The issue of how life should be ended has polarised the profession and led to increasingly vocal argument from the pro and anti-euthanasia lobbies. The British Medical Association will consider at its annual conference in Edinburgh this week whether a ballot of its members is the way to settle the matter.
The association is officially opposed to the legalisation of euthanasia and of physician-assisted suicide - the former would involve a doctor giving a lethal injection and the latter would involve prescribing a lethal drug but leaving it to the patient to take it. The association does not rule out a doctor helping a patient to end their life but says in those exceptional circumstances they should be prepared to face the sanction of the law and cast themselves on the mercy of the courts. Most doctors who have done so have been treated leniently.
Dr Mac Armstrong, secretary of the BMA, said: "The patient's best interests should be left to the judgement of the doctor in consultation with the patient with the proviso that where there is any question that the doctor has overstepped the mark they should face their peers and the courts."
In patients who are terminally ill, the intention can be difficult to establish because doctors have a duty to relieve pain, by prescribing increasing doses of drugs including heroin, which may shorten life.
Dr Vivian Nathanson, head of the BMA's ethics division, said patients who asked about euthanasia were often expressing their fear that the pain would worsen as they neared the end.
"We need to ensure doctors understand that they can and must treat patients to the best of their ability with palliative care [to ease pain] regardless of whether it shortens life and we must ensure patients understand that is what they should expect." Asking about euthanasia could also be a way for terminally ill patients to check whether they were still cared for or whether people wanted to wash their hands of them, Dr Nathanson said.
Commenting on Channel 4's television soap Brookside in which a character is terminally ill with cancer and in great pain, Dr Nathanson said what was portrayed was not good medicine. "It is not what you would want or expect from doctors and is increasingly rare. We are world leaders in palliative care. I hope the programme will reassure people about what is available."
Dr Nathanson said that the BMA ethics division had considered a ballot on euthanasia but had ruled it out because of the difficulty of constructing neutral questions.
Letters, page 18