Catholic Medical Quarterly Volume 73(2) May 2023

Submission for the Health and Social Care Committee Assisted Suicide Inquiry January 2023


The Professional and Ethical Considerations

I am a junior doctor currently training in the NHS.

I am grateful for the opportunity to put forward a written submission to the Health and Social Care Committee for your Inquiry into Assisted Suicide/Dying in the UK.

The question in the Terms of Reference which I would like to focus on is:

“What are the professional and ethical considerations involved in allowing physicians to assist someone to end their life?”

I believe there are important professional and ethical considerations in this debate. I strongly hope that Assisted Suicide/Dying will remain illegal in the UK. I outline some of my reasons for putting this request to the Committee.

BMA Survey (2020)

Firstly, I focus on some of the results of the BMA survey on Physician Assisted Dying (2020) which surveyed almost 29000 members and which high­lighted concerns.

Beneath the surface of the Survey Findings

The POST brief on Assisted Dying (2021) refers to the BMA as being one of the organisations that has changed its stance to neutral to a change in the law on assisted dying.

I would like to share concerns that the BMA survey results which contributed to the decision to change the BMA position, aren’t as conclusive as they may have appeared on the surface.

The results showed that quite a number of surveyed BMA members still personally oppose a change in the law.

Question 4.2 asked what surveyed members’ personal views were on a change in the law to permit doctors to prescribe drugs for eligible patients to self-administer to end their own life.

The results showed that whilst half (50%) of surveyed members supported a change in the law, four in ten (39%) surveyed members were still opposed and one in ten (11%) surveyed members were undecided.

The majority of surveyed members in Northern Ireland still personally oppose a change in the law to permit doctors to prescribe life-ending drugs (52%) whilst 38% supported a change.

When these results were broken down into doctors who have a license to practice and doctors who do not, the result showed less of a difference between doctors who opposed a change in the law and those who supported a change in the law – the 50% mark for a majority vote wasn’t met. Amongst doctors who had a license to practice, 48% supported a change in the law, 41% opposed a change, and 11% were undecided.

Amongst doctors who were not registered with a license to practice in the UK, 58% supported a change in the law whereas 32% did not. 10% were undecided.

When the results were broken down by branch of practice i.e. medical students, retired members, junior doctors, Public health, Consultants, Medical Academics, Staff and Associate Specialists, and General Practice, it becomes clear that support for a change in the law fell mostly in the categories of medical students, retired members, junior doctors and Public health (medical students 62% vs 26%, retired members 55% vs 34%, Junior doctors 54% vs 34%, and Public health 53% vs 37%).

Amongst Consultants and Medical academics there was a smaller difference between those who supported a change in the law and those who opposed a change in the law (49% vs 41%, and 46% vs 42% respectively). Amongst Staff and Associate Specialists, the difference between those who supported a change in the law and those who opposed a change in the law was 1% (44% vs 43% respectively). And finally, amongst those in General Practice, there were more opposed to a change in a law than supported it (41% supported a change in the law vs 47% were opposed).

These results are very relevant because they show that there was still quite a bit of opposition to a change in the law amongst those in GP, consultants, SAS doctors i.e. experienced doctors who have patient facing roles – this could be easily missed at first glance of the results.

We also see that there wasn’t an outright majority in support of changes to the law. A majority usually necessitates >50%, but here we have a result of 50%, even if we ignore the fact that this percentage isn’t consistent amongst all specialities of doctors or branches of practice.

Interestingly, when one reviews the demographics of BMA members who voted in this survey, it is apparent that only 2% of those who voted were in Palliative care. Given that Palliative care physi­cians are likely to be the most affected by a change to the law, it seems imperative that they as a specialty are consulted on this to obtain their views. As it happens in the BMA survey, of those surveyed members who work in Palliative care, the majority of them opposed a change to the law (76%). Throughout the survey, consistently more respondents in Palliative Care and General Practice opposed changes than supported them.

Great consideration should be given to the views of medical professionals in Palliative care and General Practice because they have most experience working with patients who fall into the categories of terminal illness, unbearable suffering, and nearing death which have been criteria for assisted suicide in other countries.

