Briefing Note on recent surveys, and why DiD poll claims are unreliable:
RCP Poll now live
The Royal College of Physicians’ poll of its members has just gone live. We should ask our doctors to vote since those not voting will be considered to be “neutral”.
Jane Campbell’s article for BMJ is now online –
Royal College of Physicians (RCP) Poll of Members, Feb 2019 (also links to a pdf Briefing by RCP)
Prof Raymond Tallis’s case for a neutral position on AS: https://www.rcplondon.ac.uk/news/assisted-dying-why-rcp-should-be-neutral
Dr Amy Proffitt’s case for opposing AS: https://www.rcplondon.ac.uk/news/assisted-dying-why-rcp-should-be-opposed
– – USEFUL QUOTES —
John Saunders, both a former Chair of Ethics, and a trustee of the RCP said, “the poll is designed to make a change in RCP stance inevitable and could easily do so even if a majority oppose it”. He added, “this is a sham poll with a rigged outcome”. …
Dr David Randall, of the Royal London Hospital, also criticised the survey, saying: “The membership seems to be being offered a fait accompli by members of Dignity in Dying”. He said the group – formerly the Voluntary Euthanasia Society – has “achieved positions of influence on the RCP council”, and designed the questionnaire “to ensure that the College drops its long-standing opposition to assisted suicide ahead of future parliamentary attempts at legislation”. Dr Randall observed that the notion of a 60 per cent ‘supermajority’ has “shed daylight on an apparent manipulation of procedure by pro-euthanasia activists”. …
Dominic Lawson, writing for the Daily Mail, commented that the wording change is “in itself a concession to the PR efforts of the people Dr Randall refers to as ‘pro-euthanasia activists’.” “Medically assisted suicide is the more accurate name for what is being proposed, but it is less appealing, as it translates as ‘self-killing’. He also added: “It is not unusual for a supermajority to be required for a fundamental change in a constitution: it is unprecedented for one to be required to keep things as they are.”
Dutch GP Dr Van der Muijsenberg warned: “I see a growing anxiety among patients, not just the terminally ill, that they think it is not decent not to ask for voluntary euthanasia sometimes, because they feel such a burden.” In light of the survey, Theo Boer, a former member of a Dutch board reviewing acts of euthanasia, also warned: “We have put in motion something that we now have discovered has more consequences than we ever imagined.”
— ARTICLE IN THE TIMES (of London) NEWSPAPER —
EXTRACT: In a letter to The Times, two dozen doctors and academics write: “We are worried that this move represents a deliberate attempt by a minority on [the college’s governing council] to drop the college’s opposition to assisted suicide even if the majority of the membership vote to maintain it.”
LETTER: PHYSICIANS PROTEST
Sir, We are a group of senior doctors and academics concerned about procedural irregularities related to the Royal College of Physicians’ poll of members’ views on assisted dying (Thunderer, Jan 23, and letters, Jan 24, 25, 26 & 28). Under the terms of the new census the college will adopt a “neutral” position and drop its opposition to the legalisation of assisted dying unless 60 per cent of members vote to maintain it. We contend that it is wrong to demand a supra-majority simply to maintain the status quo, and we are worried that this move represents a deliberate attempt by a minority on the RCP council to drop the college’s opposition to assisted suicide even if the majority of the membership vote to maintain it.
Although we acknowledge that there are a variety of opinions held by doctors on this issue, the last poll carried out by the college found that 58 per cent of members opposed a change in the law, with under 25 per cent believing that the college should campaign in favour of new legislation. We call on the royal college to retain the more orthodox, justifiable and democratic approach that it has used in the past when interpreting this poll.
