{"id":4708,"date":"2025-10-22T05:59:48","date_gmt":"2025-10-22T04:59:48","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4708"},"modified":"2025-11-03T02:03:46","modified_gmt":"2025-11-03T01:03:46","slug":"what-my-hand-does-my-heart-does-conscience-and-assisted-dying","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/10\/22\/what-my-hand-does-my-heart-does-conscience-and-assisted-dying\/","title":{"rendered":"\u201cWhat my hand does, my heart does\u201d: Conscience and assisted dying"},"content":{"rendered":"

By Helen Watt<\/p>\n

The Terminally Ill Adults (End of Life) Bill<\/a> would permit assisted suicide in England and Wales for mentally capable adults reasonably expected to die within 6 months. Progress on the Bill has met a roadblock:\u00a0 we now wait as the House of Lords begins committee-stage consideration.\u00a0 After vigorous<\/a> debate<\/a> in the Lords, during which opponents of the Bill \u2013 at least in its current form \u2013 outweighed supporters two to one, a House of Lords Committee will now hear evidence<\/a> from office-holders and professional groups.<\/p>\n

Before the Lords debate, I watched a Belgian documentary<\/a> on euthanasia, where during a leisurely and gentle series of interview clips, oncologist Catherine Dopchie spoke of a colleague in palliative care whom she described as very competent and close to her patients. \u00a0When one patient wanted euthanasia, her colleague spoke of loyalty to that patient, saying \u201cI don\u2019t want to do that, I don\u2019t think it\u2019s good, it\u2019s not palliative care, but I am erasing myself, I no longer exist, and I am becoming a hand that euthanises her.\u201d<\/em><\/p>\n

Dr Dopchie commented,<\/p>\n

\u201cBut for me, what my hand does, my heart does. I cannot dissociate an act that I produce from what this act will do inside of me.\u201d<\/p>\n

The \u201cheart\u201d \u2013 meaning here, the moral core of the person \u2013 cannot be split from the \u201chands\u201d carrying out another\u2019s wishes. \u00a0A doctor is not a robot, not a tool. \u00a0And this applies not just to hands that give lethal injections but to hands that write suicide prescriptions, help patients take suicide drugs or sign off on applications.\u00a0 Suicide is not something to encourage, not something to assist.\u00a0 It does not treat and it does not heal.<\/p>\n

There are important distinctions in \u201ccooperation\u201d in wrongdoing or even perceived wrongdoing \u2013 above all, the distinction between \u201cformal\u201d cooperation (such as where the assister shares the intention of the patient and colleagues that suicide occur) and \u201cmaterial\u201d cooperation (where someone assists in effect but not in intention).\u00a0 Yet important as this distinction is \u2013 and very relevant to conscientious objection<\/a> \u2013 \u00a0\u201cmaterial\u201d cooperation can also be unacceptably \u201cclose\u201d \u00a0in various ways to the wrong done by the main actor or actors.\u00a0 When double effect principles are applied, unintended harms may be in no way outweighed by any benefits: \u00a0cooperation may send out a strongly complicit message to main actors and others, destroying opportunities to witness to a wrong or even to protect a vulnerable person.\u00a0 For example, a pharmacist in training who helps prepare suicide drugs, not with the intention anyone die, but with the intention of pleasing his trainer is closely and \u201cscandalously\u201d implicated in the suicides he assists. His very obvious causal involvement in the patient\u2019s death strongly suggests absent or lacklustre moral objections or even outright approval.<\/p>\n

What about cooperation using not one\u2019s hands but \u201cmerely\u201d speech or silence?\u00a0 \u00a0Silence or vague words about a planned assisted suicide a health care professional is not intending<\/em> to enable would be material cooperation.\u00a0 Again, this may be justified or otherwise depending on the goods at stake, including the possibility that the patient or colleagues could still be dissuaded.\u00a0 But if the health care professional has the specific intention the patient access assisted suicide, she \u201cformally\u201d cooperates in assisted suicide. \u00a0The professional intends whether by speech or silence to facilitate the patient receiving assistance to take his own life.<\/p>\n

