A survey on doctors.net.uk has found majority support for legal assisted dying, writes Jacky Davis, arguing that the BMA should move to a neutral position or survey its membership
Last year, the consultant neurologist David Nicholl wrote in The BMJ about the change in his views on assisted dying.1 He explained that he had moved from being “utterly opposed” to being an ardent supporter after the assisted death of a close friend in Belgium. He argued that patients with a terminal illness should be allowed “a death with dignity on their own terms” and wondered why the views of the UK medical profession on the subject were reportedly so out of step with those of their patients, 82% of whom support legislation for assisted dying.2
The BMA has long been opposed to assisted dying, and its view is often quoted in parliamentary debate as representing that of doctors.3 BMA policy is made at its annual representatives meeting (ARM), where delegates vote after listening to debates. Thus BMA policy is the result of a debate attended by around 400 delegates. Nicholl thought that doctors’ views should be sought outside the ARM, and he approached doctors.net.uk with a view to conducting an online poll.
The poll, which ran for 10 days last October, asked whether doctors agreed that assisted dying should be made legal in defined circumstances.4 In all, 733 people participated—more than double the 313 who voted on BMA policy at the 2016 ARM—and 55% agreed or strongly agreed with the proposition. Forty three per cent were against assisted dying and 2% had no opinion. Not implacable opposition, therefore, but a clear range of views with most respondents in favour of a change in the law. The sample was small, but the results chime with a 2015 medeConnect poll of 1000 GPs, which found that 56% thought that medical bodies such as the BMA and the Royal College of General Practitioners should adopt a position of neutrality on assisted dying.5
The current disconnect between BMA policy and the views of doctors and patients undermines the BMA’s credibility, and its continuing opposition excludes it from the public debate. In a briefing to the House of Lords in 2014, the BMA said, “For reasons of inconsistency with BMA policy it would be inappropriate to engage with the detailed proposals in the Assisted Dying Bill.”6 Its stance of outright opposition means that constructive engagement is impossible. Doctors who support legal reform, now in the majority according to the latest poll, are left without a voice.
Assisted dying does not represent a leap into a dangerous unknown. Other jurisdictions have proved that it is possible to change the law, and doctors have shown that such laws can work hand in hand with excellent palliative care. Assisted dying already works safely for the 58 million Americans who have access to it. This month marks the 20th anniversary of the introduction of legislation in Oregon. Predictions of systemic abuse and inevitable broadening of eligibility criteria have not come true. The Oregon Hospice Association now supports assisted dying as one of the many choices available for patients approaching the end of life.7 In Australia, the state of Victoria has adopted legislation for assisted dying.
The spread of legislation for assisted dying means the subject will keep returning in the UK. Recently, Noel Conway, a patient with terminal motor neurone disease, brought a judicial review challenging the current law on assisted dying. He has now been granted permission to appeal an earlier decision by the High Court which rejected his case. Last year I wrote a piece on why the BMA should move to a neutral position,8 a stance that would allow for constructive engagement while acknowledging the range of views of the membership. The case for a change in policy is now stronger than ever. This latest poll throws down the gauntlet to the BMA: if it does not accept the result it must challenge it with its own ballot of the membership. If it accepts the result it cannot, in good conscience, continue to oppose assisted dying.
Ultimately legalisation for assisted dying will be a decision for UK society. The job of the BMA will be to contribute to the debate, not find itself sidelined because of its implacable opposition. Its members, and our patients, deserve better.
Association for Palliative Medicine
BMA
Royal College of General Practitioners
Royal College of Physicians of London
Royal College of Surgeons of England
General Medical Council
General Pharmaceutical Council
Royal College of Anaesthetists
Royal College of Obstetricians and Gynaecologists
Royal College of Paediatrics and Child Health
Royal College of Physicians of Edinburgh
Royal College of Surgeons of Edinburgh
Royal Society of Medicine
Royal College of Nursing
Royal College of Nursing Scotland
Royal College of Psychiatrists
Royal Pharmaceutical Society
In 2013 the RCGP ran a consultation with its members,9 which it used to justify a stance of opposition to a change in the law, but some GPs criticised the consultation as “flawed.”10
The RCP surveyed its members the following year.11 Most respondents favoured the college taking a neutral or supportive stance for legal reform, but the college remains opposed.
We invited the BMA to respond but it had not done so at the time of publication.
Provenance and peer review: Commissioned; not externally peer reviewed.
Competing interests: I have read and understood the BMJ policy on declaration of interests and declare the following: I am a member of BMA council, a board member of Dignity in Dying, and chair of Healthcare Professionals for Assisted Dying.

