Head of Public Policy Tim Dieppe explains the problems with Kim Leadbeater’s bill on assisted suicide, and how the bill has only gotten worse since going through committee stage
The Terminally Ill Adults (End of Life) Bill has now completed Committee stage. This was an opportunity to amend the Bill and to improve its safeguards. But the Committee was biased in favour of the Bill and rejected multiple reasonable amendments to improve it.
The Bill as amended in Committee can be read here.
Here are some of the significant problems that the Bill has, having gone through Committee.
Who can qualify for Assisted Suicide?
Amendments failed to rule out the following people qualifying for assisted suicide:
- Those with a mental illness or learning difficulties.
- Those who are depressed or suicidal.
- Those who are not in any physical pain.
- Those who feel they are “a burden” to others.
- Those who refuse treatment so that they can qualify.
- Those who stop eating and drinking so that they suffer malnutrition.
- Those who do not have good palliative care in their locality.
- Those who have been encouraged into requesting assisted suicide.
- Those who have to wait too long for treatment of their condition on the NHS.
- Five amendments backed by charities to exclude people with eating disorders were rejected.
- Doctors don’t need ‘reasonable certainty’ that the patient has six months to live, just a balance of probabilities.
- Absence of coercion does not have to be proved beyond reasonable doubt, but only on the balance of probabilities.
- Conditions whose progress can be controlled (e.g. diabetes) may qualify if other criteria are met.
The assessment process
There are many problems with how people are assessed to determine whether they are eligible for assisted suicide.
- Any doctor can raise the option of assisted suicide with a patient. They do not need to wait for the patient to raise the subject. Imagine the impact if your consultant suggests assisted suicide as an appropriate medical option! This will have a big impact on vulnerable patients.
- No training is required for a doctor to raise it.
- They can raise it with people with Downs Syndrome or with learning disabilities.
- They can raise it with under-18’s who will only qualify once they turn 18.
- If a doctor says a patient doesn’t qualify for assisted suicide, then the patient can ‘shop around’ for another coordinating doctor.
- The doctor is under no obligation to make further inquiries.
- There is no requirement to specify the uncertainties of the diagnosis and prognosis.
- There is no requirement to spell out the risks of complications from the lethal drugs.
- A proxy who does not know the patient can sign the assisted suicide application form.
- Patients have a right to assisted suicide, but no corresponding requirement that they have access to good palliative care. The government will be required to fund assisted suicide, but is not required to fund palliative care.
- There is no requirement for the patient to have seen a palliative care specialist to be properly informed about palliative care options.
High Court Judge replaced with ‘death panel’
The requirement for a High Court Judge to sign off on requests for assisted suicide has been replaced with a panel comprising a KC, a psychiatrist and a social worker. There are many problems with what have been dubbed ‘death panels’.
- Although the panel “must hear from” the coordinating doctor and the patient. There is no obligation to question them, and the panel can decide to waive hearing from the patient.
- Two eminent professors of psychiatry have warned that there are not enough psychiatrists to staff these panels.
- The panel does not have to ask any questions, make any further inquiries or notify anyone.
- The panel can sit in private.
- Evidence is not heard on oath.
- The panel cannot summon witnesses – even if they suspect coercion.
- Decisions of the panel are taken by majority vote.
- There is no appeal once the panel approves assisted suicide.
- The panel will be made up of volunteer members who will most likely be supportive of assisted suicide in principle and therefore biased to approve applications.
Hospices cannot opt out
Hospices and Care Homes will not be able to make themselves ‘assisted suicide free’ organisations. This is in spite of evidence given to the Committee by Dr Sarah Cox – the head of the Association of Palliative Medicine –that 43% of members of the association said they would have to leave if assisted suicide were offered in their workplace. This is likely to create a crisis in the hospice industry which is already short of specialist staff. The Bill does not prevent the government from financially penalising any hospice that refuses to facilitate assisted suicides.
Families excluded
There is no requirement for immediate family members to be informed of a decision to request assisted suicide. There is no requirement to notify the family even when assisted suicide is approved. The family may well not find out what has happened till after the patient has died. There is no route for family members to raise concerns about coercion or abuse or to register their disagreement with the patient going for assisted suicide. Jake Richards MP argued in Committee that the family’s views “are not relevant” to the decision whether to allow assisted suicide.
Lack of Regulation and Oversight
The Chief Medical Office will no longer be responsible for overseeing the provision of assisted suicide. The Assisted Dying Commissioner will monitor the system, select the members of the panel, and be the person to appeal to if their application for assisted suicide was rejected. This same person will report to the Health Secretary on how the service is working – effectively ‘marking their own homework’.
There is no regulatory regime for the provision of assisted suicide. The lethal drugs will not need to be approved by the Medicines and Healthcare products Regulatory Agency even though all other drugs require such approval. This raises the absurd possibility of a patient with terminal having to wait for a new promising drug to be approved, but not needing any approval of lethal drugs for assisted suicide.
The NHS can outsource provision of assisted suicide to private companies which are not prevented by the bill from charging or making a profit from facilitating assisted suicides.
Implementation of the bill has been delayed from two years to four years at the government’s request because of the complexity of implementation. Facilitation of assisted suicide will automatically start in four years whether the NHS is ready or not.
Conclusion
It is clear that this Bill has not been made safer in Committee Stage – in fact, it is even more worrying than it was at the beginning. As the third reading approaches, we hope that MPs will be more than aware of the dangers this Bill poses, and we pray that they would wholeheartedly reject it.
Join us outside Parliament on 16 May
We will be making a stand outside Parliament to show MPs how important it is to reject this Bill. The more people join us, the clearer the message will be.
You can register your attendance here.
