Physician assisted dying

BMA position on physician-assisted dying

We represent doctors and medical students who, like the wider public, hold a wide range of views on physician-assisted dying.

On 14 September 2021, our policy-making body (the representative body) voted in favour of a motion changing the BMA’s policy from opposition to a change in the law on assisted dying, to a position of neutrality.

This means we neither support nor oppose attempts to change the law. We will not be silent on this issue, however. We have a responsibility to represent our members’ interests and concerns in any future legislative proposals.

The debate at our annual meeting – at which we established a position of neutrality – was informed by the results of a survey of our members in 2020. This survey was not a policy-making exercise but was one of a number of factors that representatives took into account when making their decision about our policy position.

Read more about how BMA policy is formed.

Protecting and representing BMA members

The BMA’s Medical Ethics Committee has undertaken a significant piece of work to determine how we can best protect and represent our members in response to legislative proposals to permit assisted dying. We have done this by identifying those issues that would significantly impact on doctors, if the law were to change, and considering what position the BMA should take on them.

In reaching a position on these issues, the BMA has sought to consider and balance four sets of interests:

BMA members who would be willing to provide assisted dying if it were legalised;
BMA members who, for whatever reasons, would not be willing to participate in assisted dying;
patients who may wish to access a lawful assisted dying service; and
patients who may feel anxious about the provision of such a service.

The views arising from this work have been approved by the four BMA Councils across the UK; they are listed here, with further detail on each point provided below. Read a short summary of the BMA’s views.

General

an ‘opt-in’ model for doctors to provide assisted dying
a right to decline to carry out activities directly related to assisted dying, for any reason

Protection from discrimination and abuse

statutory protection from discrimination
provision for safe access zones

Delivering an assisted dying service

assisted dying to be arranged through a separate service
no duty to raise the issue of assisted dying with patients
an official body to provide information for patients
adequate funding and equitable access

Oversight and monitoring

open and transparent regulation
the collection and publication of data
a review of all assisted deaths.

BMA views

General approach

If assisted dying were to be legalised in any part of the United Kingdom or the Crown Dependencies (Jersey, Guernsey and Isle of Man), the BMA would want to see legislation that gives doctors genuine choice about whether, and if so to what extent, they are willing to participate. In particular, the BMA would want to see:

An ‘opt in’ model for doctors to provide assisted dying

The BMA believes that any legislation to permit physician-assisted dying should be based on an ‘opt-in’ model, so that only those doctors who positively choose to participate are able to do so. Doctors who opt in to provide the service should also be able to choose which parts of the service they are willing to provide (eg assessing eligibility and/or prescribing and/or administering drugs to eligible patients).

A right to decline to carry out activities directly related to assisted dying for any reason

Any legislation on assisted dying should not include a standard conscientious objection clause as found in legislation on abortion and assisted reproduction. The BMA believes that, if assisted dying were legalised, doctors should be able to decline to carry out any activities that are directly related to assisted dying (such as assessing capacity, or determining life-expectancy, specifically to assess eligibility for assisted dying) for any reason. Therefore, there should be a general right to object which does not need to be based on matters of conscience.

Protection from discrimination and abuse

Through the work we have undertaken with our members, it is clear that some doctors are concerned about how their decision to participate, or not to participate, if physician-assisted dying were legalised, might impact on them both personally and professionally. For that reason, in the event of legislation, the BMA would want to see:

Statutory protection from discrimination

If assisted dying were to be legalised, the BMA would want to see specific provisions in the legislation making it unlawful to discriminate against, or cause detriment to, any doctor on the basis of their decision to either participate, or not participate, in assisted dying.

Provision for safe access zones

The BMA believes that any Bill to legalise assisted dying should include provision for safe access zones that could be invoked should the need arise, to protect staff and patients from harassment and/or abuse.

Delivering an assisted dying service

The way in which any future assisted dying service would be delivered in practice would have a very significant impact on doctors. For that reason, if the law were to change, the BMA would want to see:

Assisted dying to be arranged through a separate service

The BMA does not believe that assisted dying should be integrated into existing care pathways (whereby a patient’s GP, oncologist or palliative care doctor would, at the patient’s request, provide assisted dying as part of the standard care and treatment they provide). In the BMA’s view, assisted dying should be arranged, but not necessarily delivered, through a separate service that would accept referrals from other professionals and/or self-referrals. (This does not necessarily mean separate from the NHS.) Doctors who wanted to do so could still assist their own patients, but this would be arranged, and potentially managed, through a different pathway. The model proposed in Jersey, whereby the Jersey Assisted Dying Service would ‘coordinate and deploy the professionals’ who would provide the service, provides an example of how this could work. In our view, this would be better for doctors and for patients and would help to ensure consistency, and facilitate oversight, research and audit of the service.

