Debates on medical ethics need balance and nuance, not sensationalism

Anthony McCarthy’s recent article on spiked about the British Medical Association’s new guidance for doctors on caring for patients who elect to voluntarily stop eating and drinking to hasten death requires some clarification. As an ethicist, Dr McCarthy will understand all too well the importance of balance and nuance in discussing what are often emotive and deeply divisive issues that can be over-simplified and sensationalised.

As chair of the BMA’s medical-ethics committee, which developed this guidance, I hope we can provide this clarification and balance to readers.

Dr McCarthy accuses the BMA of ‘promoting the idea that doctors should assist in the suicide… of patients under their care’. This is fundamentally untrue and completely misunderstands what this guidance is. There is no connection between providing good care for this group of patients and the debate about physician-assisted dying, where the BMA is neutral and neither promotes nor opposes either the principle or any attempts to change the law. This has been our position since 2020 and we have made this clear throughout the legislative journey of recent bills across the UK and Crown Dependencies.

Crucially, this guidance is a factual summary of the legal position in the UK as set out by the courts, not a policy decision by the BMA, nor any kind of moral judgment, as Dr McCarthy suggests. In the UK, patients (with the mental capacity to do so) have always had the right to refuse treatment even if that results in their death; this principle extends to the refusal of food and fluids. Patients cannot be forced to eat or drink against their wishes, and providing symptom relief to patients who refuse treatment (or food or drink) is a humane act that is fundamentally different to taking active steps to end a patient’s life. This has long been an accepted legal and ethical distinction.

Our guidance was published as a result of it becoming increasingly clear that many doctors were unsure about the support and symptom management they can legally and ethically provide to patients in this situation. As part of our work as a professional association, we often provide best-practice guidance based on the law and regulatory requirements.

While frequently invoking Hippocrates and a 2,000-year-old oath that has no legal or regulatory standing, Dr McCarthy ignores the established law on patients’ capacity to make decisions around their own medical care, or refusal of it. Dr McCarthy also ignores that doctors also have a duty to relieve suffering. By agreeing to provide support and symptom management in accordance with the law, medical ethics and good practice, and then providing that support and symptom management as and when appropriate, doctors can minimise the patient’s discomfort and pain, thereby circumventing further harm to the patient before their death.

By using sensationalist analogies like ‘one day those intent on drowning themselves will be offered handy advice on overcoming hydrophobia as part of their “care”’, Dr McCarthy is trivialising a very real and distressing dilemma for doctors and patient carers.

The more difficult and distressing a subject is, the more we have a duty to our members to ensure that they are clear about what they can and cannot do, both legally and ethically. Articles such as this, that misrepresent what we are doing, help no one – including vulnerable patients.

If campaigners wish to challenge the law, then that is well within their rights, but they should take aim at the lawmakers, rather than those helping the frontline workers navigate its complexities.

Dr Andrew Green is chair of the British Medical Association’s medical-ethics committee.