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that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
It is normal practice for the BMJ to choose letters for publication
about 4 weeks after the corresponding articles have been published.
However, selected responses to “taking the final step: time to legalise
assisted dying?” were published just two weeks after the publication of
the original articles, which suggests that the letters for publication
were chosen little more than a week after publication of the original
articles. (1) Why was this and why did the chosen articles and the summary
of responses fail to fully reflect and fully fail to answer the profound
criticism levied against the BMJ and BMA on several important issues? Was
it because the BMJ wished to put a line under the subject even though
correspondence was still steadily coming in, most of it unsupportive of
assisted dying, the BMA’s attitude to assisted dying or suspicious of how
and why the BMA came to hold its position?
On 9 October 2005, I read all 126 responses to the editors choice
entitled “A time to die” that had been posted online on that date (2). In
my opinion, 101 were obviously opposed to the idea of assisted dying
legislation and only 3 were obviously supportive of it. The remaining 22
appeared to focus on major concerns regarding the BMA’s handling of the
issue; debate technicalities without explicitly stating the author’s own
position; or contain suggestions that were not directly related to the
theme of assisted death (such as the idea that patients attending their GP
with a cold might be denied antibiotic but asked if they had written a
living will because death should not be a taboo subject). I did not repeat
the exercise with such rigour for the 82 online responses to the five
articles on assisted dying in the same issue, but my general impression
was that the balance of opinion was much the same.
This is not a new phenomenon. I also looked at the 45 online
responses to “Right to die” (3) and found that 33 were obviously opposed
to the idea of such a right, 7 were in favour of it and 5 were unclear,
neutral or debated matters unrelated to the title of the editorial
(typically whether or not withholding treatment with death as a result was
the same as administering treatment with the deliberate intention of
causing death, without stating a view on a supposed right to death).
Does the BMA or BMJ have any intention of responding to the several
serious concerns and questions raised by numerous contributors to the
recent correspondence? By my reading and understanding of it, these fall
into three main areas: questionable editorial neutrality, concern that the
view of the BMA Ethics Committee is unrepresentative of the majority of
BMA members, and use of an unrepresentative vote to determine the BMA
position on assisted dying. I have attempted to summarise them below:
With regard to the professed neutrality of the BMJ:
• Why was neutrality not evident in the selection of the five
articles printed in the 24 September 2005 issue of the BMJ, which included
two articles in favour of assisted dying, one against assisted dying and
one which gave a most questionable justification for the BMA adopting a
neutral stance?
• Why was the article against assisted dying subject to a limit of
1,000 words whilst the others were apparently not?
• Is the fact that the title of the paper opposing assisted dying ran
to two whole lines of print an acceptable justification for initially
denying it a link on the BMJ home page for that issue of the journal?
• Why is it deemed that Branthwaite, a member and former chairman of
the Voluntary Euthanasia Society, has no competing interests regarding
assisted dying, whilst George and Jeffrey do have competing interests
because they gave oral evidence to the Select Committee on Assisted Dying
for the Terminally Ill Bill on behalf of the Association for Palliative
Medicine?
• Please could the editorial board of the BMJ declare their personal
views on assisted dying and euthanasia?
With regard to the BMA Ethics Committee, it is claimed that:
• The Chairman, Michael Wilks, has privately and publicly supported
euthanasia and physician-assisted suicide for many years. On these issues,
he has always distanced himself from the majority view of BMA members by
disagreeing that opposition should be the settled position of the BMA for
the foreseeable future even though, by his own admission, ‘the majority of
its members are opposed’. He appears to represent his own views rather
more than the majority opinion: is this a correct way for him to behave
when acting in this role?
• There are three co-opted expert members who are associated with the
Voluntary Euthanasia Society and who gave evidence in a private capacity
to the Lords’ Select Committee on Lord Joffe’s Assisted Dying for the
Terminally Ill Bill. The implicit question is: are there an equal number
of co-opted expert members who oppose assisted dying and euthanasia in
such an active manner?
• There is an opinion that the committee has become more liberal in
its attitude towards euthanasia and assisted dying over the last five
years in a way that grass-root BMA membership has not. It is now viewed
with circumspection by many BMA members who feel that some of its more
senior members hold controversial and unrepresentative views.
With regard to the assisted dying debate at the 2005 BMA Annual
Meeting, I can’t vouch for the validity of any of the claims made because
I wasn’t there, but it has been expressed that:
• None of the motions worded by BMA divisions were voted on.
• A non-official delegate with known associations to the Voluntary
Euthanasia Society was allowed to participate in the debate.
• A BMA Ethics Committee Member with pro-euthanasia sympathies
defended the neutral motion.