No duty to raise the issue of assisted dying with patients

The BMA’s view is that assisted dying is not a ‘treatment option’ in the conventional sense and so the Supreme Court judgments of Montgomery (concerning the scope of information that must be provided when seeking consent to treatment) and McCulloch (which covers doctors’ duties to raise treatment options with patients) are not relevant to assisted dying. For the avoidance of any doubt, however, the BMA would want to see specific provision in any legislation to make clear that there is no duty on doctors to raise assisted dying with patients if it were legalised. Doctors should be trusted to use their professional judgement to decide when and if a discussion about assisted dying would be appropriate, taking their cue from the patient as they do on all other issues.

An official body to provide information for patients

We would support the establishment of an official body (with legal accountability) to provide factual information to patients about the range of options available to them, so that they can make informed decisions. This would ensure that doctors who did not wish, or did not feel confident, to provide information to patients about assisted dying had somewhere they could direct patients to, in the knowledge that they would receive accurate and objective information. It would also ensure that patients who may meet the eligibility criteria would be able to access the information they need without the requirement to go through their doctor and would have support to navigate the process.

Adequate funding and equitable access

If Parliaments across the UK and Crown Dependencies decided to change the law on assisted dying, the relevant Governments must ensure that additional funds are made available to ensure that the service is properly resourced, and that funding and workforce are not diverted from other, already overstretched, healthcare services. They should also ensure that if assisted dying were legalised it is available to all those who meet the eligibility criteria on an equitable basis.

Oversight and regulation

If the law changed to permit assisted dying, it would be essential that it was properly regulated with systems in place to ensure appropriate standard-setting, quality assurance and to maintain confidence in the service. For that reason, the BMA would want to see:

Open and transparent regulation

The BMA does not have a view on what form it should take but, if the law changed, we would strongly support the establishment of an independent and transparent system of oversight, monitoring and regulation.

The collection and publication of data

To ensure openness and transparency, there should be a requirement for data about all assisted deaths to be collected centrally, and for aggregated data to be published on a regular basis.

A detailed review of all assisted deaths

The BMA would support the introduction of a system for routinely reviewing all assisted deaths to ensure that the correct process was followed and to identify learning points to improve the management of cases. Review committees are common in countries that have legalised assisted dying.

Engagement

Providing briefing material and commentary on legislative proposals does not mean the BMA is giving support for a change in the law – the BMA is neutral on whether or not the law should change. We are, however, seeking to ensure that our members are protected and represented in the event of any future change in the law to permit physician-assisted dying. The BMA will therefore review and engage with any specific legislative proposals across the UK and Crown Dependencies and speak up, as and when necessary, to protect and represent our members.

Isle of Man

The Isle of Man Parliament (Tynwald) is currently debating the Assisted Dying Bill 2023 introduced by Dr Alex Allinson MHK. The information above was shared through a letter to Dr Allinson in response to his request for BMA views and through evidence to the House of Keys Committee which was subsequently set up to consider the Bill.

In addition to the points listed above, we briefed against a provision in the Assisted Dying Bill that would prohibit doctors from initiating discussions with patients about assisted dying. We believe this could impact disproportionately on some minority groups who have unequal access to information and would introduce uncertainty and legal risks for doctors. In our view, with appropriate training and guidance, doctors should be able to talk to patients about all reasonable and legally available options. Furthermore, it would set a dangerous precedent to legislate for what doctors can and cannot say to patients. Our view is that doctors should neither be required to discuss assisted dying with their patients, nor prohibited from doing so.

The House of Keys' Committee report was published on 28 March 2024, with a series of conclusions on the clauses of the Assisted Dying Bill. These included support for an ‘opt-in’ system for doctors and that the provision prohibiting doctors from initiating discussions with patients about assisted dying should be removed. The report was formally received by the House of Keys on 23 April.

Amendments have been made to the Bill by the House of Keys including:

moving to an ‘opt-in’ system for doctors;
extending the ‘conscientious objection clause’;
removing the prohibition on doctors initiating discussions on assisted dying with patients;
confirming that doctors would not be under any duty to raise assisted dying with patients; and
adding new statutory protection against discrimination for doctors.

The Bill passed its Third Reading in the House of Keys in July 2024 and moved to the Legislative Council for consideration. Read more information about the latest developments in the Isle of Man.

