Many NHS workers would use a ‘conscience clause’ if assisted death were legalised, doctors say
A significant proportion of NHS medical staff in England and Wales are likely to apply a ‘conscience clause’ if assisted dying is legalized by Parliament.
Labor MP Kim Leadbeater’s bill stipulates that no doctor would have any obligation to participate in assisted dying.
The British Medical Association (BMA), which holds a neutral position on assisted dyinghas said that doctors should be required to proactively sign up for an assisted dying process, and have the right to refuse activities directly related to assisted dying. It wants doctors to be given a “real choice about whether, and to what extent, they are willing to participate”.
Surveys by professional organizations found a mixed answer. In 2023, the Royal College of Surgeons found that 53% of respondents to a survey were in favor of assisted dying and 25% opposed.
In 2019, a Royal College of Physicians survey found 31% in favor and 43% against; and a Royal College of GPs poll in the same year found 40% in favor and 47% against. A BMA research in 2020 found that 50% were in favor of assisted dying, while 39% were against.
Some NHS medical staff are against assisted dying due to religious beliefs. According to a 2014 report, almost seven in ten NHS workers had a religious affiliation. An estimated 10% of current NHS staff are Muslim.
Prominent faith leaders, including the Archbishop of Canterbury (who announced his resignation this week), the highest-ranking Catholic leader in England and Wales, several imams and the Chief Rabbi, have spoken out against assisted dying in recent weeks.
Christian Concern, an evangelical organization that supports legal cases involving Christian workers, including NHS staff, said it planned to “oppose the bill at every stage” but would “do everything we can to ensure conscientious objection ” if it were to become law.
Mark Pickering, a doctor and director of the Christian Medical Fellowship, which has about 4,500 doctors, nurses and midwives as members, said a “conscience clause” could only provide limited protection.
“I don’t foresee a situation where someone is forced to actually prescribe the medication so that someone can commit suicide. But in Canada, for example, there have been significant issues of conscience.”
A spokesperson for Leadbeater said: “Christians, Muslims and others are protected and cannot be subject to any harm from their employers if they choose not to participate.”
Under Canadian law, health care professionals who object to assisted death are required to make an “effective referral” to a physician willing to provide the service.
“Many of our members would see that as morally problematic. Because if you say, ‘I don’t want to shoot Grandma, but I’ll send her to someone who will,’ there’s not much of a moral difference,” Pickering said.
David Randall, a kidney consultant, said his Christian faith had influenced his opposition to assisted dying, but his main concerns were about the risks to vulnerable people and the trust between doctor and patient.
The issue of assisted death was “so far removed from what I experience in the multi-ethnic, deprived areas of London where I work. One of the biggest problems is the lack of trust in medicine.”
Randall said he’s seen people show up late with advanced kidney disease due to a reluctance to see their doctor. Some were suspicious of treatment and care, and sometimes unwilling to participate in discussions about palliative care, seeing it as a way to ration expensive treatments.
“These people already face significant health inequalities in our society. There is a lot of distrust about assisted suicide among ethnic minority communities, some of it cultural, some of it religious. Many of them feel this is a way to deny them health care. Assisted suicide is not driven by ethnic minorities or disadvantaged communities,” he said.
Even with a “conscience clause” included in the legislation, he said: “I don’t see it being long before doctors are required to open conversations with patients about assisted suicide, and that’s not something I want to do.”
A survey of members of the British Islamic Medical Association This year it emerged that around nine in 10 doctors were against prescribing or administering life-ending drugs, and 56% said the legalization of assisted dying would affect their career choice.
Nadia Khan, a palliative medicine consultant in Birmingham, said the “vast majority” of Muslim healthcare professionals were against the assisted dying bill “due to practical and ethical concerns, quite apart from their religious beliefs”. Many would face “moral problems” if assisted dying were legalized, even if a “conscience clause” were included.
“It is one thing to allow conscientious objection on paper, but in practice it is not easy,” said Khan. “For some Muslim healthcare professionals, assisted dying would have an impact on their career choice. And it would probably have consequences for the specialties that people choose.”
There are also healthcare professionals who support assisted dying, sometimes because they have witnessed painful and distressing deaths. Six MPs who are also doctors and have experience with palliative care wrote a letter to colleagues this month calling on them to support a change in the law.
Sir John Temple, a surgeon and former chairman of the BMA, told a parliamentary committee last year that a change in the law was long overdue. There was currently “an unsatisfactory and unsustainable situation in which those who desire greater end-of-life choices are essentially abandoned by the system and forced to seek control in dangerous, unenviable ways,” he said in written evidence.
Members of the Royal College of Nursing in July a motion was barely passed supporting the “principles of assisted dying”.
Cat Gibbons, an emergency nurse from Oxfordshire, said during the debate: “A nurse is someone who advocates for a patient. Regardless of our own beliefs, I believe we should support our patients’ decisions if they believe assisted death is the right choice for them.”