On 21 June the Annual Representative Meeting (ARM) of the British Medical Association (BMA) in Belfast voted against going neutral on assisted suicide by a two to one majority. (1)

Delegates rejected motion 80, 'that this meeting believes that the BMA should adopt a neutral stance on assisted dying', by 198 to 115 (63% to 37%).The debate took place after a previous motion affirming that 'it is not appropriate at this time to debate whether or not to change existing BMA policy' was defeated by 164 to 160.

Fifteen doctors spoke during an impassioned debate on the two motions but the final vote was decisive, and reflected the 65% opposition to legalising assisted suicide shown in most opinion polls.

The Royal College of Physicians, Royal College of General Practitioners and British Geriatrics Society are all officially opposed to a change in the law along with 82% of Association for Palliative Medicine members. (2) Amongst all doctors, this latter group carries the greatest weight in this debate due to their understanding of the vulnerability of dying patients and their knowledge of treatments to alleviate their symptoms. Assisted suicide and euthanasia are contrary to all historic codes of medical ethics, including the Hippocratic Oath, the Declaration of Geneva, the International Code of Medical Ethics and the Statement of Marbella. (3)

Neutrality on this particular issue would have given assisted suicide a status that no other issue enjoys. Furthermore, to drop medical opposition to the legalisation of assisted suicide and euthanasia at a time of economic austerity would have been highly dangerous. Many families, and the NHS itself, are under huge financial strain and the pressure vulnerable people might face to end their lives so as not to be a financial (or emotional) burden on others is potentially immense.

In rejecting a previous attempt to move to neutral at its ARM in 2012, the BMA said that neutrality was the worst of all positions. (4) This was based on bitter experience. When the BMA took a neutral position for a year in 2005-2006 we saw huge pressure to change the law by way of the Joffe Bill. Throughout that crucial debate, which had the potential of changing the shape of medicine in this country, the BMA was forced to remain silent and took no part in the discussions. Were it to go neutral again it would be similarly gagged and doctors would have no collective voice.

Going neutral would instead have played into the hands of a longstanding campaign led by a small pressure group with a strong political agenda. (5) Healthcare Professionals for Assisted Dying (HPAD), which is affiliated to the pressure group 'Dignity in Dying' (formerly the Voluntary Euthanasia Society), at last count had just over 500 supporters, representing fewer than 0.25% of Britain's 240,000 doctors. (6) Instead the BMA ARM wisely gave short shrift to this latest neutrality proposal and signalled by the margin of defeat that this matter should now be settled for the foreseeable future.