Jersey

In November 2021, Jersey's States Assembly decided 'in principle' that assisted dying should be permitted and to make arrangements for the provision of an assisted dying service. Following public engagement and consultation, a ministerial committee was set up to refine the policy proposals. The information above was shared with the ministerial committee through a letter to the Minister for Health and Social Services.

The ministerial committee published its report on 22 March 2024 setting out its detailed policy proposals. This included extending the right to refuse on grounds of conscience to refusal on any ground. It also said that consideration would be given to the introduction of statutory protection from discrimination and the provision of safe access zones. These proposals were accepted by the States Assembly and the Bill itself is now being drafted. The Jersey proposals already included an ‘opt-in’ system for doctors, a separate assisted dying service and an information and support service for patients. Read information about the policy proposals and the latest developments in Jersey.

England

The House of Commons

Health and Social Care Select Committee

The House of Commons’ Health and Social Care Select Committee from the previous parliamentary session published its report on assisted dying on 29 February 2024. We provided written evidence to the Committee, ahead of its oral evidence sessions with a range of stakeholders. Policy insight from ourselves and others shaped the Committee’s ultimate recommendations to the Government – view these in full.

It is worth noting that one of the Committee’s recommendations was that the BMA and GMC should revise their guidance for doctors to enable them to assist their patients by writing medical reports to facilitate assisted dying abroad. We sent a letter to Mr Steve Brine MP, former Chair of the Committee, explaining that whilst doctors can and must provide copies of patients’ medical records on request – in line with their obligations under the GDPR – writing a report specifically to assist patients who are seeking assisted dying overseas could, in our view, breach the law. Therefore, we advised the Committee that we would not be in a position to revise our guidance in the way that the Committee had recommended, as this would potentially leave our members open to criminal and professional sanctions.

The Government’s response to the report was published on 29 April and can be found here.

Westminster Hall debate

The BMA’s views (as set out above) were shared with MPs in advance of a Westminster Hall debate on assisted dying, which took place on 29 April 2024.

Private Member’s Bill

On 3 October, Kim Leadbeater MP announced that – having come first in the private members’ ballot – she would be introducing a Bill to legalise assisted dying. The BMA had constructive meetings with Kim Leadbeater MP to discuss the BMA’s views in advance of the publication of her Bill. (This engagement does not indicate support for the Bill or otherwise, rather it ensures the voice of doctors is represented.)

The Terminally Ill Adults (End of Life) Bill (published on 12 November) includes many of the provisions listed above, including:

an opt-in model for doctors to provide assisted dying (doctors would choose whether to have the training required to provide assisted dying);
a general right to decline to participate in assisted dying for any reason;
protection from detriment on the basis of a doctor’s decision to, or not to, participate;
no duty to raise, or prohibition on raising, assisted dying with patients.

The Bill is due to have its Second Reading on 29 November.

The House of Lords

On 26 July 2024, Lord Falconer introduced his Assisted Dying for Terminally Ill Adults Bill – however, on 10th October, he announced that he would not proceed with his Bill in light of the introduction of a private member’s bill on assisted dying in the House of Commons (see above). The BMA met with Lord Falconer prior to his decision to step down his Bill, at which we discussed the BMA’s policy and the scope of his Bill.

Scotland

Liam McArthur MSP published his Assisted Dying for Terminally Ill Adults (Scotland) Bill on 27 March 2024. BMA Scotland has sent a letter to Mr McArthur setting out the BMA’s position in relation to his Bill and met with him to discuss this. The Bill has been allocated to the Scottish Parliament’s Health, Social Care and Sport Committee for consideration and the BMA has provided written evidence.

What physician-assisted dying is

Physician-assisted dying refers to doctors’ involvement in measures intentionally designed to end a patient’s life, covering the situations below.

Where doctors would prescribe lethal drugs at the voluntary request of an adult patient with capacity, who meets defined eligibility criteria, to enable that patient to self-administer the drugs to end their own life. This is sometimes referred to as physician-assisted dying or physician-assisted suicide.
Where doctors would administer lethal drugs at the voluntary request of an adult patient with capacity, who meets defined eligibility criteria, with the intention of ending that patient’s life. This is often referred to as voluntary euthanasia.

Eligibility

Eligibility for physician-assisted dying would be set out in any piece of legislation.

In our 2020 member survey, however, we assumed the criteria would fall within the following boundaries, to cover patients who:

are adults
have the mental capacity to make the decision
have made a voluntary request and
have either a terminal illness or serious physical illness causing intolerable suffering that cannot be relieved.