Doctors split on assisted dying – Doctors.net.uk survey
20 November 2023
Getty/sittithat tangwitthayaphumBy Sarah Lowden
Doctors remain fairly evenly split on whether physician-assisted dying should be legalised, as the political debate on the issue progresses, a survey by Doctors.net.uk has found.
Almost 48% of respondents were against legalising it, while nearly 45% said they supported the prospect. And a majority said a physician-assisted dying (PAD) law would negatively impact the medical profession.
More than 1,000 GMC-registered members responded to an online survey in October, which asked for doctors’ views on whether physician-assisted dying should be legalised, and explored to what extent they would be prepared to be involved in the process.
Physician-assisted dying is currently an offence in England, Wales and Northern Ireland. In Scotland, a person assisting in a suicide can be prosecuted under related crimes, such as murder.
As a new law is soon to be proposed in Scotland, this survey has captured a current snapshot of views across the UK’s medical profession to hopefully better inform further discussion.
The headline result is not dissimilar from the findings of a British Medical Association survey in 2020.
It found 50% of respondents supported a change in the law, 39% were opposed and the rest were undecided. This helped inform the BMA’s vote on its physician-assisted dying policy, which resulted in it moving from an opposed to a neutral position in September 2021.
This latest survey comes as some movement is being made towards potentially legalising physician-assisted dying in some areas.
The Isle of Man could become the first part of the British Isles to enact a law. A proposal to allow terminally ill, mentally competent adults to choose an assisted death has been backed by its parliament, but there are further steps yet to go through.
In Scotland, a new bill is expected to be published before the end of the year, in a fresh attempt to get the measure enacted.
And at Westminster, the Health and Social Care Committee is to publish its findings following an Assisted Dying/ Assisted Suicide Inquiry it held earlier this year.
‘Risk of coercion’
The two most popular reasons against legalising were ‘to protect vulnerable people from risk of coercion’, and because the ‘focus should be on improving palliative care’.
Total number of respondents: 521
Some of the other reasons doctors gave for saying ‘no’:
“Mission creep to apply legislation to groups it would never have been intended for at the outset.”
“It is an unwelcome slippery slope that the profession does not need at a time of low morale and staffing challenges.”
“Current culture in NHS or UK does not guarantee the possibility of proper regulation.”
“It is not necessary. The vast majority of deaths are comfortable and pain free.”
“As a doctor I want to preserve life and improve peoples quality of life, I wouldn't feel comfortable prescribing medications to end their life.”
“It influences the value system of a society as a whole, how we value life, care, vulnerability, what exactly we value in being alive, what it means to be human and what to be humane.”
‘To give patients dignity’
Among those responding in support, more than nine in ten respondents said ‘to prevent suffering’ and ‘to give patients dignity in their final days’ were reasons they held that view. Respondents could select as many reasons as they liked from a list and add their own.
Total number of respondents: 488
Some of the other reasons doctors gave for saying ‘yes’:
“To shift the balance in our later years to quality rather than quantity of life, towards a good and timely death instead of life at any cost.”
“To reduce the suffering of patients and their relatives and possible neglect or abuse specially in those with Dementia.”
“To provide reassurance to patients that this option is open, perhaps preventing them from taking premature decisions about either suicide or travelling abroad for physician-assisted dying.”
“To enable those who would not be physically able due to their terminal condition be able to end their own life.”
“Doctors should be able to ease the suffering of patients in their final days.”
“We put down animals to prevent their suffering; why do we not do it with human beings too?”
Doctors’ involvement
Doctors were also asked how involved in the process they would be willing to be, should assisted dying be legalised.
Nearly six in ten (58%) said they would provide information or have a discussion with a patient about it, with three in ten unwilling to do so. A minority of respondents said they would be willing to go further, by either prescribing (37%) or administering lethal drugs (27%).
| Scenario | Yes | No | I don’t know |
| Provide information or have a discussion with a patient | 58% | 31% | 11% |
| Prescribing drugs to a patient to self-administer* | 37% | 53% | 9% |
| Administering drugs to a patient* | 27% | 59% | 13% |
| Total number of respondents: 1,088 | *subject to eligibility criteria and safeguards |
Half said it would ‘negatively impact’ the profession
The final question sought to find out what perceived impact a law change might have on the medical profession.
More than a quarter (26%) thought it would have a positive impact, but nearly half (47%) thought the opposite. One in ten (11%) believed it would have a neutral impact and 16% were unsure.
End-of-life care is primarily a concern for palliative care doctors, oncologists and GPs.
Among the palliative medicine group (51 respondents) there was a clear majority opposed (73%), with 18% saying it should be legalised.
The largest single specialty to answer the survey were GPs, with 337 respondents. Within this group, half (52%) said it should not be legalised, 40% said it should, the rest said ‘I don’t know’.
‘Undermine trust’
There was a common concern among this group, with many saying that legalising PAD would risk undermining the trust between doctors and their patients.
Others were concerned about it leading to conflict with colleagues, and an increased administrative burden. Some said they would resign from the NHS.
One doctor said it would change the nature of medicine “from improving and preserving life to also include removing life”.
Another simply said it would “end the NHS”.
Increasingly out of touch?
But a GP in support said their role was to “prevent suffering”. Another warned: “The medical profession is looking increasingly out of phase with the views of the public.”
In July 2023, an Ipsos MORI survey suggested nearly two-thirds of adults in the UK were in support of legalising it, while 17% were opposed and 14% unsure.
In the last few years, some of the royal colleges have moved from a position of opposition to one of neutrality, after surveying their members. They include the Royal College of Physicians, which explained its reasoning at the time, and the Royal College of Surgeons.
Whatever happens next along the path of political and moral debate, the disagreement among the doctor community is showing no sign of changing.
And there are still many questions about the practical implications for doctors and their patients, and how safeguards would be implemented.
The online survey was hosted on Doctors.net.uk between 25 October and 1 November 2023 and was completed by 1,088 practising GMC-registered doctors. The survey consisted of 12 questions. No financial incentive or prize was offered for taking part. The respondents were told their answers would be kept anonymous.
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