BMJ 2002;325:66 ( 13 July )
Linda Beecham BMJ
Doctors at the annual representative meeting of the BMA last week debated whether the 1961 Suicide Act should be amended. The high profile cases of Diane Pretty, who wanted her husband to be allowed to help her to die without fear of prosecution, and of Miss B, who successfully asked for treatment to be withdrawn so that she could die, were the background to the debate.
Despite speeches in support of changing the law, the meeting decided, by 96 votes to 82, that it was not "necessary and desirable" to amend the act "to take account of mentally competent individuals who wish to take their own lives but are physically incapable of so doing."
The motion was not about euthanasia or physician assisted suicide, according to the motionís proposer, Dr Alex Freeman, a GP in Southampton. It was about patient autonomy. The 1961 act replaced earlier legislation that made suicide a crime. The act was now out of date and should be amended for a very small number of people.
Dr Robin Arnold, a consultant psychiatrist in Bristol, agreed. Pain could not always be treated, he said. He recalled a patient with motor neurone disease who lost the ability to swallow. "We saw the look of panic in her eyes as she began to drown in her own saliva," Dr Arnold said. Because of the law no one had been able to discuss with the patient what she wanted to do. The issue of indignity should not be ignored.
The chairman of the medical ethics committee, Dr Michael Wilks, said that although the motion referred to the Suicide Act it could not be separated from physician assisted suicide. The BMA had a policy on this, but it could be changed.
Giving a personal view, Dr Wilks said that there was now a well established gap between what the law said about physician assisted suicide (that it was a serious offence punishable by up to 14 years in prison) and what the courts actually did in cases like that of Mrs Pretty. Relatives who helped someone to die were rarely treated harshly by the courts.
This gap was unhelpful and caused great distress. He thought that there was a case for considering amending the Suicide Act, not to decriminalise physician assisted suicide but perhaps to make it a lesser offence.
Opposing a change in the law, a GP in Folkestone, Dr Hugh Robertson-Ritchie, said that if the late Diane Pretty had had her wish and her husband had been allowed to help her to die, doctors would be drawn into helping patients commit suicide, and that would be unethical. A doctor would have to make a diagnosis, make a prognosis, confirm that the patient wanted to die, confirm that the patient was not mentally ill, prescribe a means of suicide, and confirm death.
Dr Anthony Cole, a consultant paediatrician in Worcester, said that the law had been changed in 1961 for compassionate reasons. It was no longer a criminal offence to commit suicide. But there was never an intention to grant a right to die. He reminded the meeting that in the Diane Pretty case judges had said that it was difficult to draw a distinction between helping someone to die and homicide. The law could not be amended in isolation.
A consensus conference on physician assisted suicide in 1999 had decided
that there was no need to change the law, and this had been endorsed by
the annual meeting in 2000. "We should not vote for a U turn on a such
a vital matter that has already been exhaustively debated," he said.
© 2002, BMJ