BGS Position Statement on Assisted Dying (Physician Assisted Suicide and Voluntary Active Euthanasia)
This statement sets out the BGS position on assisted dying, our priorities for end of life care, and our concerns that effective legal safeguards cannot be created to protect older people from unwarranted harms.
Introduction
This statement sets out the BGS position on assisted dying (AD), our priorities for end of life care, and our concerns that effective legal safeguards cannot be created to protect older people from unwarranted harms.
The BGS position on Assisted Dying
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Health and social care context
BGS priorities for end of life care
- Allowing death due to natural causes at the right time, instead of continuing unwanted interventions aiming to prolong life. This is distinct ethically from the intentional ending of life, even when life is unquestionably coming to an end.
- Improving timely recognition of terminal decline due to underlying disease processes including multimorbidity, advanced dementia and severe frailty. This is consistent with national guidance advocating the timely identification of patients approaching the last 12 months of life to tailor their care according to their individual preferences and wishes.9
- Deploying effective health communication systems to share information regarding individual preferences, including advance care plans incorporating advance decisions to refuse treatment and preferred place of death, also shared with individuals with valid powers of attorney for health and welfare.
- Enabling holistic, multidisciplinary care services to deliver Comprehensive Geriatric Assessment focused on multimorbidity, dementia and frailty, with recognition these conditions cannot always be ameliorated.
- Providing universally accessible, high-quality supportive and palliative care services making provision for those whose terminal decline is due to multimorbidity, dementia and/or frailty which enable individuals to enjoy naturally enduring life by ameliorating unpleasant physical, psychological and existential symptoms which otherwise cause end of life to be distressing and burdensome.
- Shifting societal attitudes to de-medicalise death and supporting wider societal care provision to alleviate distress in terminal disease.
Safeguards for older people
Supporting statements, methodology and rationale
- Physician Assisted Suicide (PAS): where healthcare professionals prescribe lethal drugs within defined criteria at the voluntary request of an adult patient with mental capacity to make this request, to enable them to self-administer the drugs to end their own life; and
- Voluntary Active Euthanasia (VAE): where healthcare professionals administer lethal drugs within defined eligibility criteria at the voluntary request of an adult patient with mental capacity to make this request with the intention of ending that patient’s life.
Background
Timeline
10 May 2024 | 13 June 2024 | 11 July 2024 | 2 September 2024 | 23 September 2024 | 24 October 2024 |
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Survey
- Establish the professional views of respondent BGS Members on the legalisation of Assisted Dying.
- Understand the views of respondent BGS members on what position BGS should take on the legalisation of Assisted Dying.
- Understand whether respondent BGS members would be willing to engage professionally in the processes of Assisted Dying for eligible individuals in the event of a change in UK law.
- Understand the level of confidence among respondent BGS members that effective safeguards could be developed to protect the interests of older people in the event of a change in UK law on Assisted Dying.
Survey design, administration and utilisation
Survey summary outcomes
Demography
- A total of 775 responses were received (15.5% of BGS membership) which is a high response rate for a BGS survey of this kind.