中文翻译：

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一项新的民意调查显示，大多数英国医生支持辅助性死亡：BMA的反对派不代表成员

对doctors.net.uk的调查发现多数人的支持法律协助死亡，写杰基·戴维斯，认为应该BMA移动到中间位置或调查其成员
去年，顾问神经学家戴维·尼科尔中写到的BMJ关于变更1他解释说，在比利时的一位密友死后，他已经从“完全反对”变成了热情的支持者。他辩称，应允许患有绝症的患者“按自己的意愿有尊严地死亡”。他想知道为什么英国医学专业对此主题的看法与他们的患者不一致（据报道，其中82％支持辅助染色法2
BMA长期以来一直反对辅助死亡，在议会辩论中经常引用其观点代表医生的观点。3BMA政策是在其年度代表会议（ARM）上制定的，代表们在听取辩论后进行表决。因此，BMA政策是大约400名代表参加辩论的结果。Nicholl认为应该在ARM之外寻求医生的意见，因此他访问了doctors.net.uk进行了在线民意调查。
这项于去年10月进行了10天的民意测验询问医生是否同意在确定的情况下使辅助死亡合法化。4共有733人参加，比2016年ARM投票赞成BMA政策的313人增加了一倍多，并且55％同意或强烈同意这一主张。百分之四十三反对辅助死亡，百分之二反对。因此，这并不是一成不变的反对，而是大多数受访者对法律的改变持清晰的看法。样本很小，但结果与2015年medeConnect的1000名GP的调查结果一致，该调查发现56％的人认为BMA和皇家全科医师学院等医疗机构应在辅助染病中采取中立立场。5
BMA政策与医生和患者的意见之间当前的脱节破坏了BMA的信誉，其持续的反对将其排除在公开辩论之外。BMA在2014年向上议院进行的情况通报中说：“出于与BMA政策不一致的原因，不宜参与《辅助染色法案》中的详细提案。” 6其彻底反对的立场意味着建设性参与是不可能的。根据最新的民意测验，目前支持多数法律改革的医生绝无声音。
辅助死亡并不代表您将跃入一个未知的危险世界。其他司法管辖区已证明可以修改法律，而医生已证明此类法律可以与姑息治疗并驾齐驱。辅助染病已经对5800万能够使用它的美国人安全地工作。本月是俄勒冈州立法颁布20周年。关于系统性虐待和不可避免地扩大资格标准的预测还没有实现。俄勒冈临终关怀协会现在支持辅助死亡，这是临终患者可用的众多选择之一。7在澳大利亚，维多利亚州通过了辅助死亡的立法。
有关辅助染病的法规的广泛传播意味着该受试者将继续返回英国。最近，患有终末运动神经元疾病的患者Noel Conway进行了司法审查，对现行有关辅助死亡的法律提出了挑战。现在，高等法院已驳回了他的案子，他已被许可上诉。去年，我写了一篇文章，阐述了BMA为什么应保持中立立场8，这一立场允许建设性参与，同时也承认会员国的观点范围。现在，改变政策的理由比以往任何时候都要强大。这项最新的民意调查使BMA陷入僵局：如果它不接受BMA的结果，则必须以其成员资格的投票来挑战它。如果接受结果，它就无法良心继续反对辅助死亡。
最终使辅助染色合法化将是英国社会的一项决定。BMA的工作将是促进辩论，而不是因为它的顽固反对而被淘汰。它的成员，以及我们的患者，都应该得到更好的对待。
协会姑息医学
BMA
全科医师皇家学院
伦敦皇家内科医学院
英国皇家外科医学院
医学总会
通用药学委员会
麻醉师皇家医学院
妇产科皇家学院和妇产科医师
儿科的皇家学院和儿童健康
的皇家内科医学院爱丁堡
皇家医学院爱丁堡
皇家医学院
皇家护理
学院苏格兰
皇家护理学院皇家精神科医生学院
皇家药学会
2013年，RCGP与会员进行了一次咨询，9它曾为反对法律变更的立场辩护，但一些全科医生批评该咨询。 10
RCP在第二年对其成员进行了调查。11大多数受访者赞成该大学对法律改革采取中立或支持的立场，但该大学仍然反对。
我们邀请BMA回应，但在发布时尚未回应。
出处和同行评审：委托；没有外部同行评审。
利益竞争：我已阅读并理解BMJ的利益声明政策，并声明以下内容：我是BMA理事会成员，Dignity in Dying董事会成员以及Assisted Dying保健专业人士的主席。