British Medical Journal publishes euthanasia opinions

Next month's debate in the House of Lords could begin the process of changing the law on euthanasia and physician assisted suicide. To help doctors decide where they stand, the British Medical Journal has published a range of opinions.

People who want assisted suicide should have the same rights as patients who can end their lives by refusing life sustaining treatment, argues retired barrister Margaret Branthwaite.

She points out that public support for legislation to permit assisted dying has grown from 69% in 1976 to 82% in 2004, and that most professional bodies have now adopted a neutral stance.

Data from countries where assisted dying has been legalised also answer some of the concerns expressed by opponents of the proposed legislation, she adds. For example, in the US state of Oregon, the number of assisted suicides has changed little under Oregon's Death with Dignity Act.

These views are echoed in an ethical analysis by Professor Torbjorn Tannsjo, who argues that a system for euthanasia would mean that people could approach the terminal phase of their lives without fear. "They would know that, if, when their turn comes, and things turn out to be terrible, they have a way out," he writes.

But in another article, senior palliative care doctors warn that legalised euthanasia would leave vulnerable groups open to therapeutic killing without consent.

Rob George and colleagues argue that assisted suicide cannot be separated from euthanasia, and reject the arguments that legalised euthanasia promotes autonomy of the dying in general or that any safeguards are ethically sustainable.

Before another bill is laid before parliament, doctors must consider all the moral and practical implications of legalisation, they write.

The adequacy of safeguards in any proposed legislation will also be a priority for the British Medical Association, which has recently adopted a neutral policy on assisted dying. From the BMA's perspective, a neutral position entails a campaign for better palliative care, robust safeguards for patients, training and support for health professionals, and clear conscientious objection clauses.

Finally, research among doctors in the Netherlands shows that, although with the introduction of review procedures for euthanasia and physician-assisted suicide the public oversight and legal control has increased, almost half of all euthanasia and physician assisted suicide are still not reported.