Forthcoming RCoA member survey on assisted dying

Published: 17/06/2024

Assisted dying (or assisted suicide) is a sensitive subject about which members may have differing and strongly held views.

Although currently illegal in the UK, the question of whether the law should change to allow assisted dying under certain circumstances is increasingly a topic for public debate. So far this year there has been a parliamentary debate in response to a public campaign for a change in the law, a Member’s Bill introduced to the Scottish Parliament and a report from the Health and Social Care Committee’s Inquiry into assisted dying/assisted suicide. Changes in the law are being considered in the Isle of Man and Jersey.

The College currently has a ‘no stance’ position on assisted dying, which means we do not actively contribute to public debate on the subject. As members, your views are of course crucial, and we would like to know what you think about assisted dying so that Council can consider whether to change or maintain the College’s ‘no stance’ position.

Next month we will invite all members to complete a short survey on assisted dying. The survey will be anonymous and advisory to Council. It is not a mandate for the College to take any particular action but will enable Council to have an informed discussion based on your views. This discussion will not take place until much later this year – for now we remain focused on our work to implement the resolutions from the 2023 Extraordinary General Meeting. But we encourage all members to consider responding to the survey so that we can fully understand your views.

The survey questions have been developed by our Ethics Committee and agreed by Council. All members of the Royal College of Anaesthetists and the Faculty of Pain Medicine will be invited to complete the survey, which is being conducted on our behalf by independent research agency Research By Design. The findings will be reported to Council by Research by Design and we will publish the report.  

All members will receive an email from Research by Design with a link to the survey on 2 July 2024. In the meantime, we have provided below some information about the questions the survey will ask and some links to relevant resources that you may find helpful.  

What is assisted dying?

A research briefing published by the Parliamentary Office of Science and Technology in 2022 defines assisted dying as: “The involvement of healthcare professionals in the provision of lethal drugs intended to end a patient’s life at their voluntary request, subject to eligibility criteria and safeguards. It includes healthcare professionals prescribing lethal drugs for the patient to self-administer (‘physician-assisted suicide’) and healthcare professionals administering lethal drugs (‘euthanasia’).”

What is the current law on assisted dying?

In England and Wales, suicide or attempted suicide are not criminal offences. However under section 2(1) of the Suicide Act 1961 it is an offence for a person to act in a way which is “capable of encouraging or assisting the suicide or attempted suicide of another person,” and to act in a way which was “intended to encourage or assist suicide or an attempt at suicide.”

In Northern Ireland, ‘assisting or encouraging’ the suicide of another is illegal under section 13 of the Criminal Justice (Northern Ireland) Act 1966, which extends the Suicide Act 1961 to Northern Ireland.

The law on assisted dying is devolved in Scotland and is covered by common law. A briefing published by the Scottish Parliament Information Centre in 2015 notes: “The legal position relating to assisting a suicide in Scotland has not been clarified by case law. However, there would appear to be a number of possible crimes in Scots law, including murder, culpable homicide and reckless endangerment.”

What questions will the survey ask?

The survey will ask members for their views on what they think should be the College’s position on a change in the law regarding two scenarios:

  • Allowing a doctor to prescribe drugs so that an eligible patient can self-administer them to end their own life.
  • Allowing a doctor to administer drugs to end an eligible patient’s life.

What constitutes ‘eligibility’ would be set out in any piece of legislation, but for the purposes of our survey we are assuming that the criteria for ‘eligible patients’ would fall within the following boundaries to cover patients who:

  • are adults;
  • have the mental capacity to make the decision;
  • have made a voluntary request; and 
  • have a progressive condition where death within six months in consequence of that condition could reasonably be expected.

For each scenario, members will be asked to select whether they think the College should:

  • Actively support attempts to change the law (‘Supportive’)
  • Actively oppose attempts to change the law (‘Opposed’)
  • Neither actively support nor actively oppose attempts to change the law (‘Neutral’)
  • Retain its current position of ‘no stance’

Members will also have the option of selecting none of the above and registering their view as ‘I am undecided’ or ‘I would rather not say’.

Members will be invited to expand on their views via a free text field if they so wish.

Resources to support consideration

1. Parliamentary briefings/reports

House of Commons Library Research Briefing: The law on assisted suicide, 25 April 2024

  • This briefing explains the law on assisted suicide in England and Wales. It examines recent parliamentary activity, developments in other legal jurisdictions, human rights challenges, and stakeholders' views.

