RCP’s Position: Neutrality with a Focus on Patient Care

the Royal College of Physicians (RCP) maintains a neutral position on assisted dying, reflecting the diverse opinions of it’s members. This stance means the RCP neither supports nor opposes changes to the law regarding assisted dying in England adn Wales.

While societal decisions on assisted dying are ultimately made through Parliament, the RCP emphasizes the importance of professional and clinical considerations in legislation, regulation, guidance, and the safe and effective implementation of any changes.

The RCP underscores that the primary concern of physicians is ensuring the best possible care for our patients. As clinicians caring for patients nearing the end of their lives, RCP members are committed to advocating for the highest quality of care.

Concerns and Considerations

Some RCP members have voiced concerns that introducing assisted dying and requiring related discussions with patients could fundamentally alter the doctor-patient relationship.

The RCP acknowledges that while the Terminally Ill Adults (End of Life) Bill has undergone changes, there currently remain deficiencies that would need addressing to achieve adequate protection of patients and professionals.

Key Factors for Legislation: RCP’s Advice

The RCP advises that if assisted dying were to become legal in England and Wales through the Terminally Ill Adults (End of Life) Bill, the following key factors must be protected in the legislation:

• Patients must have equitable access to end-of-life services.
• Doctors must have the option to abstain from participating in any aspect of assisted dying.
• Prognosis decisions must be informed by expert clinical professionals, including those familiar with the patient.
• Prognostic uncertainty must be understood and accepted by both the patient and the professionals involved.
• Capacity decisions and safeguards against coercion must involve face-to-face assessments by appropriately skilled health and care professionals,including those trained in mental health to assess for remediable suicidal risk factors.
• Services delivering assisted dying must be closely regulated and monitored.
• Medicines prescribed and administered in assisted dying must be regulated for safety and efficacy for this specific use.
• Assisted dying services must not divert resources from other end-of-life care or disadvantage the provision of end-of-life and other services.

Shared Concerns and Existing Healthcare Challenges

The RCP shares the concerns expressed by the Royal College of Psychiatrists regarding the limitations of the current Mental Capacity act in this context.

A significant concern is that patients may not have equitable access to services due to the under-provision of end-of-life and palliative care in england and Wales, especially affecting disadvantaged populations. Widespread shortages in health and social care staff, coupled with increasing demand and service delivery variations, exacerbate these inequities.

The RCP notes that there is a risk that some patients may chose assisted dying because they fear their needs would not be met, by services that are currently not adequate. Two national reviews of End of Life and Palliative Care are underway to further inform this concern.

If a large proportion of primary care and hospital doctors are unwilling to participate in assisted dying, it could create inequality of access.

prognostic Uncertainty and Decision-Making

The RCP highlights the high degree of prognostic uncertainty for individuals approaching the end of their lives with six months or fewer to live. This uncertainty may prevent some individuals with deteriorating illnesses from accessing assisted dying. Conversely, the bill’s definition of terminal illness may influence assessing doctors to make prognoses despite their potential inaccuracy.

The current bill describes the coordinating doctor and independent doctors as working alone in making decisions around prognosis, available treatments, mental capacity, and ensuring that patients have not been coerced. The RCP emphasizes that these decisions would not be made by doctors alone in any other aspect of clinical practice. While the bill stipulates that the assessing doctor must make inquiries of relevant professionals, it does not mandate a multidisciplinary discussion and decision. Face-to-face assessments by a clinician trained in mental health and a social worker are deemed crucial.

secondary Legislation and Guidance

The legislation includes provisions for significant secondary legislation, guidance, and regulation to be developed later by the Secretary of state or Chief Medical Officers (CMOs) after the bill’s passage. These elements are crucial for ensuring safe, effective, and legal service provision and include:

• Training, qualifications, and experience required for coordinating doctors.
• Regulation of medicines or substances to be prescribed and administered.
• Regulation of any provider delivering assisted dying services.
• A code of professional practice for those participating.
• Operation of the act and provision of services.

The involvement of professional and regulatory bodies, including the Care Quality Commission (CQC) and the Medicines and Healthcare products Regulatory Agency (MHRA), will be crucial in their development.

The Broader Context of the NHS

The RCP stresses that the current bill and patient decisions must be considered within the context of the NHS and healthcare in England and Wales, particularly regarding access, availability, and equity of services for terminally ill individuals. Such as,many patients requiring medical admission spend considerable time in temporary care environments,such as emergency department corridors,and many of these patients are older,vulnerable individuals approaching the end of life.This potential experience could inform their decisions.

FAQ: Assisted Dying and the RCP’s Position

What is the RCP’s stance on assisted dying?

The RCP has a neutral position, neither supporting nor opposing changes to the law.

Why is the RCP neutral?

To reflect the range of views among its members.

What are the RCP’s main concerns?

Ensuring patient safety, equitable access to care, and protecting the doctor-patient relationship.

What safeguards does the RCP recommend?

Equitable access, doctor’s right to abstain, expert prognosis, mental health assessments, and service regulation.

what is the RCP’s view on the current bill?

The RCP believes the bill has deficiencies that need addressing to protect patients and professionals.