Reasons for opposing a change in the law

Some BMA members who opposed a change in the law commented on their reasons for doing so:

  • “The most commonly expressed reason, given by just over a fifth (22%), was that assisted dying goes against their medical ethical beliefs around the role of doctors. The Hippocratic oath of ‘do no harm’ was quoted in many of the free text responses falling into this theme, with surveyed members commenting that the role of doctors is to heal their patients and to provide support and care rather than bring about their deaths”. I would add that the Hippocratic oath and Beauchamp and Childress’s principles of medical ethics both direct us as doctors to do no harm to our patients. I would further add that Good Medical practice directs us to make the care of our patients our first concern – care has traditionally referred to providing treatment to our patients to help them to get better, not to kill them.
  • “Risks to vulnerable patients was the second most commonly expressed reason for oppos­ing a change in the law, given by 18%. There were concerns around how certain groups of patients could be protected, for instance those who may feel a burden to their families, patients who might be coerced into making this decision and those suffering from mental health issues.” I would add patients with disabilities who are concerned about the implications of legalisation of Assisted Suicide/Dying on them (Thomas, 2021).
    I would like to share the following video from the Dying Well website in which a patient with a disability in Canada and her family share their experiences of the impact of the legalization of Assisted Suicide on their disabled relative: please visit
  • “The third most commonly given view, by 14%, was that the focus should instead be placed on providing better quality palliative and end-of-life care, rather than on assisted dying. Free text responses indicated a concern that palliative care provision may worsen as a consequence of such a change in the law and that, if high quality palliative care was readily available for every patient who needs it, those patients may change their minds about requesting to end their lives in this way”
  • “One eighth (12%) felt the negative consequences of assisted dying are yet unknown and gave views which stated the implications of such a change in the law are greater than we imagine. This category included views that a change in the law would be merely the start­ing point (‘the thin end of the wedge’) and that we would then be on a ‘slippery slope’ to further negative impacts, for example, a widening in eligibility criteria and the devaluing of the lives of older people and other groups in society”
  • “A tenth (9%) cited their own personal ethical or religious beliefs as reasons for opposing a change in the law. Surveyed members in this group cited their own religious beliefs, a feeling that life is sacred or, for some, that to take part in assisted dying would be ‘playing God’.”
  • “Six percent felt that prescribing life-ending drugs would negatively impact on the relationship between patient and doctor. Surveyed members in this group mentioned that being able to prescribe these drugs would harm the trust between doctors and their patients.”
  • “Six percent also expressed the view that the risks to doctors of prescribing life-ending drugs are too great. Legal liability was a concern expressed here, as was having adequate time to carry out the task of prescribing sufficiently well given doctors’ already heavy workloads”

Ethical Conflicts and the impact on doctors’ well-being

The results of the survey also showed that majority of doctors were opposed to administering the lethal medications themselves. This isn’t a finding that should be overlooked or ignored by the Committee, given the key role that doctors are expected to play in countries where Assisted Suicide is legalised e.g. Holland and Canada.

The relevant question I refer to was:
5.4 “What are surveyed members’ views on whether they would be prepared to actively participate in any way in the process of administering drugs to eligible patients?”

Surveyed members were asked whether they would be prepared to actively participate in the process of administering drugs, should it be legalised.

Overall, 54% were not prepared to actively participate in the process, a quarter (26%) were willing to actively participate, while one fifth (20%) were undecided on the matter.

The reasons given by the survey respondents for opposing a change in the law to permit doctors to administer life-ending drugs were as follows:

“Just under half (48%) of surveyed members who gave a free text response at this question gave at least one reason which opposed doctors adminis­tering life-ending drugs...

The top reason, given by 22%, this time that administering goes against their medical ethical beliefs around the role of doctors. Some surveyed members cited the Hippocratic oath of ‘do no harm’ and commented that doctors administering life-ending drugs is a step further than prescribing and that this does not fit with their views around the role of doctors.

Differing to views on prescribing however, personal beliefs and principles was the second most common reason for opposing doctors administering life-ending drugs, given by 17%, in comparison with 9% where it was the fifth most common reason for opposing prescribing life-ending drugs. Some surveyed members mentioned their own personal religious beliefs and that this would be a line that should not be crossed by doctors.

From the findings above, it would suggest that doctors do not feel comfortable with the process of Assisted Suicide/Dying even if some doctors may express support for legalising Assisted Suicide/Dying. This is of little surprise given that it is probably counter-intuitive of most doctors to end the life of their patients, when I suspect that most doctors entered medical school with a desire to help patients to get better and an interest in medicine as a means of doing this.

There is an incongruence between surveyed BMA members supporting a change to the law and
surveyed BMA members opposing having involvement in administration of the lethal medications. In view of this, I suspect that doctors who have expressed a support to a change in the law in favour of legalising Assisted Suicide/Dying may not maintain their position if faced with patients requesting for Assisted Suicide/Dying in their day-to-day clinical practice. The inconsis­tency of the findings calls into question what it is that the survey respondents are really supporting here in the case of those who have expressed a support for Assisted Suicide/Dying? Is it really assisted suicide/dying or is it the right to auton­omy and choice? The latter can be supported in many other ways without legalising Assisted Suicide/Dying. Afterall medicine is built on a professional code of conduct (Good Medical Practice) with ethical principles which already support autonomy and patient choice for treat­ments that can potentially help them to feel better (in most cases). Interventions that kill should not be included in the definition of ‘treatments’.

