FIRST, DO NO HARM

Does Her Majesty's Government deserve our sympathy? To anyone daft enough to tune into the "keynote address" recently given by the Chairman of the BMA to its annual conference, the answer has to be a resounding "Yes". Sporting a natty little gong which may have had medical significance, but was equally likely to have been one of those inconsequential chevalier de fromage medallions so beloved of "civic dignitaries" to puff up their self-importance, Dr Chaand Nagpaul delivered 25 minute's worth of unmitigated bile from which a listener would have deduced that if only the BMA had been running the show, the UK would have avoided the worst ravages of the Covid pandemic altogether.

No-one seemed to escape denunciation. Naturally, the government was flayed for its alleged uselessness, incompetence and U-turns, but Nagpaul even managed to stick the boot into the NHS (gasp) for failing to defend GPs from the accusation that some of them may, perhaps, have shirked just a tad on their duties during the crisis. Barely drawing breath, he also pilloried the General Medical Council for having the audacity, from time to time, to bring proceedings against BAME practitioners. Nagpaul pronounced himself "stunned" that the government simply doesn't get the structural racism that is, apparently, poisoning the medical profession. Perhaps Dr Nagpaul forgot to ask himself why, if the UK's healthcare arrangements are such nests of racial discrimination, nearly one quarter of serving GP's received their training outside the EEA or why nearly two thirds of new registrations to the GMC in 2019 qualified abroad. But what is the point of positive  outcomes in a healthcare crisis if they are delivered by a system based upon "oppression" or, even worse, by "private sector" providers? 

Can no-one be found to stand up to this divisive and mendacious man, or to his idiotic assertions, such as "No-one is safe until everyone is safe" ? Nagpaul is that public sector type to which elected governments give far too much consideration - a taxpayer subsidised, special-interest agitator who thinks problems can only be solved by adding to them, preferably with oodles of cash that can be directed at the producer interest rather than that of the patient.

Certainly the things that seem to exercise the BMA would appear to have little relevance to the healthcare needs of UK citizens. Once they had finished denouncing the lack of consideration given to the "suicidal" propensities of BAME medics (huh?) and Johnson's personal responsibility for deaths due to Covid, Nagpaul led his delegates, without a trace of irony, into a discussion about what is modishly called "Assisted Dying". By the slenderest of margins, the delegates voted by 49% to 48% that the BMA adopt a position of "neutrality" on whether or not the profession assists patients to commit suicide. We should perhaps be grateful that BMA members are at least trained in medicine if not in ethics or logic. How can doctors be professionally agnostic about such a matter of human life-and-death? And what about the  3% who abstained on this motion for abstention? Was it an acte gratuite of some new and obscure philosophy? Bizarrely, the lobby group Dignity in Dying hailed the vote as a "victory for common sense". It was anything but.

Members of the Palliative Care profession, who (unlike the practitioners represented by the BMA), rely upon charitable donations for nearly two thirds of their funding, could be forgiven for blowing a raspberry at this post-Modernist nonsense. Certainly a Macmillan nurse would appear to have a better grasp of how to deal sensitively and effectively with the sometime painful experience of that inescapable part of human existence than do the Confused.coms at the BMA. What ethical or medical problem is the Assisted Dying lobby trying to solve? Can it seriously believe that the patient/practitioner relationship will not be fundamentally altered by a move to Assisted Dying, with all its "protocols", flimsy "safeguards" and a new army of apparatchiks to oversee the whole "process"? At what part of your cancer diagnosis will you be asked to "consider" an assisted death or be offered "counselling" to "inform" your decision? And what about that cohort of nurses and palliative care experts who get both pleasure and professional pride from the comfort they can give to the afflicted? What dismal path will we be invited to walk in which a diagnosis of terminal illness takes on a whole new and frightening meaning? Will councils decline to offer funding to guests at respite homes or hospices on the grounds that they haven't yet properly considered topping themselves? (Please tick Box A. The security of your data is important to us).

Naturally, the Assisted Dying lobby scoffs at such doubts. No one will be put at risk, it says. This is about "dignity" and that most unanswerable of modern morals, "choice". No one will be forced or cajoled into sitting on the ejector seat. Palliative care will still have an "important" role (although not one that might commend itself to the bean counters in the NHS or other funders). This might sound all fine-and-dandy for a cancer riven investment banker or lawyer who is in charge of their mental faculties, with a loving family, and who has had a high life but a currently low tolerance of pain and "indignity". But it seems far less appealing to a poor widow with no grasp of the probabilities of her medical condition, stuck in her tenth floor flat, and with indifferent relatives who live miles away. No doubt she will be an incentive to the management consultants who will measure how speedily local Health Boards whizz around doing their suicide "counselling". (Whoops - she wasn't actually terminally ill. O well, we'll "take learnings" from her premature "choice to die"). To the system, the frightened widow will be just another instrument of our valueless and post-Christian polity.

On this, as on pretty much every other issue Dr Chaand deems important, the BMA needs to be told to put a sock in it.