RCGP members issue legal challenge to Council’s ‘unrepresentative’ and ‘irrational’ decision on assisted dying

• Doctors challenge RCGP Council’s decision to remain opposed to assisted dying despite majority support for a change in stance and huge shift in members’ views.
• Letter urges College to reconsider its unrepresentative position, listen to the membership and adopt a neutral position so that they can truly represent their members and GPs’ views as a whole.
• New medeConnect polling finds that majority of GPs also disagree with RCGP’s decision to remain opposed given the range of views expressed in RCGP’s membership survey.

Two eminent members of the Royal College of General Practitioners (RCGP) have today issued a letter calling for the RCGP Council to review its decision to maintain its opposition to assisted dying. The Council’s decision was taken in February this year despite a clear change in the views of its members and a majority of responses to a membership survey demanding the College change its position.

Professor Aneez Esmail and Sir Sam Everington, high-profile members of the RCGP, have alongside the Good Law Project, issued a legal challenge that raises serious concerns that the decision taken by the Council at their meeting on 21st February 2020 was “irrational, failed to take into account relevant factors and took into account irrelevant factors”. The legal challenge has been prepared by solicitors at Bindmans LLP with support from Dignity in Dying.

The RCGP’s Council agreed in June 2019 to survey its members for their views on what position the College should take on the issue of assisted dying and “to assess whether [members’] views have shifted”. A previous survey in 2013 found that 77% of RCGP members preferred the College to oppose assisted dying. The 2019 survey – the largest ever conducted by the RCGP on an issue of public policy – saw a dramatic change in members’ views, with just 46% agreeing the College should maintain its opposition. Meanwhile doctors who wanted the College to support a change in the law jumped from just 5% in 2013 to 41% in 2019, with 10% preferring the College to take a neutral position.

A poll of 1000 GPs carried out by medeConnect and released today reveals that most GPs believe that the College should not oppose legalisation. When presented with the assisted dying survey results 38% of GPs said the College should now adopt a neutral position on law change, with 20% saying it should support it. Just 35% agreed with the Council’s decision to retain a position opposed to legalisation

Professor Aneez Esmail said:

“The RCGP Council’s decision to remain opposed to assisted dying goes against the views of its members and goes against the entire purpose of asking their members at all. The survey was intended to find out if RCGP members had changed their views since 2013 and there is undeniable evidence that they had. Those who backed the College’s position dropped by almost half, alongside an eight-fold increase in those who wanted the College to support a change in the law. If that doesn’t represent a shift in views, what on earth would?

“Promises were made to members and to the RCGP Council that the survey responses would be robustly analysed and compared with previous surveys, but we are now told that the 2013 and 2019 surveys are incomparable. To ignore the express, stated purpose of the survey in favour of maintaining a status quo supported by only a minority of members is unacceptable.

“We have tried to raise these concerns with the RCGP through Council members but have been stonewalled at every turn. Regrettably, we have been left with no alternative but to seek a legal resolution to ensure the College’s leadership does not maintain this unrepresentative stance. The profession deserves a body that represents their views, rather than ignores them.

“Today’s poll shows most GPs disagree with Council’s decision on this issue, giving further evidence that the Council’s decision was out of touch. It’s time for the College to reconsider its unrepresentative position, listen to the membership and adopt a neutral position so that they can truly represent their members and GPs’ views as a whole.”

Sir Sam Everington said:

“Perhaps the most worrying thing about the RCGP’s survey has been the lack of transparency in the decision-making process. Far from being straight with their members, the RCGP has resisted every step of the way to explain why they have shifted the goalposts or why their full analysis has not been published.

“We have also found out that a steering group was set up to analyse the results and no details have ever been published about the membership of that group, how they were chosen, their remit, or the reasons for their recommendations.

“All of us in general practice face the most challenging times we have ever known and we need more openness and accountability from our representative body. It is imperative that the leadership at the RCGP gets its house in order, listens to the voices of its members and revisits this undemocratic decision. GPs deserve better than a defensive, opaque establishment that protects a harmful status quo at all costs and without justification.”

Jolyon Maugham, Director of Good Law Project said:

“The RCGP’s decision to ignore the views of the majority of its members does raise real questions around its governance. The lack of transparency around how it came to this decision, and who precipitated it, is further cause for alarm. As it seems to me, the RCGP is failing in its obligation fairly to represent the views of its members on assisted dying. This issue is one of profound importance, and I do hope it revisits the decision urgently.”

Sarah Wootton, Chief Executive of Dignity in Dying, said:

“We know that medical opinion is changing and the RCGP’s own survey has proved that. It’s time for representative bodies to actually represent the diversity of their members’ views. Neutrality is the only right position for medical bodies to take on the subject of assisted dying, allowing them to contribute their expertise to the debate in a balanced way and ensuring that all of their members’ beliefs can be represented, not just the vocal minority who oppose any change in the law. What is the point in asking doctors for their views if they are going to ignore the results?