Health and Social Care Committee report: Assisted Dying/Assisted Suicide, 20 February 2024

  • Report of the Health and Social Care Committee’s Inquiry into assisted dying/assisted suicide. The report is intended to provide a broad body of evidence to help inform future debates on assisted dying. It covers parliament and the current law, international examples of jurisdictions where assisted dying is available, the involvement of physicians and assessments of eligibility and capacity to give informed consent, and palliative and end-of-life care.

Parliamentary Office of Science and Technology (POST) Research Briefing: Assisted Dying, 26 September 2022

  • This POST brief provides a brief overview of assisted dying, including ethical debate and stakeholder opinion. It examines how assisted dying functions within health services in countries where it is a legal option, focusing on jurisdictions where most data are available on outcomes: Belgium, Canada, the Netherlands, Oregon (United States), Switzerland and Victoria (Australia).
2. Bulletin and journal articles

Members will need to login to My RCoA to read these Bulletin articles.

Assisted Dying and the Royal College of Anaesthetists, Dr David Bogod, former Chair of the College’s Ethics Committee, October 2022  

  • Dr David Bogod’s personal perspective on the ethical and practical arguments in favour of assisted dying.

Euthanasia: ‘no opinion’ is not neutral and a valid expression of some truths, Dr Barry Miller, Former Dean, Faculty of Pain Medicine, July 2023

  • Dr Barry Miller’s personal perspective on the question of whether the College should change its ‘no stance’ position.

The debate rages on: physician-assisted suicide in an ethical light (Dr John Shenouda is a member of the College's Ethics Committee)

  • Shenouda J. Blaber M. George R. Haslam J. (2024). ‘The debate rages on: physician-assisted suicide in an ethical light.’ British Journal of Anaesthesia, 132(6), p1179-1183. DOI: https://doi.org/10.1016/j.bja.2024.01.002

Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying

  • Sinmyee S, et al. (2019). ‘Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying.’ Anaesthesia, 74(5), p630-637. DOI: https://doi.org/10.1111/anae.14532

General anaesthesia in end-of-life care: extending the indications for anaesthesia beyond surgery

  • Takla A, et al. (2021). ‘General anaesthesia in end-of-life care: extending the indications for anaesthesia beyond surgery.’ Anaesthesia, 76(10), p1308-1315. DOI: https://doi.org/10.1111/anae.15459
3. Recent proposals to change the law in the UK and Crown Dependencies

Assisted Dying for Terminally Ill Adults (Scotland) Bill, introduced to the Scottish Parliament on 27 March 2024

  • This bill was introduced to the Scottish parliament by Liam McArthur (Scottish Liberal Democrat and MSP for Orkney Islands). If enacted, it will allow terminally ill adults in Scotland to lawfully request and be provided with assistance by health professionals to end their own life.

Government of Jersey: Assisted Dying in Jersey

  • Jersey is considering proposals to allow assisted dying. This resource includes details of who would be eligible for an assisted death and how the proposed assisted dying service would work.

Assisted Dying Bill 2023, introduced to the Isle of Man Parliament (Tynwald)

  • This Private Members Bill was introduced to the Tynwald by Dr Alex Allinson. If enacted it will enable certain adults who are terminally ill to be provided at their request with specified assistance to end their own life.

House of Lords Library, Assisted Dying Bill (not passed)

  • This Private Member’s Bill was introduced by Baroness Meacher in October 2021. It intended to create a legal framework to allow a terminally ill patient to end their life, provided they have the consent of two medical practitioners. The High Court would also have to provide consent. The bill proceeded to committee stage but ran out of time before the parliamentary session ended.
4. Resources from other jurisdictions 
5. Relevant reading from related organisations
  • The Royal College of Surgeons of England changed its position on assisted dying from opposition to neutral in 2023, informed by a survey of its members.
  • The British Medical Association changed its position on physician-assisted dying from opposition to neutral in 2021, informed by a survey of its members. The BMA website includes a range of resources on assisted dying including the current law in the UK and around the world and surveys of public and professional perceptions.
  • The Royal College of General Practitioners is opposed to a change in the law on assisted dying, informed by a survey of its members in 2020. In 2023, the RCGP Council gave the go-ahead for a working group to be set up to ensure that the College is prepared for any potential changes in the law on assisted dying across the UK.
  • The Australian and New Zealand College of Anaesthetists has a neutral position on assisted dying, as set out in its position statement.
  • The Royal College of Physicians of Ireland (RCPI) opposes the introduction of any legislation supportive of assisted suicide.