What of a doctor who engages in a \u201cpreliminary discussion\u201d with the patient, of the kind referred to in the current Bill<\/a>? \u00a0Such a doctor may again intend \u2013 even if conditionally \u2013 that the patient take suicide drugs, if found to be eligible. \u00a0Alternatively, the doctor may not intend this, but may simply want to have the conversation, because they see responding to suicidality as part of their normal work and\/or because they do not want such discussions restricted to doctors who favour assisted suicide.<\/p>\n

Whether the Bill\u2019s \u00a0\u201cpreliminary discussions\u201d can be reasonably engaged in by doctors opposed to assisted suicide will depend on the details.\u00a0 What will they be expected, in any final law or guidelines, to say to the patient or report to others?\u00a0\u00a0 A quick generic recital of legal facts may perhaps be compatible \u2013 albeit with some strains \u2013 with the normal protective response to patient suicidality.\u00a0 But it may transpire that any doctor agreeing to a preliminary discussion will be expected to provide, or refer for, precise details of assisted suicide \u201ccare\u201d and how to obtain it. \u00a0Giving similar details would be inconceivable with \u201cprivate\u201d suicide (as with information on high buildings, lethal doses of over-the-counter drugs or Swiss suicide providers).\u00a0 And if doctors do not want to provide, or refer for, \u00a0details on how to access assisted suicide, and are therefore recusing themselves from the Bill\u2019s \u201cpreliminary discussions\u201d, \u00a0they may also not want to signpost, as the current Bill requires, to those with fewer qualms. \u00a0If risking patient suicide is harmful, it is harmful both for colleagues and those who point in their direction.<\/p>\n

The Royal College of Psychiatrists has expressed serious concerns<\/a> about the Bill, not least because its provisions are difficult to reconcile with their normal response to suicidal patients. Such patients include those who would not in any case be eligible for assisted suicide but may ask for information on how to access it.\u00a0 Will doctors seeking to protect a patient precisely against suicide be pressed to have \u2013 or signpost for \u2013 a how-to consultation that may be exactly what he or she does not need?<\/p>\n

A change in the law is not inevitable, and seems less likely after the Lords debate. As we continue to discuss the Bill, we need to consider not only conscientious objection but the nature of health care in terms of protecting \u2013 or at least respecting \u2013 functionality and palliating unpleasant symptoms.\u00a0 Suicide assistance does none of that:\u00a0 it is not health care but has the reverse aim and effect. On that ground alone, no person, and no organisation, should be pressed \u2013 or arguably, permitted \u2013 to join a suicide-enabling chain.<\/p>\n

 <\/p>\n

Author:\u00a0<\/strong>Helen Watt<\/p>\n

Affiliations:<\/strong>\u00a0Senior Research Fellow, Bios Centre, London<\/p>\n

Research Fellow, Blackfriars Hall, Oxford<\/p>\n

Competing interests<\/strong>: None declared<\/p>\n

Social Media accounts of post author:<\/strong><\/p>\n

X @BiosCentreUK<\/p>\n

FB @BiosCentreUK<\/p>\n","protected":false},"excerpt":{"rendered":"

By Helen Watt The Terminally Ill Adults (End of Life) Bill would permit assisted suicide in England and Wales for mentally capable adults reasonably expected to die within 6 months. Progress on the Bill has met a roadblock:\u00a0 we now wait as the House of Lords begins committee-stage consideration.\u00a0 After vigorous debate in the Lords, […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":503,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8127,2148,2745],"tags":[],"class_list":["post-4708","post","type-post","status-publish","format-standard","hentry","category-assisted-dying","category-law","category-professionalism"],"yoast_head":"\n\u201cWhat my hand does, my heart does\u201d: Conscience and assisted dying - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/10\/22\/what-my-hand-does-my-heart-does-conscience-and-assisted-dying\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u201cWhat my hand does, my heart does\u201d: Conscience and assisted dying - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Helen Watt The Terminally Ill Adults (End of Life) Bill would permit assisted suicide in England and Wales for mentally capable adults reasonably expected to die within 6 months. 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