think many fellow GPs do as well), in that I would wish to have this service available but I don’t wish to personally participate in providing it (not least for the present treacherous medico-legal environment). Maybe the younger members of the profession will feel more comfortable with it? (if they haven’t all RLE)

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  • Excellent article Sam - you've convinced me. Just slightly worried though, does drinking a large glass of barbiturates cause much suffering prior to death in an assisted suicide? I suppose no one can really tell us

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  • I think being concerned about being found on the wrong side of history is rarely a good perspective from which to make such sweeping changes to society. My concern is that history will let us that changing the law will open the floodgates to elder abuse via coercion to end their lives. After all with the inheritance system in our country, coupled with a huge increases in housing and cost of living, and the present social care costs, and poor care in hospitals - it’s a perfect storm. Personally I’d rather be on the side of history that doesn’t facilitate the coercion of the elderly to end their lives for financial gain. Safeguards in the present climate would undoubtedly fail.

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  • RCGP Council exhibit la-la ears and make the rules up to fit the desired outcome. Shame on them.
    The only thing that would make them reconsider would be the mass resignation of 51% members. Money talks - especially lack of it.

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  • Sam
    I work in a poorer area than you
    The RCGP are at best irrelevant, at worst malevolent.

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  • its seems to be working OK in Victoria, Australia.....

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  • Good article Sam. But I feel the real problem here is the lack of funding for high quality terminal care services.
    The people we have providing this at the moment are great. We need more of them.
    I feel uneasy where a change in the law may eventually lead, epecially with the psychos currently gaining power in today's world.
    Logan's run?

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  • I am sure our current Home Secretary would be a safe pair of hands....

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