Many NHS staff would use ‘conscience clause’ if assisted dying legalised, say doctors

A significant proportion of NHS medical staff in England and Wales are likely to exercise a "conscience clause" if assisted dying is legalised by parliament.

Labour MP Kim Leadbeater's private member's bill stipulates that no doctor would be under any obligation to participate in assisted dying.

The British Medical Association (BMA), which holds a neutral position on assisted dying , has said doctors should be required to proactively "opt in" to an assisted dying process, and have a right to decline to carry out any activities directly related to assisted dying. It wants doctors to be given a "genuine choice about whether, and if so to what extent, they are willing to participate".

Surveys by professional bodies have found a mixed response. In 2023, the Royal College of Surgeons found 53% of respondents to a survey were in favour of assisted dying and 25% opposed.

In 2019, a Royal College of Physicians poll found 31% in favour and 43% opposed; and a Royal College of GPs survey the same year found 40% in favour and 47% opposed. A BMA survey in 2020 found 50% backed assisted dying, with 39% opposed.

Some NHS medical staff oppose assisted dying because of religious beliefs. According to a 2014 report, nearly seven of 10 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 this week he was standing down), the most senior Catholic leader in England and Wales, several imams, and the chief rabbi, have stated their opposition to assisted dying in recent weeks.

Christian Concern, an evangelical organisation that supports legal cases involving Christian workers including NHS staff, said it was planning to "resist the bill at every stage" but would "do all we can to ensure conscientious objection" should it become law.

Mark Pickering, a doctor and the chief executive of the Christian Medical Fellowship, whose membership includes about 4,500 doctors, nurses and midwives, said a so-called conscience clause may provide only limited protection.

"I don't foresee a situation in which anyone is forced to actually prescribe the medication for somebody to kill themselves. But, for instance in Canada, there have been significant problems around conscience."

Under Canadian law, healthcare professionals who object to assisted dying are required to make an "effective referral" to a medic who is 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 granny, but I'll send her to someone who will', there isn't much moral difference," said Pickering.

David Randall, a renal consultant, said his Christian faith had influenced his opposition to assisted dying, but his primary concerns were about the risks to vulnerable people and the relationship of trust between doctor and patient.

The issue of assisted dying was "so far away from what I experience in the multi-ethnic, deprived areas of London where I work. One of the biggest issues is the lack of trust in medicine".

Randall said he saw people presenting late with advanced kidney disease because of a reluctance to consult their GP. Some were suspicious about treatment and care, and were sometimes unwilling to engage in discussions about palliative care as they saw it as a way of rationing costly treatment.

"These people already face significant health inequalities in our society. There is a lot of suspicion about assisted suicide among ethnic minority communities, some of it cultural, some of it religious. A lot of them feel this is a way of denying them health care. Assisted suicide is not being driven by ethnic minority or deprived communities," he said.

Even with a conscience clause included in legislation, he said: "I can't see it taking long before doctors are required to open conversations with patients about assisted suicide, and that's not something I'm willing to do."

A survey of members of the British Islamic Medical Association this year found that about nine out of 10 opposed doctors prescribing or administering life-ending medication, and 56% said the legalisation of assisted dying would affect their choice of career.

Nadia Khan, a palliative medicine consultant in Birmingham, said the "vast majority" of Muslim healthcare professionals were against the assisted dying bill "because of practical and ethical concerns, quite apart from their religious beliefs". Many would face "moral distress" if assisted dying were legalised, even with the provision of a conscience clause.

"It's one thing to allow conscientious objection on paper, but in practice it's not easy," said Khan. "For a proportion of Muslim health care professionals, assisted dying would impact their choice of career. And it would be likely to affect the specialisms people choose."

There are also healthcare professionals who support assisted dying, sometimes because of witnessing painful and distressing deaths. Six MPs who are also medics with experience of palliative care wrote to colleagues this month urging them to support a change in the law .

Sir John Temple, a surgeon and former president 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 where those who desire more end-of-life choice are in essence abandoned by the system and forced to seek control in dangerous, unenviable ways", he said in written evidence .

In July, members of the Royal College of Nursing narrowly passed a motion supporting the "principles of assisted dying".

Cat Gibbons, an emergency care nurse from Oxfordshire, said during the debate: "A nurse is somebody who is an advocate for a patient. No matter our own beliefs, I think we should support our patients' decisions if they believe assisted dying is right for them."