How a minority in the BMA got their way on euthanasia

It was a Homer Simpson moment for the British Medical Association. At the end of its annual representative meeting on 30 June 2005, delegates voted to withdraw the organisation’s firm and long-standing opposition to euthanasia and assisted suicide. This leaves the world’s most prestigious gathering of medical professionals in the absurd position of having no opinion on whether killing their patients is good or bad. Doh!

Admittedly, this is an advance on the double-Doh position of the UK Royal College of General Practitioners. At present this august body has a policy of total ignorance: it doesn’t support euthanasia; it doesn’t condemn euthanasia; and it is not neutral.

MA for moral agnostic is not a qualification that most people want on their doctor’s brass plaque. If their teenage son wants steroids so that he can have a body like Arnold Schwarzenegger, they do not expect their GP to hand them over. If their teenage daughter has anorexia nervosa, they do not expect their GP to tell her that it is a lifestyle choice. And if their aged parent is depressed and wants to die, they expect cheery advice and a pat on the hand, not a needle.

In the past few weeks, the BMA has thundered from Olympus on smoking bans in Scotland (courageous), third world disease (‘indefensible’), junk food in schools (‘madness’) and discrimination by sexual orientation (‘zero tolerance’). On issues that are not its core business, it speaks as the conscience of Britain. On the one issue in which it has literally the power of life and death, it has no opinion.

This marks a break with more than 2,000 years of fealty to the Hippocratic Oath – ‘I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing’ – decades of opposition to euthanasia, and solidarity with colleagues around the world. The World Medical Association still firmly opposes the legalisation of euthanasia, as do the American Medical Association and the Australian Medical Association.

Furthermore, the BMA’s stand is sure to be interpreted as support for euthanasia, not as agnosticism. The experience of the Royal College of General Practitioners is instructive. It adopted a position of neutrality and was soon compelled to issue a press release declaring that ‘We would not want euthanasia campaigners to exploit our neutrality for their own agenda’. But the public and politicians have every right to assume that neutrality means support. Even other doctors assume this. Within days of the BMA’s vote, the New Zealand Medical Association announced that it would re-examine its position on euthanasia.

Neutrality on euthanasia is so daft a policy for doctors that only two things can account for it: monumental stupidity on the part of the profession or a Byzantine plot to legalise it. It may reassure readers to learn that the latter is the case. Here is what happened.

The BMA’s ethics committee is firmly in the hands of euthanasia activists. Its head is Dr Michael Wilks, who personally supports a change in the law. The committee includes three pro-euthanasia experts in medical ethics: Sheila MacLean (Glasgow University), John Harris (Manchester University), and Len Doyal (University of London). Dr Wilks also chaired the agenda committee of the annual representative meeting.

A 30-minute open debate on euthanasia took place on Tuesday 28 June. The majority of the speakers opposed euthanasia. But in a striking departure from past procedures, no vote was taken. This was not the only departure: Liberal Democrat MP Evan Harris – another pro-euthanasia member of the ethics committee – was allowed to speak, even though he was not a delegate. Notwithstanding, the tenor of the debate confirmed what everyone knew: that three out of four British doctors would refuse to practise euthanasia even if it were legalised.

Based on the issues raised in the debate, the apparatchiks of the agenda committee drafted three motions. These were voted on two days later, on Thursday, only minutes before the end of the four-day meeting. Most of the nearly 450 delegates had already packed their bags. Only 175 actually voted.

Critics of the BMA’s decision claim that there had been a gentleman’s agreement to vote first on whether the status quo should be preserved. This would almost surely have passed. Instead, the first motion put to the meeting was whether the BMA should support euthanasia. Unsurprisingly, this failed by 101 to 73. Next came a vote on whether the BMA should withdraw its long-standing opposition. This carried by a vote of 93 to 82. Whether British doctors should uphold the status quo was never voted upon at all.

In short, a rigged vote by a fraction of delegates to the annual representative meeting made what is probably the most momentous decision in the BMA’s history.

Doctors who oppose euthanasia have every right to feel outraged and to demand a referendum of all members on this vital issue. Controlling an agenda, breaking unwritten agreements and manipulating a quorum have been standard fare in shady trade union ballots. But it beggars belief that eminent doctors and experts in medical ethics should use these Stalinist tactics to engineer a change in the BMA’s euthanasia policy and very soon, perhaps, a change in the law. It is a chilling start to debate on Lord Joffe’s Assisted Dying for the Terminally Ill Bill.

But perhaps we shouldn’t be too surprised. Expertise in medical ethics is no guarantee of integrity in political ethics, or indeed in any ethics. The experience of the Netherlands, where euthanasia has been legal since 2002, shows that deception is part and parcel of euthanasia legislation. Instead of making the process more transparent, Dutch doctors only report half of the people whom they put down. Why? There is too much paperwork.

Michael Cook is editor of the international bioethics newsletter, BioEdge. Email him at mcook@australasianbioethics.org.