By Trevor Stammers, Director of the Centre for Bioethics and Emerging Technologies
This week the American Medical Association (AMA) discussed its own Council on Ethical and Judicial Affairs’ (CEJA) report on physician-assisted suicide (PAS).
The Council had been commissioned to "study the issue of aid-in-dying with consideration of data collected from the states that currently authorize aid-in-dying, and input from some of the physicians who have provided medical aid-in-dying to qualified patients." A highly sensible way to proceed since there is absolutely no substitute for exploring what effects legalising doctors to enable or assist patients to end their lives has had in states which have allowed it, to see what further effects AMA endorsement of the procedure might have for the whole nation. A few States have been carrying out assisted suicide, for many years in some cases, especially Oregon which was the first to take this path in October 1997.
By contrast, earlier this year, the UK’s Royal College of Physicians (RCP), without any apparent consultation with its own ethics committee, suddenly announced it would poll its members on the issue and require a majority of 60% of its voting members to vote assisted suicide in a 3-way poll if it were to retain its then long-standing opposition to legalising the procedure. This was arguably tantamount to a small number of RCP members in power determining RCP policy in effect, since there is no way such a majority could be attained in a 3-way vote. Sure as night follows day, in the eventual poll of 6885 (20% of) RCP members, 43% voted in favour of the College remaining opposed to PAS, 32% thought it should support changing the law to legalise it, with only 25% of members supporting a neutral position. So the College following the rules they set up for the poll, has now changed its official position to that voted for by the lowest number of voting members. It’s perhaps not surprising that there have been adverse repercussions for the College. Several prominent members of the RCP resigned including the Chair of its own ethics committee and now the Charity Commission is investigating the RCP about its own concerns over the conduct of the poll.
This decision of the RCP could have profound implications on the public if it helps to swing any future vote in Parliament in favour of PAS; the last vote on the Marris Bill in 2015 saw PAS rejected by MPs with a large majority of 330 to 118. However because the RCP is not itself a public body, a case brought by RCP members to challenge the legitimacy of the poll in court was not allowed to proceed.
This sorry state of affairs for the RCP contrasts markedly with that of the AMA in the US where the CEJA pursued over several years a course of detailed investigation of PAS and its consequences, hearing testimony and wrestling with the clinical and ethical research along with protracted discussion and deliberation. The outcome in the US was a vote this week of 392- 192 of the AMA’s House of Delegates in favour of retaining the AMA’s opposition to PAS. The outcome of the UKs RCP poll is several resignations, a Charity Commission investigation and ongoing accusations of a rigged procedural process which was unfit for purpose. I have been and still am highly critical of many aspects of medical procedure in the US but on this issue the AMA have got it absolutely right.
By Trevor Stammers, Director of the Centre for Bioethics and Emerging Technologies