- The majority (74%) were from England
- 63% were female and 35% were male
- 50% were consultant geriatricians
- 86% were independent prescribers
- 46% declared their religion as Christian and 39% declared no religion
- 74% declared their ethnicity as white (English, Welsh, Scottish, Northern Irish or British)
Respondent views on a change in UK law on Assisted Dying (PAS and VAE)
- For PAS, 50% were opposed, 33% were supportive and 17% were undecided on a change in UK law
- For VAE 55% were opposed, 27% were supportive and 18% were undecided on a change in UK law
Respondent views on BGS position on a change in UK law on Assisted Dying (PAS and VAE)
- For PAS 60% responded that BGS should be opposed, and 40% responded that BGS should be supportive of a change in UK law for eligible individuals
- For VAE 66% responded that BGS should be opposed and 34% responded that BGS should be supportive of a change in UK law for eligible individuals
Respondent views on professional engagement with the process of Assisted Dying (PAS and VAE) in the event of a change in the UK law
- For PAS 52% were not willing, 27% were willing and 21% were undecided on professional engagement with the process
- For VAE 60% were not willing, 21% were willing and 19% were undecided on professional engagement with the process
Respondent views on confidence in development of effective safeguards for Assisted Dying (PAS and VAE) in the event of a change in the UK law
- For PAS 50% either disagreed or strongly disagreed, 35% either agreed or strongly agreed and 15% were undecided about effective safeguards
- For VAE 53% either disagreed or strongly disagreed, 30% either agreed or strongly agreed and 17% were undecided about effective safeguards
Without access to AD, individuals may feel obliged to endure physical, psychological and existential symptoms accompanying the last stages of the end of their life without alleviation. The BGS recognises these concerns as valid, resonating with the experiences of many members’ professional and personal experience where patients in advanced states of multimorbidity, dementia and/or frailty are subject to unnecessary and burdensome treatments during the last months of their life.
- Assessing and prescribing
- Administrating
- Certifying death
- Reviewing the process.
Respect for patient autonomy, and the attendant rights this affords people to make their own decisions, is fundamental to the delivery of effective health care. No decision is more profound than whether a person wishes to continue living.
The BGS acknowledges the potential for challenge of their current position on AD as being paternalistic by imposing a professional view which restricts the right of an individual to make their own choice.
- There is a fundamental difficulty in defining a minimum legal and clinically applicable standard for autonomous choice within current UK consent law.
- There is a risk that the autonomous choices of some to end their life may impinge on the rights of others, and justice principles already require some individual societal freedoms to be curtailed to protect the wider interests of others.
- Accepting the high likelihood of professional conscientious objection in the event of AD being legalised, adherence to ethical principlism focused solely on respect for autonomy risks undermining the professional relationships which exist between patients and their health care professionals.
Acknowledgements
The position statement has been created by a BGS working group comprising the following members:
- Professor Martin Vernon (Co-chair), Consultant Geriatrician and Associate Medical Director, Tameside and Glossop Integrated NHS Foundation Trust and Honorary Professor, University of Chester.
- Dr Andrew Stanners (Co-chair), Consultant in Geriatric Medicine, Mid Yorkshire Teaching NHS Trust and Inter-Disciplinary Ethics Applied Centre, University of Leeds.
- Dr Esther Clift, Consultant Physiotherapist in Acute Frailty, Isle of Wight NHS Trust
- Dr Liz Davis, Acting Frailty Consultant, Liverpool University Hospitals NHS Foundation Trust.
- Dr Sarah Evans, Consultant Geriatrician, Whittington Health NHS Trust.
- Professor Rowan Harwood, Professor of Palliative and End of Life Care, University of Nottingham and Honorary Consultant Geriatrician, Nottingham University Hospitals (dissents from the conclusions of the statement).
- Shireen Ismail, Registered Osteopath, Verdure Clinic.
- Mrs Gabrielle Jenkinson, Advanced Clinical Practitioner, The Princess Alexandra Hospital NHS Trust.
- Dr Eva Kalmus, GP with Extended Role in Frailty
- Dr Katherine Patterson, Consultant Geriatrician, Belfast Health and Social Care Trust.
- Dr Louis Savage, GP with Special Interest/ Specialty Doctor in General Medicine, Gloucestershire Hospitals NHS Foundation Trust.
- Professor David G Smithard, Consultant in Acute Frailty, Lewisham and Greenwich NHS Trust, and Visiting Professor, University of Greenwich.
- Dr Joanna M. Ulley, Consultant in Geriatrics and General Medicine, The Rotherham NHS Foundation Trust.
- Dr Stephanie Wells, Consultant Geriatrician, University Hospital of Wales.
References
Appendix
The raw anonymised data collected from the BGS member survey on assisted dying is available on request. Please email Lucy Aldridge, BGS Policy Coordinator, at l [dot] aldridge [at] bgs [dot] org [dot] uk to request this information as a Microsoft Excel document.