RCP consultation: key takeaways

more: Articles, Medical Opinion, Articles/Medical Opinion

16th April 2019

According to a specialty by specialty breakdown, the closer respondents to this year's Royal College of Physicians' consultation were to the care of dying people, the more likely they were to be opposed to assisted suicide

When the Royal College of Physicians announced they were changing the rules for their latest consultation on assisted suicide - that rather than adopt the most favoured stance among members, they would move to neutral unless two thirds (later 60%) favoured an alternative stance - it looked likely that the shift was a done deal. And so it came to pass: opposition, still the most favoured, was dropped in favour of neutrality, the least favoured.

The College has subsequently published a specialty-by-specialty breakdown of the results, and they make for very interesting reading.

No to neutrality

First, not a single specialty saw a majority in favour of the College going neutral. Neutrality secured a plurality in just one, anaesthesia - where 6 of 13 respondents favoured the new stance.

Closer to dying people, further from assisted suicide

The best-represented specialties were those closest to the patients an assisted suicide law would affect: of the 6,885, 10.98% (c 756) were from geriatric medicine, 8.25% (c 568) were from palliative medicine and 8.05% (c 554) were from respiratory medicine.

Palliative medicine professionals remain overwhelmingly against assisted suicide: 80.9% wanted the College to remain opposed, and 84.3% expressed personal opposition (with personal support for a change in the law in single digits). The Association for Palliative Medicine's leading role in opposing the RCP's mooted move this year was justified: these numbers actually represent increased opposition within the specialty, when we recall that a 2015 APM members' survey found that 82% were opposed, with 72% saying passage of a Falconer-type bill would have an adverse effect on the delivery of palliative care.

Similarly, remaining opposed was the clear winner for geriatric (44.1%) and respiratory (48.3%) specialists, while both saw overall majorities for personal opposition - 52.3% and 54.6% respectively. Geriatric medicine is the largest specialty in the country, and its doctors confront the frailties, fears and pressures old age can bring. Respiratory specialists play a key role in caring for patients with conditions like that of campaigner Noel Conway (Motor Neurone Disease), whose legal challenge to the protections of the law on assisted suicide failed to convince the courts.

The few larger specialty groups (c100 or more respondents) where support for assisted suicide was more significant are not typically associated with - or, perhaps, as experienced in - care of the dying. These included genito-urinary medicine (sexual health) and dermatology (skin).

The smaller the number of respondents from a specialty - and thus the less representative the sample - the greater the likelihood of a pro-assisted suicide majority, likely encouraged by pro-assisted suicide campaigners. No specialty with more than 50 respondents saw a majority for moving the college in favour.

Assisted suicide has no place in medicine

Respondents were asked:

'Regardless of your support or opposition to change, if the law was changed to permit assisted dying, would you be prepared to participate actively?'

The geriatric, palliative and respiratory specialists were, again, among the strongest opponents, with 57.9%, 84.4% and 63.5% respectively saying they would not assist their patients' deaths. A majority of respondents in a majority of specialties said the same, and no specialty with more than three respondents saw a majority for 'yes'.

The clear message, which the Council should have taken into account before announcing that they were to adopt the least favoured stance, was that their members and fellows clearly feel that assisted suicide is incompatible with the practice of medicine. Overall, 55.1% of respondents said 'no', with fewer than a quarter saying 'yes'.

So?

The RCP's new stance is the product not of a change on the part of doctors, but of a rule change decided in a closed room, in such a way that the chair and two members of the College's own ethics committee resigned. Opposition is still the most favoured stance for doctors, and among those working closest with dying people, the 'no' is as loud and clear as ever.