The medical association should represent members’ views on euthanasia

A growing proportion of Norwegian doctors no longer support the Norwegian Medical Association’s views on euthanasia. A number of medical associations have taken a neutral position. The Norwegian Medical Association should consider the same.

In line with changing public opinion and the fact that more and more countries allow euthanasia, a number of medical associations have changed their position on euthanasia, including the German and Canadian medical associations. (1, 2). Recently, the British Medical Association dropped its express opposition to euthanasia in favor of a neutral stance (3). The change is justified by the fact that the opponents are no longer in the majority among British doctors and that euthanasia is an ethical and political question on which the public should be able to decide within the framework of ordinary democratic processes. The World Medical Association (WMA) has, alongside these broader changes, chosen a less critical attitude towards physicians who perform euthanasia (4).

The Norwegian Medical Association has long been a clear opponent of euthanasia, while a growing proportion of its members support euthanasia in one form or another. (5). In a 2016 survey, 31% of Norwegian doctors slightly or strongly agreed that active euthanasia should be allowed in cases of fatal illness with a short life expectancy. (6).

Euthanasia is a complex, multi-faceted subject that involves multiple parties and considerations. There are hardly any clear answers. The experiences of countries that have legalized euthanasia show that it can be regulated and practiced very differently, with different consequences for patients and healthcare professionals. (seven). Some countries have regulated both euthanasia and medically assisted termination of life, while others exclusively regulate variants of medically assisted termination of life. In general, there is broad support for euthanasia among physicians in the countries where it is practised, and the data does not indicate that the practice is abusive or that vulnerable patient groups are pressured to accept euthanasia (8, 9). To be a categorical opponent of euthanasia in all possible circumstances and with all real or imaginable forms of regulation is not to take this complex matter seriously.

To be a categorical opponent of euthanasia in all possible circumstances and with all real or imaginable forms of regulation is not to take this complex matter seriously.

Given the diversity of opinions among Norwegian doctors and political developments in this area, we believe it is time for the Norwegian Medical Association to reconsider its categorical position. We have different opinions on euthanasia, but we are partly concerned that opponents in influential positions are drowning out a significant proportion of colleagues who think differently. For example, Siri Brelin and Morten Horn, members and former members of the Medical Ethics Council respectively, recently went to lengths in a Journal column to warn the Norwegian Medical Association against changing its position. (ten).

Horn and Brelin fear a more neutral stance could remove ‘a significant hurdle’ to legalization (ten). The conclusion – the “right answer” – was given to them in advance, and the position of the Norwegian Medical Association is a useful obstacle to the processes of democratic change. But the Norwegian Medical Association is not – and should not be – an instrument for opinionated opponents of euthanasia. It is a democratic association that will represent the members.

The Norwegian Medical Association as a provider of premises

The Norwegian Medical Association as a provider of premises

The Norwegian Medical Association is also partly a provider of premises in the public debate on euthanasia. Despite clear support for euthanasia in the general population, politicians are reluctant to put the issue on the agenda. Likewise, few physicians have publicly presented a more nuanced position than the Norwegian Medical Association. (11). It is not unlikely that the Norwegian Medical Association’s clear support for a total ban is contributing to this. A move towards a more neutral position will contribute to greater openness on euthanasia, which will serve the diversity of opinion among doctors and the rest of the population.

A move towards a more neutral stance will contribute to greater openness to euthanasia

Some think it is not possible to be “neutral” in the case (ten). Either you support the introduction of euthanasia or you don’t. On the other hand, we believe that individuals, as well as the organizations that represent them, do not necessarily have to take a clear political position. Euthanasia is more an ethical and political issue than a medical one. It is not the job of the Norwegian Medical Association to be an obstacle to what the majority of the population achieves through democratic processes.

Nor is it necessary for the Norwegian Medical Association to have definite answers to all questions related to euthanasia to deviate from its support for a total ban. If this were the case, the Norwegian Medical Association should also have a clear justification why a total ban is the best solution, even for decision-making, patients with terminal illness and a short life expectancy who sincerely wish to co-manage their own end of life. However, if a bill were to be considered by the Storting, the Norwegian Medical Association must relate to the proposal and submit a consultation statement reflecting the views of the members. Given the developments in the field at the international level, it is probably only a matter of time. We hope that the Norwegian Medical Association will facilitate an inviting and broad exchange of opinions where all members have the opportunity to be heard. Norway needs an open, sober and informative debate on euthanasia.

Alec Dittman

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