Several countries or states have legislation permitting or decriminalising euthanasia or physician assisted suicide (PAS). These include Switzerland ; The Netherlands ; Belgium ; the US state of Oregon ; and, since 2008, Luxembourg . These practices are legally distinct from withholding or withdrawing lifesaving or life-sustaining treatments, and from the administration of treatments which primarily aim to relieve suffering, but may incidentally also shorten life. Whilst euthanasia and PAS are supported by 70–80% of the general population in the UK [6–9], with similar proportions being found whether the research is funded by supporters of a change in the law [8, 9], by detractors , or by independent, disinterested groups , the practice remains illegal.
Groups favouring a change in the law have presented opposition to euthanasia or PAS as primarily religious , and one independent report commented on the apparent increase in support for legalisation as an index of declining religious adherence . In 2005, the British Medical Association voted narrowly to drop its longstanding opposition to assisted dying at its annual conference , but this opposition was reinstated the following year by a larger margin .
In recent years three attempts have been made to change the law in England and Wales to allow assisted dying for the terminally ill through Bills presented to Parliament by the human rights lawyer Lord Joffe : the Patient (assisted dying) Bill in 2003  and the Assisted Dying for the Terminally Ill Bill in 2004 and 2005 [16, 17]. This proposed legislation is largely similar to the Death with Dignity Act of the US State of Oregon.
Under the terms of the Assisted Dying Bill, it would have become legal for doctors to prescribe a lethal dose of medication to patients who requested it, if the patient was diagnosed with a terminal illness, considered to be suffering unbearably, and had mental capacity to make the decision . "Terminal illness" in this context means an illness which, in the opinion of two doctors, is inevitably progressive, cannot be reversed by treatment and will be likely to result in the patient's death within a few months . The stipulation of possession of mental capacity was consistent with the decision being autonomous, and consistent with the values of the individual, with an absence of a disorder of mind or brain that could influence the decision-making process.
The Assisted Dying for the Terminally Ill Bill was defeated in the House of Lords in May 2006, but given the support for assisted dying by groups such as Dignity in Dying, and the state of public opinion, it is likely that a further Bill will be presented to Parliament in the future.
The proposed change in the law would affect the working practices of many senior doctors in England and Wales, but there are few peer-reviewed studies of their views. The most recent, published in 2006, surveyed the views of GPs in Wales. The response rate was 65%, the number responding was 1202, and 62% of these opposed a change in the law to allow physician assisted suicide . In 1999 an attempt was made to survey all 742 members of the British Geriatrics Society and all 820 members of the Intensive Care Society. Participants were asked about their views on legalisation of assisted suicide and voluntary euthanasia, but only their opinions on the legalisation of active voluntary euthanasia were published. Eighty percent of geriatricians and 52% of intensive care doctors considered the deliberate administration of a treatment intended to kill as unjustified in any circumstance. The response rates were 45% and 37% in the two groups . The views of the geriatricians from this survey had previously been published separately . In 1998, 322 (72% participation rate) UK and Irish psychiatrists were sent a questionnaire asking their views on the legalisation of assisted suicide. Forty four percent opposed a change in the law, 18% were neutral, and 38% support this . In 1994, 424 GPs and hospital consultants in one area of England were asked by questionnaire whether they thought the law in the UK should be changed to allow voluntary euthanasia, similar to the situation in the Netherlands. Of the 309 (74%) doctors who returned the questionnaire and answered the question, 146 (47%) supported a change in the law, 103 (33%) opposed any change, and 60 (20%) were undecided . Three of the four surveys described above showed doctors to be more opposed than in support of changes in the law to allow assisted suicide or voluntary euthanasia. The survey which showed support for a change in the law was the earliest and concerned voluntary euthanasia rather than PAS.
There are many other (non peer-reviewed) surveys of British doctors' views in the public domain, a total of fourteen of which are thoroughly reviewed in the seventh appendix of the 2005 report of the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill . In addition to these is the submission to the committee by the Association for Palliative Medicine of a survey of 610 members carried out in 2003 showing 565 (93%) opposed legalising assisted suicide. No participation rate was published. The conclusion of the report is that, while the surveys should be interpreted with caution, doctors "...appear to be notably less in favour of legalising euthanasia [or PAS (implied)] than the general public." It is of note that a 2006 survey of doctors in the UK found low (2.6%) support for the idea that a new law to allow assisted dying or voluntary euthanasia would have helped real patients whose deaths they had attended, and a similarly low figure (4.6%) felt that the current legal situation interfered with the best management of patients .
There is evidence from Europe that health professionals, especially those who work with the dying, are similarly less supportive of a change in the law than the public: A Swiss survey contacted 726 palliative care specialists, 148 oncology clinicians and 140 medical students over the years 2000–2005. About a third of the members of professional groups were doctors, the rest being other healthcare professionals. The response rates were 56%, 59% and 'near 100%' respectively. The palliative care specialists were 44% in support of PAS, the oncology clinicians were 73% in favour, as were 77% of the medical students . A 1998 Finnish survey attempted to compare the attitudes to PAS of 506 doctors, 800 nurses and 1000 members of the general public. The response rates were 62%, 68% and 59%. Twenty percent of the doctors, 34% of the nurses and 42% of the general public supported PAS in the scenario of an incurable cancer .
Even in countries where PAS is legal, support for this practice is far from universal among doctors. A Swiss group investigated the views of 2589 GPs, physicians, gynaecologists, oncologists and geriatricians in that country. The responders numbered 1650 (64%), and of them 32% had ever been asked to assist with a patient's suicide. Of these, 49.7% refused. Among those who had never been asked to assist with a suicide, 59% reported they would refuse .
There have been no published studies examining attitudes to PAS across all specialities and general practice in England and Wales, the region of jurisdiction of the proposed Bill. In this study we aimed to measure support for legalising physician assisted suicide, in any form, in a representative sample of senior doctors working in the NHS in England and Wales.
We found more doctors opposed than supported a change in the law to permit Physician Assisted Suicide, and that religious doctors were more likely to oppose such a change. Doctors who reported working frequently with the dying were also more likely to oppose a change in the law, but there was no effect of specialty, gender or years in post.