• Wilks drew up a consensus statement that ostensibly summarised the
open debate on Physician Assisted Suicide but actually over-promoted his
own views.
• Only motions drafted by the Agenda Committee, chaired by Wilks,
during the conference, also chaired by Wilks, were put to delegates at the
end of the conference, two days after the open debate had taken place and
after many of the delegates had gone home.
• The order of voting on motions was reversed. In the first vote, 58%
opposed and 42% supported lobbying in favour of assisted dying. 53%
subsequently agreed and 47% disagreed that, in the event of any
legislation being proposed, the BMA should withdraw opposition to assisted
dying but campaign for robust safeguards. Delegates were denied an
opportunity to vote for maintaining the former position of the BMA.
• Only 175 votes contributed towards the second of these votes which
has been used to represent the opinion of the whole BMA membership and has
reshaped BMA policy.
• The whole deabate and voting process has not been reported by the
BMA in a proper, open and detailed manner for the benefit of all its
members, so that they can see for themselves the strength of support for
the change in policy and decide for themselves whether the whole process
was fair and beyond all reproach.
Surely the official position of a trade union on such an important
subject should represent the majority view of its membership as determined
by fair and democratic means. The repeated overwhelming opposition to
assisted dying in the BMJ correspondence appears to contrast starkly with
the outcome of the votes at the 2005 BMA Annual Meeting. In view of this,
would the BMA consider a ballot of its whole membership for a more
representative view that inspires greater confidence? Would the BMA then
consider revising its own position if it is found to be unrepresentative
of the majority of its membership?
BMA Head of Ethics, Ann Sommerville, has said: “The BMA needs to
continue to be open to the voices of doctors who oppose its new policy”
(4). Therefore I hope that all of these concerns, which appear to be held
by several people, will be answered in print in the BMJ in the near future
as a demonstration of that openness and in order to correct any inevitable
misunderstandings that this letter might contain.
Thank you in anticipation of your response.
Yours sincerely,
1. Letters: Time to legalise assisted dying? BMJ 2005;331:841-843.
What are you playing at?
It is normal practice for the BMJ to choose letters for publication
about 4 weeks after the corresponding articles have been published.
However, selected responses to “taking the final step: time to legalise
assisted dying?” were published just two weeks after the publication of
the original articles, which suggests that the letters for publication
were chosen little more than a week after publication of the original
articles. (1) Why was this and why did the chosen articles and the summary
of responses fail to fully reflect and fully fail to answer the profound
criticism levied against the BMJ and BMA on several important issues? Was
it because the BMJ wished to put a line under the subject even though
correspondence was still steadily coming in, most of it unsupportive of
assisted dying, the BMA’s attitude to assisted dying or suspicious of how
and why the BMA came to hold its position?
On 9 October 2005, I read all 126 responses to the editors choice
entitled “A time to die” that had been posted online on that date (2). In
my opinion, 101 were obviously opposed to the idea of assisted dying
legislation and only 3 were obviously supportive of it. The remaining 22
appeared to focus on major concerns regarding the BMA’s handling of the
issue; debate technicalities without explicitly stating the author’s own
position; or contain suggestions that were not directly related to the
theme of assisted death (such as the idea that patients attending their GP
with a cold might be denied antibiotic but asked if they had written a
living will because death should not be a taboo subject). I did not repeat
the exercise with such rigour for the 82 online responses to the five
articles on assisted dying in the same issue, but my general impression
was that the balance of opinion was much the same.
This is not a new phenomenon. I also looked at the 45 online
responses to “Right to die” (3) and found that 33 were obviously opposed
to the idea of such a right, 7 were in favour of it and 5 were unclear,
neutral or debated matters unrelated to the title of the editorial
(typically whether or not withholding treatment with death as a result was
the same as administering treatment with the deliberate intention of
causing death, without stating a view on a supposed right to death).
Does the BMA or BMJ have any intention of responding to the several
serious concerns and questions raised by numerous contributors to the
recent correspondence? By my reading and understanding of it, these fall
into three main areas: questionable editorial neutrality, concern that the
view of the BMA Ethics Committee is unrepresentative of the majority of
BMA members, and use of an unrepresentative vote to determine the BMA
position on assisted dying. I have attempted to summarise them below:
With regard to the professed neutrality of the BMJ:
• Why was neutrality not evident in the selection of the five
articles printed in the 24 September 2005 issue of the BMJ, which included
two articles in favour of assisted dying, one against assisted dying and
one which gave a most questionable justification for the BMA adopting a
neutral stance?
• Why was the article against assisted dying subject to a limit of
1,000 words whilst the others were apparently not?
