Monday, July 07, 2014

The BMJ steps out of line

One of the world's most prestigious medical journals, the BMJ (formerly the British Medical Journal) has come out in favour of legalising assisted suicide.

The publication - which claims to advance healthcare worldwide by sharing knowledge and expertise  - says "Lord Falconer's Assisted Dying Bill is expected to receive its second reading in the House of Lords this month. The BMJ hopes that this bill will eventually become law. . . let us hope that our timid lawmakers will rise to the challenge."

But how can something that has been wrong for centuries suddenly become right?

The BMJ's editors claim there are few dangers in legalisation (despite the well-publicised and well-justified fears of organisations supporting the disabled). They base their argument on patient autonomy:

"People should be able to exercise choice over their lives, which should include how and when they die, when death is imminent. In recent decades, respect for autonomy has emerged as the cardinal principle in medical ethics and underpins developments in informed consent, patient confidentiality, and advanced directives. Recognition of an individual's right to determine his or her best interests lies at the heart of efforts to advance patient partnership. It would be perverse to suspend our advocacy at the moment a patient's days are numbered."

So respecting choice is now more important than preserving life?

A strong influence in forming their argument is the experience of Oregon, in the USA, where assisted suicide is legal, and in their view, unproblematical. Based on figures from Oregon, they say legislation would hardly affect the lives of British doctors:

"Each year about one patient per general practice of 9,300 patients would discuss the issue of assisted dying; each general practice would issue one prescription for life-ending medication every five or six years, and every eight to nine years one patient per general practice would take life-ending medication."

Are they sure?

In Oregon in 1998 there were 34 prescriptions written and 16 assisted suicide deaths. By 2012 numbers had risen to 116 prescriptions and 82 deaths. That's a 380 per cent increase in prescriptions and a 430 per cent increase in deaths by assisted suicide.

The BMJ's publishers, the British Medical Association, immediately disassociated itself from the BMJ editorial. Said Dr Mark Porter, chairman of the BMA council: "There are strongly held views within the medical profession on both sides of this complex and emotive issue. The BMA remains firmly opposed to legalising assisted dying.. . Recent calls for a change in the law have persistently been rejected."

Said Dr Peter Saunders, of Care Not Killing: "About two-thirds of doctors in recent surveys are opposed to any change in the law along with all the major medical institutions including the BMA, RCGP, British Geriatrics Society and the Association for Palliative Medicine.

"In a free society choice is important, but it has its limits. The duty to protect life trumps the so-called 'right to die.'"
There are 11 days to the proposed vote in the House of Lords.


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