Mr James North Johnson FRCS
Chairman of Council
29 July 2005
Further to my previous letter of 22 June 2005 I am writing again on behalf of the Christian Medical Fellowship to express our further concern that the voices of grassroots doctors are being increasingly marginalized on ethical issues within the BMA. This has been highlighted by events leading up to and including the BMA ARM and in particular the vote and debate on Assisted Dying.
BMA Council and Ethics Committee member John Chisholm has claimed that the BMA's new neutral position on assisted dying was 'decided democratically' at the June ARM (Opinion, Doctor, 19 July 2005). I'm not sure that many BMA members who know the facts would see it quite like that. An alternative reading of events is as follows.
Michael Wilks, BMA Ethics committee chair, has for many years both privately and publicly supported the legalisation of euthanasia and physician-assisted suicide. In March 2000 a two-day BMA consensus meeting on physician-assisted suicide opposed any change to that policy, although to grass-roots BMA members who attended, it was very clear that there had been a quantum shift towards liberalisation of the law amongst BMA Ethics committee members. In July 2000 at the BMA ARM Wilks said from the platform, in opposing the view that opposition should be 'the settled position of the BMA for the foreseeable future', that 'in order to lead the debate' the BMA could not be committed to a position. Since that time he has always made a point of saying in any public statement on the issue that the BMA is opposed to assisted dying 'for the time being' and 'because the majority of its members are opposed'.
Since 2000 the pro-euthanasia bias of the Ethics committee has been further bolstered by 'expert' members co-opted from the political and academic liberal elite – three of whom (Liberal Democrat MP Evan Harris and Bioethics and Law Professors Sheila McLean and John Harris) actually gave evidence 'in a private capacity' on behalf of the Voluntary Euthanasia Society to the Lords' Select Committee on Lord Joffe's Assisted Dying for the Terminally Ill Bill last autumn whilst Wilks was acting as the official spokesman for BMA policy. Another co-opted member, Bioethics Professor Len Doyal (London), I think holds a record for attracting one of the biggest postbags of angry correspondence for a BMJ editorial for his 2001 piece arguing that euthanasia was the path of 'beneficence' for some mentally incapacitated people.
At this year's ARM Wilks used his position as ARM chairman to introduce a new procedure for deciding the issue: in a departure from normal protocol none of the motions submitted by BMA divisions would be voted on. Instead the Agenda committee, which Wilks also chairs, would listen to a half hour debate on the Tuesday of conference and draft motions to be put to delegates on the closing Thursday. Michael Wilks acted as chair of the ARM considering the issue, chair of the Ethics committee providing 'expert input' and chair of the Agenda committee framing the motions to be considered.
He also sought permission from those present to allow Evan Harris to participate in the Tuesday debate (although he was not an official delegate) and for the order of voting on motions on the Thursday to be reversed, so that the motion to maintain the status quo was never in fact voted upon. Finally it was John Chisholm, another Ethics committee member with strong pro-euthanasia leanings, who spoke in favour of the neutral motion, effectively as the official voice of the BMA Ethics Committee.
The narrow 53% to 47% vote in favour of the BMA adopting a neutral policy, which resulted from a barely quorate meeting in the closing hours of conference when many delegates had gone home, was not surprising in the circumstances. And so in this way history was made by 93 delegates deciding for 133,000 to overturn a policy opposing euthanasia, which had stood since the BMA's inception, by voting on a motion tabled on the day that grass-roots members had never seen.
The BMA may now have a neutral policy on assisted dying, but the process by which it was derived was hardly democratic, especially as the majority of BMA members still oppose euthanasia. To the contrary, the way in which this 'new position' was arrived at raises very serious questions about corporate governance at the BMA. Should such a small handful of people with such controversial views be wielding such power?
We would therefore urge the BMA Council immediately to set in motion the appropriate procedures that will prevent individuals wielding too much power within the organisation – in order to enable all sides of fundamental ethical arguments to be properly aired and debated.
I would also be very grateful for your reassurance that the events of the ARM did not breach the BMA's own standing orders and guidelines for the formulation of policy.