IN THE HALF-MILLENNIUM since it was founded the Royal College of Physicians has seen plenty of squabbles, including the storming of its building in the 18th century over its exclusion of non-Oxbridge graduates, and a long battle over whether to admit women (which, after four centuries, it did). The latest row is over one of the most fundamental medical questions of all: should doctors help willing patients to die?
The college is surveying its 35,000 members on whether to back changes to the law on assisted dying, which is illegal in Britain. Five years ago 44% of them voted against and 25% in favour (the rest were neutral). Under the rules then, the plurality of votes against changing the law was enough to carry the day. This time, the college has decided that a supermajority of 60% is needed for either side to win. Since neither the pro nor anti doctors are expected to reach this threshold, the organisation looks likely to default to a neutral stance.
This has provoked fury among medics who oppose assisted dying. Some have accused the college of a “stitch-up”. A former chairman of its ethics committee, John Saunders, has threatened legal action over what he called a “rigged” vote. Further inflaming the row is the presence on the college’s governing council of a handful of prominent supporters of Dignity in Dying, a campaign group which backs assisted suicide and which wants the college to take a neutral position on the issue.
The contretemps inside the college comes just as the question of assisted dying is back in the headlines. In November Noel Conway, who is terminally ill with motor-neurone disease, lost a Supreme Court bid to overturn the ban on assisted suicide. Earlier this month Geoff Whaley, an 80-year-old with the same condition, became the latest Briton to travel to the Dignitas clinic in Switzerland to end his life. His last act was to release an open letter which castigated the British authorities for investigating his wife for helping him to make his final journey.
Despite the heightened pitch of campaigning, the matter is at an impasse. Judges have declined to rule on cases such as Mr Conway’s, insisting that it is the job of Parliament, not the courts, to legalise assisted dying. Some eight in ten voters would like to see such a change. But it is more than three years since MPs debated an assisted dying bill. Although that effort, led by a Labour backbencher, Rob Marris, was overwhelmingly rejected, Dignity in Dying has said it will renew its efforts in Westminster given the stalemate in the courts.
It is this return to the legislature that has spooked some doctors. Several medics campaigning against the college’s poll pointed to other jurisdictions, such as Canada and California, that have recently introduced assisted dying. Shifts to neutrality by local doctors’ associations were cited by activists and politicians as evidence that the medical profession was no longer opposed, helping to clear the ground for a change in the law.
Andrew Goddard, the college’s president, has pledged not to campaign for assisted dying should the college abandon its opposition. But this has not assuaged his critics. “Neutrality is not a position, it’s a cop-out,” despairs Amy Proffitt, a palliative care consultant who opposes assisted dying. The requirement of a supermajority was designed to prevent acrimony should the vote end in a wafer-thin margin for one side or the other. The results of the poll will not be known until March, but that hope already seems dashed.