The anthropologist Mary Douglas once noted of taboos: ‘Without the taboos, which turn basic classifications into automatic psychological reflexes, no thinking could be effective, because if every system of classification was up for revision at every moment, there would be no stability of thought.’

The taboo on suicide in our culture is powerful enough that promoters of the recently defeated Terminally Ill Adults (End of Life) Bill claimed that it was not concerned with ‘suicide’. The rich dishonesty of that stance was revealed when they sought to amend the Suicide Act of 1961 so that ‘assisting a person to seek to end their own life in accordance with the act’ would not fall foul of the prohibition on assisting suicide. The bill fell apart under scrutiny as the House of Lords, the House of Commons and, before that, medical royal colleges and disability groups – among others – showed it to be bad and dangerous legislation.

Yet, less than a month before the defeat of the bill, the British Medical Association (BMA) issued guidance clearly promoting the idea that doctors should assist in the suicide (here, suicide by omission) of patients under their care, whatever parliament may decide on ‘assisted dying’. As with the bill, the BMA’s guidance doesn’t use the word ‘suicide’ except to claim that what it proposes is not ‘assisting in suicide’ according to the law.

The BMA’s guidance is aimed at those ‘caring for patients who elect to voluntarily stop eating and drinking (VSED)’. It concerns specifically patients who ‘with the mental capacity to decide to do so, and in the absence of control or coercion, [make] an informed decision to stop the oral intake of food and fluids with the intention to end their life’. The guidance cannot bring itself to call such decisions ‘suicidal’, even though suicide is precisely the decision to end one’s life, by whatever means.

So what does the BMA recommend? It appeared to have as much difficulty with the term ‘assisting’ as it does with ‘suicide’. Repeatedly throughout its guidance, the BMA assures its members that whatever they are recommending, it is not assistance in suicide – not legally, at least.

Doctors are merely giving ‘information’, the BMA claims. But this ‘information’ includes tips on altering a patient’s diet in preparation for starvation or fatal dehydration. It instructs relatives not to offer food, and tells doctors what to do if one asks for food and water when delirious, and so on. In other words, doctors are actively encouraged to advise suicidal patients on how to prepare for and carry out their suicidal plan most comfortably, as with ‘decreasing caloric intake one week before’. Perhaps one day those intent on drowning themselves will be offered handy advice on overcoming hydrophobia as part of their ‘care’.

Faced with a suicidal person determined to starve and dehydrate themselves to death, the BMA tells its members that doctors should not ‘judge or try to persuade the patient to change their decision, and patients should not be put in a position where they are forced to justify or defend it’.

But doctors don’t simply exist to facilitate a patient’s wishes. In fact, doctors are forever persuading people to live healthier lifestyles, sometimes to an intrusive degree. Yet when it comes to those wanting to take the ultimate, irreversible decision against their life and health – the very values that make sense of the doctor’s profession – a suicidal decision is seemingly so sacrosanct that a doctor should in no way even try to persuade the patient to see life differently. There was a reason Hippocrates took it as paradigmatic of medicine that doctors should not use their skills to further a death wish of their patients.

According to the BMA, so sacrosanct are suicidal desires in this context that ‘conversations with family and friends to ensure that they understand the care plan and the patient’s desires may help to mitigate any deviations from the care plan not agreed to by the patient. This may be especially important if the patient elects to VSED at home.’

Heaven forbid that the family and friends of the suicidal patient might want to ‘persuade’ their loved one not to kill themselves, and that there be some ‘deviation’ from their plan for self-termination. The doctor, whose privileges derive precisely from caring for life and health, is here helping shield the patient from family and friends who may care for such things more than the doctor.

The BMA admits that doing so ‘may be difficult for doctors and healthcare professionals, ancillary staff, and families, as they instinctively want to care for their patients and loved ones’. It adds that offering ‘food and/or fluids to patients is usually good practice but this may not be regarded in the same way when the patient has elected to VSED.’ So ‘good practice’ no longer applies, and those wholesome instincts of care exhibited by health care workers and ‘loved ones’ must be suppressed.

Even the suicidal patient’s ‘request to drink or eat’ may, we are told, be ‘due to symptoms of thirst or hunger, rather than a genuine desire to reintroduce food and/or fluids to stop or prolong the process of VSED’. Faced with a patient begging for food or drink, the doctor is not to provide ordinary basic care immediately as a matter of course, but should rather weigh such requests against what the doctor thinks the patient ‘really wanted’ in light of earlier suicidal wishes.

Won’t all this bring about a terrible toll on doctors? A doctor who went into the profession to heal and care for fellow human beings, and is now assisting in the starvation and dehydration of a patient, may perhaps feel significant inner turmoil. Fortunately, the BMA is on hand to acknowledge, in the tone of a tick-box commissar, that the ‘concepts of moral distress and moral injury may have salience here’.

Finally, lest any doctor be in any way unclear how to act, the BMA guidance helpfully suggests some examples of behaviour that must be prohibited:

‘When a patient has agreed to being offered food and / or fluids, doctors should not: attempt to entice them to change their minds about VSED, for example, by bringing in ice cream on a hot day; bring trays of food or glasses of liquid in front of them several times a day; repeatedly, and outside of the agreed upon intervals, ask them if they want to eat or drink; or purposefully prescribe medicines that need to be taken orally with liquids or food.’

Perhaps instead of giving dire warnings to doctors about the dangers of offering ice cream to a starving and suicidal patient on a hot day, the British Medical Association should revisit the foundational values of the profession. Recovery of some basic Hippocratic principles in this area might bring back some ‘stability of thought’ to an institution where it is strikingly lacking.

Dr Anthony McCarthy is the director of the Bios Centre.