Memorandum by the General Medical Council
1. We understand that the aim of this Bill
is to make it lawful for terminally ill patients to receive medical
assistance to end their life. The question whether assisted dying
should be legally permitted in some form raises difficult ethical
and moral issues concerning the rights and freedoms of individuals.
2. The General Medical Council licenses
doctors to practise medicine in the UK under the provisions of
the Medical Act 1983 (as amended). Our objective, as defined in
the Medical Act, is to "protect, promote and maintain the
health and safety of the public". Our four main functions
To keep up-to-date registers of qualified
To foster good medical practice.
To promote high standards of medical
To deal firmly and fairly with doctors
whose fitness to practise is in doubt.
3. One of the ways in which we foster good
medical practice is by giving advice to the profession, primarily
through our published guidance, on the standards of practice expected
of them. We require doctors to observe the law (paragraph 11,
Good Medical Practice) and our guidance will always be
consistent with the law. Consequently we have not developed policy
or issued guidance on euthanasia.
4. The proposal to legalise physician-assisted
dying is an issue which raises strong views. These views are predominantly
based on personal beliefs and individual moral values, rather
than the knowledge and experience particular to doctors or patients
or any other professional or social role. We believe that it is
for society as a whole to determine, through its democratic processes,
how best to respond to the conflicting wishes of its citizens.
5. In order to address the difficult dilemmas
faced by doctors about how best to meet the needs of a terminally
ill patient we published guidance on Withholding and Withdrawing
Life-Prolonging Treatments: Good Practice in Decision-Making.
The aim of the guidance is to provide a clear framework for professional
practice within the current law, and therefore starts from the
premise that any medical intervention where the doctor's primary
intention is to end the patient's life is unlawful.
(As the Committee will be aware, this guidance
document was recently judicially reviewed, and the judgement handed
down from the High Court specifies parts of our guidance which
will need to change, although Justice Munby called the booklet
". . . overall . . . a document whose contents, indeed whose
whole approach, should greatly reassure patients and their relatives.")
6. A change in the law to allow to physician-assisted
dying would have profound implications for the role and responsibilities
of doctors and their relationships with patients. Acting with
the primary intention to hasten a patient's death would be difficult
to reconcile with the medical ethical principals of beneficence
7. If the law were to be changed, a balance
would need to be struck between the autonomous right of an individual
to decide how they wish to die, and the impacton those
close to the patient, those involved in making and acting on the
decision, and on society as a wholethat the granting of
such a wish might have. The Committee will need to consider whether
allowing killing under any circumstances will affect the value
of human life in society.
8. Implementing the proposals in the Bill
would depend on the participation of doctors and other healthcare
practitioners, and a crucial consideration would be the degree
of support amongst these groups for the legalisation of assisted
dying along the lines described in the Bill. We cannot offer a
view about the position of doctors on this issue, but no doubt
you will have approached the British Medical Association and other
representative bodies for evidence.
9. It is likely that there would be a significant
number of clinicians with a conscientious objection to involvement
with assisted dying, and we are pleased to note the inclusion
of clause 7(1-3) relating to this. We would expect a doctor to
respect a patient's wishes, including their right to refuse life-prolonging
treatment, but it would not be a doctor's duty to assist a patient
to die. As the Bill is currently drafted, a doctor with a conscientious
objection would need to `take appropriate steps to ensure that
the patient is referred without delay' to a doctor with no such
objection. We understand the need to ensure continuity of care
for a terminally ill patient, and agree that it is a doctor's
duty to ensure it. However, we believe that this clause would
be of great concern to some doctors with a conscientious objection
who would want a statutory right to withdraw entirely from the
situation. The Committee will need to consider whether such a
doctor, by ensuring the patient's referral, would still feel complicit
in the act of assisting the patient to die.
10. We assume that the Committee will consider,
along with the general question of principal, any concerns about
the scope of the draft Bill and the adequacy of the projections
it proposes. In recent years there have been a number of high
profile legal judgements, interpreting Articles 2, 3 and 8 of
the European Convention on Human Rights, which the Committee will
no doubt take into consideration.
11. We are grateful for the opportunity
to participate in this debate, and look forward to the outcome
of the Committee's deliberations on this important issue.