Panel proposes framework to underpin any future change in law on assisted dying for terminally ill people
The Commission on Assisted Dying has published a 400 page report into the safeguards that would need to be in place for a safe assisted dying law to operate in England and Wales. The expert panel Chaired by Lord Falconer QC includes members of the House of Lords and House of Commons, a former president of the General Medical Council, a former Police Commissioner, a leading consultant in disability equality, an Anglican priest and medical, mental health, palliative care and social care specialists.
>> The Falconer commission was sponsored by Dignity in Dying, formerly the Voluntary Euthanasia Society, and financed by Terry Pratchett one of their patrons, with panel members being handpicked by Lord Falconer, a leading advocate of changing the law. Nine of its eleven members were known backers of assisted suicide with a strong ideological vested interest in this as the outcome. Asking this group for guidance on assisted suicide laws is like asking Philip Morris and British American Tobacco to advise on smoking legislation!
Over the last twelve months the Commission has held extensive public evidence hearings and consultations, conducted international research visits and commissioned expert briefing papers to produce the most comprehensive study to date of how a change in the law on assisted dying might affect English and Welsh citizens.
>> 46 high profile individuals and 40 organisations invited by Falconer to give evidence to his commission opted not to do so on the grounds that it was unnecessary, biased and lacking in transparency. With so many people pulling out Falconer was able only to hold six monthly oral evidence sessions and ran out of witnesses half way through the year. He then asked Dignity in Dying to email all their supporters to provide 'evidence' by filling out simple questionnaires. These responses made up the bulk of the 1,200 responses the commission claims to have received. Falconer also fails to tell us that in 2005 a balanced House of Lords Select Committee carried out an official parliamentary Inquiry into assisted suicide. This covered some 246 Hansard columns and two volumes of 744 pages and 116 pages respectively, 15 oral sessions, 48 groups or individuals giving evidence, with 88 witnesses giving written evidence; 2,460 questions were asked and the committee received 14,000 letters. Falconer's enquiry, in comparison, was not only unbalanced but miniscule.
The Commission finds that the choice of assisted dying could safely be offered to people who are suffering at the end of life and likely to die within twelve months, provided that they satisfy the eligibility criteria. People who might not have the mental capacity to make such a choice, who might be clinically depressed or experiencing pressure from friends or relatives, would be protected by a comprehensive set of safeguards.
>> Well no surprises here.
The Commission also finds that the provision of high quality end of life care must be a priority for Government, independent of the issue of assisted dying. It recommends that in parallel with any change in the law, the Government should also take action to tackle inequalities in end of life care and ensure that good quality end of life care is available to every person approaching the end of their life.
>> Well would hope so. We all want this. Wouldn't it have been wonderful if some of the time and money wasted on this commission might have been spent on achieving such ends.
Under the proposed framework, a dying person who met the legal criteria would be able to ask their doctor to prescribe them a dose of medication that would end their life. The person would need to be able to take the medication themselves, as a clear expression of the voluntariness of their choice. Appropriate practical support to take the medication should be provided if it is required by a terminally ill person with physical impairments but this could not take the form of another person administering the medication on their behalf (euthanasia). The Commission does not propose that any form of euthanasia might be allowed if the law were to be changed.
>> OK so they are recommending the law be changed to decriminalise assisted suicide (where people are helped to kill themselves) but not euthanasia (where people have their lives ended by someone else). But they use the word 'medication' when what they really mean is 'lethal drugs'. And to say that 'no form of euthanasia is proposed' is splitting hairs because assisted suicide is a form of euthanasia. It is euthanasia one step back. The intention and result are the same. In fact the difference can be as little as one centimetre – if you put the lethal drugs in the patients hand that is assisted suicide; on the tongue and that's euthanasia. And in about one in six cases assisted suicide doesn't work(see original NEJM paper by Groenewoud)leaving the euthanasiast to wade in with a lethal injection.