• Is the fact that the title of the paper opposing assisted dying ran
to two whole lines of print an acceptable justification for initially
denying it a link on the BMJ home page for that issue of the journal?
• Why is it deemed that Branthwaite, a member and former chairman of
the Voluntary Euthanasia Society, has no competing interests regarding
assisted dying, whilst George and Jeffrey do have competing interests
because they gave oral evidence to the Select Committee on Assisted Dying
for the Terminally Ill Bill on behalf of the Association for Palliative
Medicine?
• Please could the editorial board of the BMJ declare their personal
views on assisted dying and euthanasia?
With regard to the BMA Ethics Committee, it is claimed that:
• The Chairman, Michael Wilks, has privately and publicly supported
euthanasia and physician-assisted suicide for many years. On these issues,
he has always distanced himself from the majority view of BMA members by
disagreeing that opposition should be the settled position of the BMA for
the foreseeable future even though, by his own admission, ‘the majority of
its members are opposed’. He appears to represent his own views rather
more than the majority opinion: is this a correct way for him to behave
when acting in this role?
• There are three co-opted expert members who are associated with the
Voluntary Euthanasia Society and who gave evidence in a private capacity
to the Lords’ Select Committee on Lord Joffe’s Assisted Dying for the
Terminally Ill Bill. The implicit question is: are there an equal number
of co-opted expert members who oppose assisted dying and euthanasia in
such an active manner?
• There is an opinion that the committee has become more liberal in
its attitude towards euthanasia and assisted dying over the last five
years in a way that grass-root BMA membership has not. It is now viewed
with circumspection by many BMA members who feel that some of its more
senior members hold controversial and unrepresentative views.
With regard to the assisted dying debate at the 2005 BMA Annual
Meeting, I can’t vouch for the validity of any of the claims made because
I wasn’t there, but it has been expressed that:
• None of the motions worded by BMA divisions were voted on.
• A non-official delegate with known associations to the Voluntary
Euthanasia Society was allowed to participate in the debate.
• A BMA Ethics Committee Member with pro-euthanasia sympathies
defended the neutral motion.
• Wilks drew up a consensus statement that ostensibly summarised the
open debate on Physician Assisted Suicide but actually over-promoted his
own views.
• Only motions drafted by the Agenda Committee, chaired by Wilks,
during the conference, also chaired by Wilks, were put to delegates at the
end of the conference, two days after the open debate had taken place and
after many of the delegates had gone home.
• The order of voting on motions was reversed. In the first vote, 58%
opposed and 42% supported lobbying in favour of assisted dying. 53%
subsequently agreed and 47% disagreed that, in the event of any
legislation being proposed, the BMA should withdraw opposition to assisted
dying but campaign for robust safeguards. Delegates were denied an
opportunity to vote for maintaining the former position of the BMA.
• Only 175 votes contributed towards the second of these votes which
has been used to represent the opinion of the whole BMA membership and has
reshaped BMA policy.
• The whole deabate and voting process has not been reported by the
BMA in a proper, open and detailed manner for the benefit of all its
members, so that they can see for themselves the strength of support for
the change in policy and decide for themselves whether the whole process
was fair and beyond all reproach.
Surely the official position of a trade union on such an important
subject should represent the majority view of its membership as determined
by fair and democratic means. The repeated overwhelming opposition to
assisted dying in the BMJ correspondence appears to contrast starkly with
the outcome of the votes at the 2005 BMA Annual Meeting. In view of this,
would the BMA consider a ballot of its whole membership for a more
representative view that inspires greater confidence? Would the BMA then
consider revising its own position if it is found to be unrepresentative
of the majority of its membership?
BMA Head of Ethics, Ann Sommerville, has said: “The BMA needs to
continue to be open to the voices of doctors who oppose its new policy”
(4). Therefore I hope that all of these concerns, which appear to be held
by several people, will be answered in print in the BMJ in the near future
as a demonstration of that openness and in order to correct any inevitable
misunderstandings that this letter might contain.
Thank you in anticipation of your response.
Yours sincerely,
1. Letters: Time to legalise assisted dying? BMJ 2005;331:841-843.
2. Rapid responses to “A time to die”.
http://bmj.bmjjournals.com/cgi/eletters/331/7518/0-g (Accessed 09/10/05)
3. Rapid responses to “Right to die”.
http://bmj.bmjjournals.com/cgi/eletters/330/7495/799 (Accessed 09/10/05)
4. Sommerville A. Changes in BMA policy on assisted dying. BMJ
2005;331:686-688.
Competing interests:
Hospice Doctor
Competing interests: No competing interests