Dr Charlotte Abson FRCP, Consultant Clinical Oncologist, Kent; Dr Rosemary Anthony-Pillar MRCP, Consultant Palliative Care Physician, London; Professor Nigel Biggar PhD, Regius Professor of Moral and Pastoral Theology, University of Oxford; Dr Stephen Brennan FRCP, Retired Consultant Physician, Sheffield; Dr Alison Brownell FRCP, FRCPath, Consultant Haematologist, Essex; Dr Alex Bunn MRCP, Lead GP, HMP Wansworth; Dr Simon Clift MFOM, Consultant in Occupational Medicine, Southampton; Dr Anthony Cole FRCP, Consultant Paediatrician, Worcester; Professor Rob George FRCP, Professor of Palliative Medicine, King’s College London; Dr Mark Harbinson FRCP, Consultant and Clinical Academic, Belfast; Dr Catherine Harper-Wynne FRCP, Consultant Oncologist, Kent; Dr Michael Hunter FRCP, Consultant Physician, Belfast; Dr Ian Jessiman FRCP; Retired GP, Kent; Dr Dermot Kearney MRCPI, Consultant Cardiologist, Gateshead; Dr Gareth Lewis FRCP, Consultant Acute Physician, Northern Ireland; Dr Amy Proffitt MRCP, Consultant Palliative Care Physician, London; Dr Paul Ryan FRCP, Consultant Physician, Kent; Professor John Saunders FRCP, Former chair of ethics, councillor and trustee, Royal College of Physicians; Dr Trevor Stammers FRCGP, Director, Centre for Bioethics and Emerging Technologies, St Mary’s University, Twickenham; Professor Simon Taylor-Robinson FRCP, Professor of Translational Medicine, London; Dr Adrian Treloar FRCP, Consultant in Old-Age Psychiatry, London; Dr Dominic Whitehouse FRCP, Consultant Physician, Palliative and Respiratory Medicine, Chichester; Professor John Wyatt FRCP, Emeritus professor of ethics and paediatrics, University College London
AND OTHER LETTERS:
“The disabled need to know doctors won’t back assisted dying”
This week we have heard about widespread abuse of disabled people on social media, with MPs backing a petition to criminalise such vitriol. Those of us who are disabled console ourselves with the thought that we can at least look to our doctors for support. But now we find the Royal College of Physicians (RCP) is consulting its members on whether seriously ill people should be given lethal drugs to end their lives.
Consultations are to be welcomed, provided they are run fairly. In the past the RCP has done that. The majority of its members said in 2014 that they opposed an assisted dying law, and that became the college’s declared position. Not any longer. This time the college has decided to change the rules: it will be “neutral” unless at least two thirds of members vote otherwise. Yet in the last consultation the neutrals made up only 31 per cent of the votes.
Why has this crazy change been made? The official reason is that by being neutral the college can reflect the differing views of its members. The real reason is activism by the assisted dying lobby. Only a small minority of members want to see an assisted suicide law. They know there is no chance of the college supporting their project but neutrality is, for them, the next best thing because it suggests (misleadingly) that there is a shift in medical opinion. So the activists have been lobbying the college’s management to go neutral.
That a venerable institution like the RCP should have allowed itself to be pushed into fixing the rules — there is no other word for it — for a consultation on a subject that lies at the heart of medicine is deeply worrying.
Disabled people can all too often find themselves at the margins of health care and many of us worry about how that would worsen under legalised assisted dying. Though activists in Britain say we aren’t in their sights as candidates for assisted suicide, we note with concern that they also commend such legislation abroad that includes disabled people.
It is right for the RCP to consult its members on this important subject, though why another consultation is needed less than five years after the last one is not easy to see. But let it be a fair one. If, as I would expect, most members express their opposition to assisted dying, let that be its position, while also making clear that there are other minority views among its members.
What is being done now is a travesty of a consultation and, unless it is halted and restarted, it risks bringing the college into disrepute as a professional body.
Baroness Grey-Thompson is a crossbench peer and disability rights campaigner
Disabled rights and the poll on assisted dying
Sir, As a disabled person and a lifelong campaigner for disabled people’s rights, I strongly disagree with Baroness Grey-Thompson’s assertion (Thunderer, Jan 23) that disabled people would somehow be made more vulnerable or marginalised if assisted dying were legalised as a choice for terminally ill people at the end of life. Such a change in the law is supported by an overwhelming majority of disabled people (86 per cent, according to a 2015 Populus poll, even more than the general public at 82 per cent), who like me understand that assisted dying is about allowing terminally ill people to die well, not about devaluing or ending the lives of people who may otherwise be helped. This strength of feeling signals to me that change can and will come to the UK, as it has done in American and Australian states and across Canada. It is vital that our doctors are fully engaged in this debate.
I therefore welcome the decision of the Royal College of Physicians to poll its members on this important issue. It shows pragmatism and is certainly not the “travesty” that Lady Grey-Thompson claims it to be.
