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Doctors & prosecution guidelines

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11th March 2014

BMA past president tells the House of Lords that claims that prosecutorial guidelines 'inhibit' doctors are 'unfounded'

Doctors & prosecution guidelines

Baroness Hollins was speaking in a House of Lords debate considering the Director of Public Prosecutions' guidelines on dealing with assisted suicide cases. The crossbencher, who is a past president of the BMA and the current chair of the BMA Board of Science, spoke to refute claims that doctors feel inhibited in talking to dying patients by prosecutorial and professional guidance (also the subject of 'Martin's' action in the courts, alongside but distinct from Nicklinson and Lamb). Lady Hollins' comments are reproduced below; they can be seen in context here.

'My Lords, the current policy for prosecutors provides a clear picture of how prosecution decisions are made in this area of the law and what kind of circumstances might influence a decision to prosecute. But it also avoids sending the message that assisting someone to commit suicide is permissible under certain circumstances.

[...]

'One factor listed in the policy for prosecutors as a potential aggravation of the offence is a circumstance whereby assistance with suicide has been provided by a doctor or a nurse to a patient under their care. Some, including the noble Baroness, Lady Jay, have claimed that this factor inhibits discussion between doctor and patient—that doctors are afraid to discuss the subject of assisted suicide with patients who raise it, in case such discussions should be construed as assistance and result in charges being brought against them. This claim is unfounded. The position was made quite clear last year in guidance issued by the General Medical Council, which I quote in full:

"Where patients raise the issue of assisting suicide, or ask for information that might encourage or assist them in ending their lives, doctors should be prepared to listen and to discuss the reasons for the patient's request but they must not actively encourage or assist the patient as this would be a contravention of the law".

'I will also quote some of the evidence heard by the group chaired by the noble and learned Lord, Lord Falconer, when it examined assisted suicide in 2011.

"We don't get asked about this very often",

'said a representative of the GMC.

"It's a subject which actually is a small issue in terms of numbers for our members",

'said the Medical Protection Society.

"I've not heard any colleagues mention it to me",

'said a consultant in old-age psychiatry. The group was told even more explicitly by the medical director of a hospice that,

"it's quite clear that we can have discussions with patients. It's the act of doing something with the intention of causing death that is illegal".

'These are all statements that concur with my own experience as a doctor and a psychiatrist. This is a criticism of the policy for prosecutors which simply will not fly. Doctors are not afraid to talk to patients about death and dying, and clear professional guidance is available for them, including from the BMA. The policy for prosecutors is carefully balanced. That some have chosen to misread it is regrettable.'

Later in the debate, a 'cross' Baroness Murphy stated that

'I should also like to say to my two medical colleagues... Lady Finlay and Lady Hollins, that, if their patients do not talk about dying or the wish to die when they are terminally ill, I just do not think they are listening very well...

'Of course people talk about this. They do not sit there quietly. I read the BMA guidelines again today to make sure that I was up to speed—being a member of the BMA, I would, wouldn't I?—and I can tell your Lordships that they make it very clear that you must not discuss any of these issues.'

Lady Murphy wisely chose not to tackle the crystal clear guidance issued by the General Medical Council, quoted by Lady Hollins (you can read it here) but rather than accuse respected colleagues from across the profession of not listening, she would do well to reread the BMA's guidance which is, contrary to her assertion, similarly clear even giving contact details for doctors seeking case-specific advice. Download it here.

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