Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence

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 are:

    —  To keep up-to-date registers of qualified doctors.

    —  To foster good medical practice.

    —  To promote high standards of medical education.

    —  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 and non-maleficence.

  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 impact—on those close to the patient, those involved in making and acting on the decision, and on society as a whole—that 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.

September 2004

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