Lord Low of Dalston
House of Lords
Sir, It is difficult to understand why those opposed to assisted dying such as Baroness Grey-Thompson are so dismayed that an organisation might take a neutral view on the subject. A neutral stance on such a divisive issue is a reasonable one to take, as it would allow the Royal College of Physicians to properly represent the range of opinions held by its members, not just a small section. Last time the RCP’s members were polled on this issue more than 50 per cent were either neutral or in favour of a change in the law. Polling consistently shows that more than 80 per cent of people with disabilities support a more sensitive, safeguarded and compassionate assisted dying law for terminally ill adults. Principled objections are entirely valid, but the voices of the small number who shout loudest should not drown out the vast majority who disagree.
Lord Falconer of Thoroton, QC
House of Lords
Sir, The question is not whether assisting suicide is right or wrong but whether it should be a new duty for doctors. We are clear that there is a chasm between symptom control to relieve suffering and prescribing or administering drugs to kill. Palliative medicine is there to help people live as well as possible until they die. No service can relieve all suffering, because its roots often lie in a person’s life, not their illness. Where we fall short we must learn and improve, not counter failures with a lethal solution.
If society wants death on demand it should own it and not place it at the door of medicine. Ending a life does not need a doctor. A profession’s representative body must have a clear position on what might become a new duty, otherwise what is its purpose? Tragically, the Royal College of Physicians risks failing both medicine and the public with this muddle. As a fellow and former secretary of the RCP ethics committee, I am embarrassed.
Professor Rob George, MD, FRCP
Medical director, St Christopher’s Hospice; honorary professor of palliative care, King’s College London
DOCTORS AND DYING
Sir, The majority of practising doctors are opposed to legalising assisted suicide (letters, Jan 24 & 25). A 2015 survey of GPs found that only one in seven would be willing to consider a request for lethal drugs. Opposition is particularly strong among those of us who care for dying patients day in and day out. In a 2014 survey of its membership, the Association for Palliative Medicine found that nine out of ten of us would not participate in any legalised “assisted dying” regime.
Yes, there are Royal College of Physicians members who are neutral on the issue but they are a minority. By its twisting of the rules to require a two-thirds majority for any position to be adopted, the RCP is effectively disfranchising the majority. It is a device that is as nonsensical as it is politically motivated. The RCP should focus on its role of maintaining and improving medical standards and not allow itself to be manipulated into playing politics.
Dr Amy Proffitt
Consultant in palliative medicine, executive secretary, Association for Palliative Medicine
Sir, Doctors are technicians, not moral arbiters. Assisted dying might need doctors to be part of anti-exploitation controls, in testing whether people were able to make rational decisions, but from there on there would be no need for doctors to be involved at all. The actual help in dying could be carried out by suitably trained people, leaving doctors to care for those who really want their help.
Sir, In the debate about assisted dying (Letters Jan 24, 25 & 26) is it not time that doctors turned their attention to pre-palliative care in helping fit people to prepare and make choices for their medical management when body and soul start to deteriorate? A legal contract could be made and respected. A decline into a condition like Alzheimer’s could result in withdrawal of unnecessary treatments that prolong life but not quality of life. Prior to retirement I suggested this course to patients and it was warmly received.
Dr Peter Barling
No To Assisted Suicide was formed to oppose the Marris assisted suicide Bill in 2015. The campaign is headed up by Dr Kevin Yuill, academic and author of
‘Assisted Suicide: The Liberal, Humanist Case Against Legalization’.
Care Not Killing is a UK-based alliance of individuals and organisations which brings together disability and human rights groups, healthcare providers, and faith-based bodies, with the aims of:
- promoting more and better palliative care;
- ensuring that existing laws against euthanasia and assisted suicide are not weakened or repealed;
- influencing the balance of public opinion against any further weakening of the law.
Living and Dying Well researches and analyses the evidence surrounding the end-of-life debate. Living and Dying Well was formed to research the serious evidence surrounding these issues, to apply clear thinking to them and to publish the results. We produce regular reports on specific aspects of the end-of-life debate and we hold seminars from time to time on topical issues.
Not Dead Yet are our sister organisation in the United States. They are a grassroots disability rights group that opposes the legalisation of assisted suicide and euthanasia as deadly forms of discrimination against old, ill and disabled people.