Committee for Ethical Issues in Medicine

Editor – The excellent paper by John Saunders (Clin Med October 2008 pp 508–11), outlining the role of the Committee for Ethical Issues in Medicine (CEIM), Royal College of Physicians (RCP), describes the role the RCP played in the recent euthanasia debate. It demonstrates with great clarity why I feel that the many RCP members who support euthanasia have been let down by the College.

The function of any ethics committee is to debate the ethical issues involved in a topic and give a reasoned view on what could be considered ethical and what is not. Questions to be considered in the euthanasia debate include: can euthanasia be considered ethical per se? Can euthanasia be delivered ethically within a legal framework? Is it ethical to withhold the option of euthanasia from competent autonomous terminally ill adults? Any ethics committee, including the CEIM, should provide a commentary and a view on these and allied questions to inform the debate. Rarely, if ever, can a yes/no answer be given. Yet this is what CEIM has done.

By using one simple binary question, a complex topic has been distilled into a single yes/no answer which has informed the RCP response. I would expect the RCP to take a more sophisticated approach that takes into account all shades of ethical and pragmatic opinion. The response should include a discussion of the ethics of the many issues involved, describing what it considers acceptable and unacceptable. The views of the Fellows and Members have a place, though I would like a more extensive and unbiased set of questions. The views of all Fellows and Members should be represented without the editorial comment of the CEIM or the College Officers.

Democracy requires rule by the majority with reference to, and respect for, the views of the minority. It is frequently possible to have the views of many groups catered for. The bill that was being considered would not have made euthanasia compulsory. It would have made it possible for those who wished to treat and be treated. Those doctors and patients opposed to euthanasia need not get involved. By rejecting this bill, those opposed to euthanasia, possibly the majority of Fellows and Members of the RCP, have imposed their will on those who support and welcome it. Supporters of euthanasia do not, however, want to impose our will on its opponents.

The CEIM have played a part in denying a section of society an option that they feel is ethically justifiable and legally controllable. They have done so without a clear and full discussion of the issues but by opinion poll politics.

• © 2009 Royal College of Physicians