The Commission recommends that if Parliament were to decide to adopt assisted dying legislation in the future, this should include the following eligibility criteria:
1.The person concerned is aged 18 or over and has a diagnosis of terminal illness
>> There is a huge difference between being terminally ill and having a terminal illness. Many live for years with terminal illnesses.
2.The person is making a voluntary choice that is an expression of his or her own wishes and is not unduly influenced by others
>> So what does unduly mean? And how is a doctor who does not know the patient or the relatives supposed to be able to make this assessment?
3.The person has the mental capacity to make a voluntary and informed choice, and the person's decision-making is not significantly impaired as a result of mental health problems such as depression
>> What do we mean by significantly impaired and how is this to be assessed?
The Commission recommends that any future legislation should also include the following safeguards to ensure that potentially vulnerable people were protected:
1. A decision-making model involving the assessment, advice, support and independent judgements of two independent doctors, with support from other health and social care professionals where necessary.
2.A safeguard to ensure the person has been fully informed of all other treatment and end of life care options that are available and still wishes to proceed;
3.Safeguards to ensure that the eligibility criteria are met
4.Safeguards to ensure that the person has a settled intention to die
5.Safeguards to ensure the safe storage and transportation of lethal medication
6.Safeguards to ensure the person has a reliable and supported assisted death
7.Safeguards to ensure that assisted deaths are reported correctly
8.Monitoring and regulatory oversight by a national monitoring commission with powers to investigate suspected non-compliance.
>> This is a system very similar to the abortion act 1967 which was initially intended to apply only in extreme cases but has resulted in over seven million cases of abortion (prenatal involuntary euthanasia) since it was instituted – now about 200,000 per year. It is not difficult to find a small number of doctors who will willingly tick boxes and even perjure themselves in the process. After the event the key witness is dead and cannot give evidence about whether or not procedures were followed or just alleged to have been followed. Otherwise these safeguards were all (with the possible exception of no 5) included in the Joffe Bill which was rejected by 148-100 in 2006 by the House of Lords on the grounds of public safety. Peers considered its so-called safeguards were paper thin. The commission is proposing a less safe version of the highly controversial Oregon law, which sees the terminally ill offered drugs to kill themselves, but not expensive life saving and life extending drugs. Except that the Oregon Law uses a six month life expectancy for terminal illness, not twelve months like Falconer. In practice both limits are equally problematic as it is very difficult for any doctor to predict life expectancy accurately apart from in the last hours or days of life. These recommendations if implemented will place vulnerable people under increased pressure to end their lives so as not to be a burden on others. This pressure can be especially intensely felt at a time of economic recession when families and the health service are already feeling the pinch.
The Commission stresses that the issue of assisted dying cannot be viewed in isolation from the need for adequate health and social care, and emphasises the urgent need to improve discussions with patients about the care they wish to receive at the end of life. The Commission recommends that if assisted dying were to be legalised in the future, we would need to make improvements in end of life care in parallel, to ensure that all people dying in the UK could expect to receive an adequate level of care, regardless of where they lived. The Commission puts forward a series of core principles that frame and run throughout their recommendations on assisted dying. These are:
• Open discussion about death and dying
>> Well we have that already – we have been talking about it continually for the last five years as we are subjected to wave after wave of campaigning form the pro-euthanasia lobby.
• Each person should be entitled to core rights in end of life care
>> Well of course unless we mean the right to be killed or to have someone help you kill yourself which is not a right recognised by any religion or historic ethical or legal code or declaration.
• Good quality end of life care should be available in all settings
>> Well that goes without saying but what is Falconer doing to achieve it?
• An end to all forms of discrimination in end of life care, whether these are based on geographical location, physical condition, ethnicity or wealth
>> Great although not yet achieved since the foundation of the world in any country and legalising assisted suicide will provide a cheap alternative - £1,000 a week for care or £5 for a glass of barbiturates?
• More choice in how people die and clear and accessible information
>> Well we all know what that means…
• Effective support and protection for more vulnerable people
>> So why are we changing the law to remove legal protection from vulnerable people?