The role of the NHS

In my view, and I suspect in the view of many others, the appropriateness of the NHS as a place within which Assisted Suicide takes place, is important to establish. In my view, Assisted Suicide/Dying doesn’t belong in an NHS health­care system which is struggling with resources and which at its core (from my understanding) was set up to make healthcare available to people who could not otherwise afford to receive treatment for their illness in a post-war Britain. I quote from a really interesting article which I found in the National Archives (see references). It details the origins of the National Health Service (NHS):

“The Beveridge Report of 1943 set out plans for the future of post-war Britain. It identified the main issues facing British society, including disease, and laid the foundations of what would become known as the Welfare State. When Labour came to power in 1945, an extensive programme of welfare measures followed - including a National Health Service (NHS).”

I would respectfully request that the Committee reads this article in the National Archives. You will note in doing so the role of churches (and charities) in provision of voluntary healthcare – the very organisations which are at threat of their core values being compromised should Assisted Suicide become legalised in the UK.

Conscientious objection

The point above, logically leads to the concerns about the impact of legalising Assisted Suicide on conscientious objection. I am concerned about how the right to conscientious objection will be protected.

If we turn to Canada, we see an example of the ethical conundrums and moral implications that have arisen following legalisation of Medical Assistance in Dying (MAiD) in the paper by Schiller et al (2019).

The abstract of this paper, ends with the following appeal:

“We conclude with an appeal for morally sustainable workspaces that, when implementing MAiD, appropriately balance patient choices and nurses' moral well-being.”

As mentioned in the paper above, once something becomes legalised, there is then a duty and/or obligation for somebody to provide it. I share the concerns that legalising Assisted Suicide in Canada has or will lead to MAiD being embedded in healthcare facilities and the impact of this on conscientious objection. I am concerned that if legal and embedded in the NHS, this will create moral war zones for healthcare professionals who conscientiously object. The Article 9 right to freedom of conscience and religion are met with threat from a system which offers little protection to those who hold a conscientious objection, something that Catholic organisations have expressed concern about in an article written by Jones back in 2017 following legalisation of Assisted Suicide in Canada.

Rather, as this article illustrates to me, those holding a conscientious objection are placed in a position of pressure to conform and compromise their core values under the premise that to not do so will be unprofessional given Assisted Suicide/Dying is legal. It is concerning that such arguments can be put forward when the procedure in question lacks unanimous support from members of the medical profession, as we have seen in the BMA survey.


A further concern I have as a healthcare professional is what safeguards will be put in place to ensure that personalities such as Harold Shipman who have abused their position of power to exploit vulnerable individuals do not exploit the system?

Furthermore, what safeguards will there be for patients with mental illness who are suicidal and have treatable mental illness? How will an expansion to include mental illness as we see proposed in Canada not undermine the suicide prevention work that psychiatric services work so hard to uphold? Girma et Paton (2022), found evidence that legalisation of assisted suicide is associated with a significant increase in total suicides and this increase is observed most strongly for the over-64s and for women. There was also evidence (though weaker) that assisted suicide is associated with some increase in unassisted (unregulated) suicides, most particularly in women and 35–64 age bracket.

Concluding thoughts

The concerns of the medical profession raised in the BMA 2020 survey should seriously be considered in this inquiry given that doctors are, in my view, the key stakeholders in this debate.

I am of the opinion that the ethical and moral implications of legalising Assisted Suicide should be brought to the forefront of this debate because of the potential harms to the mental health and moral wellbeing of doctors involved. Further consultation with qualified doctors who have a license to practise and who are in active clinical roles (not organised by the BMA as not all doctors are BMA members) is imperative in this debate. These are the people after all who I suspect will be most affected by any change in the law.

My view when taking all the above into consideration is that the law in this country, which maintains that Assisted Suicide is an illegal practice, ought to remain in place. I question whether support for a change in the law is coming from a vocal group of people who are not medical, not registered with a license to practice and not regularly in patient facing roles.

I firmly believe that Assisted Suicide should not be brought into the NHS, especially when services are already overstretched and morale low. I am concerned it will serve to add moral, ethical and professional complications to an already under resourced system.

Thank you for considering these issues.