“All around the world, whether in the USA, Australia, Canada or likely in New Zealand later this year, we have seen that safeguarded, legal assisted dying can be introduced safely. Doctors who do not wish to take part can exercise their conscientious objection, while doctors who respect their patients’ wishes to take control of their deaths can do so under a robust and compassionate law. It is time for the RCGP to listen both to their members and to patients who want a grown-up conversation about assisted dying, not simply avoiding the argument and maintaining their monolithic opposition.”

***ENDS***

For more information or interview requests, please contact Tom Davies, Director of Campaigns and Communications at Dignity in Dying: thomas.davies@dignityindying.org.uk / 07725 433 025.

The full letter to the RCGP’s Chair of Council and Chair of Board of Trustees can be found here.

About:

Professor Aneez Esmail MFPHM, MRCGP, FRCP and Sir Sam Everington, Barrister, MBBS, MRCGP, OBE have published a number of papers together on discrimination in the NHS and the RCGP, including ‘Racial discrimination against doctors from racial minorities’, published in the BMJ in 1993: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677082/

The Good Law Project is a not for profit that uses strategic litigation for a better world. Its past successes include a series of landmark constitutional cases to protect the sovereignty of Parliament.

Dignity in Dying campaigns for greater choice, control and access to services at the end of life. It campaigns within the law to change the law, to allow assisted dying as an option for terminally ill, mentally competent adults with six months or less to live – something supported by 84% of the public (Populus, 2019).

medeConnect survey of GPs

Dignity in Dying commissioned medeConnect Healthcare Insight to survey 1,000 regionally representative GPs in the UK. Fieldwork was undertaken between 9th July and 31st July 2020.

Respondents were posed the following question:

“In 2019 the Royal College of GPs surveyed its members on assisted dying. The survey included a question on what position GPs believe the RCGP should hold on whether or not assisted dying should be legalised. The results showed that GPs have a range of views, with no one position obtaining an outright majority of votes. 46% of respondents wanted the RCGP to oppose law change, 41% wanted it to support law change and the rest favoured a neutral position or abstained from expressing a view.

With these results in mind, what position do you think the RCGP should adopt on the legalisation of assisted dying?”

The responses were as follows:

A full breakdown of results is available on request.

Notes:

A change in the law on assisted dying is overwhelmingly supported by the general public, as evidenced by polls over the last three decades. A poll of more than 5,000 people conducted in 2019 found 84% of the British public want to see the legalisation of assisted dying for terminally ill, mentally competent adults.

Healthcare professionals

The Royal College of GPs announced on 21 February 2020 that it will maintain its opposition to assisted dying, despite a dramatic shift in views from its 2013 poll. When it launched the survey in October 2019, the RCGP told its members it would provide the weighted and unweighted results for the RCGP Council to consider. Weighting the data ensures that the survey results are representative of the whole membership of the RCGP, even if a particular group/s replied to the survey in greater numbers than others. However, when the announcement was made on 21 February, only the unweighted results of one question of nine were released publicly.

It is not clear whether the Council had sight of the full, weighted results when voting to maintain the RCGP’s opposition to a change in the law on assisted dying. The RCGP Council was later petitioned by over 5000 doctors, patients and concerned citizens to publish the full, weighted data, which it has now done – several weeks after the initial announcement was made.

The British Medical Association conducted its first ever membership survey on assisted dying in February 2020, the results of which are due to be published later this year. Its current position (opposed to a change in the law) is also due to de debated at their next Annual Representative Meeting in 2021.

In March 2019, the Royal College of Physicians dropped its longstanding opposition to assisted dying in favour of neutrality following a member survey.

Assisted dying proposals in the British Isles and Crown Dependencies

A Westminster Hall debate on assisted dying took place on 23 January 2020, in which a majority of speakers backed growing calls from across society for an inquiry into the UK’s current laws on assisted dying. The functioning and impact of the current law was debated at a backbench business committee debate in July 2019. Proposals for assisted dying legislation were last debated in the Commons in September 2015.

The Government of Jersey announced in February 2020 that it would launch a Citizen’s Jury on assisted dying, which will give recommendations to the States Assembly ahead of a debate at the end of this year. In 2019 the Government of Jersey announced that it would undertake detailed research into the views of residents, overseas developments and potential legislation.

The Isle of Man’s Parliament, Tynwald, debated assisted dying at its January sitting on 22 January 2020. It last debated legislation in 2015.

The Legislative Assembly of the Falkland Islands voted in favour of two motions on assisted dying in July 2018 (that terminally ill residents should have the right to die at a time and place of their choosing, and that should legislation be introduced in the UK, the Falkland Islands would consider adopting it).

The States of Guernsey last debated assisted dying proposals in May 2018.

International developments

Assisted dying as an option for terminally ill, mentally competent adults in their final months of life is legal in ten US jurisdictions: Oregon (1997), Washington, Vermont, Montana, the District of Columbia, California, Colorado, Hawaii, New Jersey and Maine (June 2019).

Victoria became the first Australian state to legalise assisted dying for terminally ill people in June 2019. Western Australia voted to legalise a similar bill in December 2019. The health committee of the Government of Queensland published a report in March 2020 recommending that legislation enabling terminally ill citizens the option of assisted dying be introduced, the result of a year-long investigation.

New Zealand will put an End of Life Choice Bill to a public referendum in October, after legislation passed third reading in November 2019.