Notes to editors:
…Evidence brought before the Commission on Assisted Dying has led the Commission to conclude that the current policy outlined by the Director of Public Prosecutions in February 2010 is unsustainable for the following reasons:
• The current law concentration of too much power in the hands of the DPP
>> Agreed. He does seem to lack the courage to prosecute people. We need to be encouraging him to do his job more effectively!
• The absence of a robust scheme of safeguards
>> We would not need safeguards with a blanket prohibition on assisted suicide as at present. The number of cases is very small – 20-25 per year – but we would have 1200 a year with an Oregon law and 13,000 with a Dutch law according to the 2005 House of Lords report
• The absence of a factor based on suffering or a medical condition
>> The problem is that many people without terminal medical conditions claim to be suffering (at least mentally). If we legalise it only for those who are terminally ill we will very soon see claims of discrimination by others and Equality Law will be brought into play to extend the boundaries
• The lack of clarity for health and social care professionals
>> The law and the DPP guidelines are actually very clear. If you are a doctor don't assist with suicide or you may well be prosecuted
• The reliance of amateur assistance
>> OK so let's have professional assistance? Why not just enforce the existing law.
• The discrimination against people who not have the capacity to end their own life
>> A strange sort of discrimination indeed!
• The impact of friends and family being treated as 'suspects'.
>> How else are the police supposed to find out if the law has been broken other than by investigating each case?
The Commission on Assisted Dying is made up of (I have added other relevant facts which are linked elsewhere on this blog)
Lord Charles Falconer (Chair) Barrister and Senior Counsel based in Gibson, Dunn & Crutcher's London office. Former Lord Chancellor and Secretary of State for Justice in the Blair government.
>> Long time supporter of assisted suicide who tried to legalise it via an amendment to the Coroners and Justice Bill in 2009. Defeated by 194-151!
Professor Sam Ahmedzai Professor of Palliative Medicine and head of the Academic Unit of Supportive Care at the School of Medicine and Biomedical Sciences, University of Sheffield.
>> Unlike 95% of palliative medicine physicians a supporter of assisted suicide explaining his presence on the committee
Lord Ian Blair of Boughton Cross Bench Peer and former Commissioner of the Metropolitan Police.
>> Strong supporter of the legalisation of assisted suicide
Sir Graeme Catto President of the College of Medicine and former President of the General Medical Council.
>> And supporter of Healthcare Professionals for Assisted Dying – set up under the auspices of DID
Dr Carole Dacombe Medical Director, St Peter's Hospice.
>> Unlike 95% of palliative medicine physicians a supporter of assisted suicide explaining her presence on the committee
Dr Stephen Duckworth Founder and former Chief Executive of Disability Matters Limited and board member of the Olympic Delivery Authority.
>> Another black sheep. Unlike the five major disability rights groups in the UK (NCIL, SCOPE, UKDPC, RADAR, NDY) he actually supports assisted suicide legislation and was chosen for this purpose. His organisation Disability Matters Limited stopped trading last year
Penny Mordaunt MP Conservative Member of Parliament for Portsmouth North.
>> Chair of the All Party Parliamentary Group on Choice at the end of life – the political wing of Dignity in Dying, which provides its secretariat.
Baroness Elaine Murphy of Aldgate Crossbench life peer, Secretary to the All Party Parliamentary Group on Mental Health and a vice-president of the Alzheimer's Society.
>> Long-time supporter of assisted suicide who has voted to decriminalise it in the past
Dame Denise Platt DBE Member of the Committee on Standards in Public Life.
>> Prior views not known but has clearly 'come around'
The Reverend Canon Dr James Woodward Anglican priest and Canon of St George's Chapel, Windsor.
>> The 'token vicar' who is grought on to legitimise the enquiry but who does not actually support the Commission's conclusions
Baroness Barbara Young of Old Scone Life Peer in the House of Lords and Chancellor of Cranfield University.
>> Long-time supporter of assisted suicide who has voted to decriminalise it in the past