Head of Public Policy Tim Dieppe on the expert evidence warning peers about the assisted suicide bill
The House of Lords’ assisted suicide bill select committee has now concluded its hearings and published a report of the sessions.
The committee met on eight occasions and heard evidence from over 40 witnesses. The published report of the committee runs to 188 pages and consists of transcripts of the evidence hearings. No conclusions or recommendations are made, in accordance with the terms of reference of the committee.
The Terminally Ill Adults (End of Life) Bill will now move to be scrutinised by a committee of the whole house starting today (14 November), with three further sittings planned through November and December. There are already over 900 amendments proposed to the bill – a sign of just how inadequate and controversial this bill is.
Several witnesses raised serious concerns about the bill as it stands:
Opt-in rather than opt-out
Written evidence from the Royal College of General Practitioners (RCGP) argued that GPs and other healthcare professionals should have to opt in to help with ‘assisted dying’, and that it should not be deemed core GP work.
The College argued that: “There should be a right for GPs to refused to participate in the assisted dying process on any ground, and statutory protection making it unlawful to discriminate against them for doing so.”
Additionally, it proposed that: “Any assisted dying service would need to be separately and adequately resourced and should not in any way, result in a de-prioritisation of core general practice, or palliative services.”
When questioned by the committee, Dr Michael Mulholland, Honorary Secretary of the RCGP said: “The whole question of making decisions for assisted dying is against everything that I have been trained in and I have practiced for 30-plus years.”
Assisted suicide is not treatment
Professor Katherine Sleeman, Professor of Palliative Care, argued that the bill should clarify that assisted dying is not a medical treatment. If it were a medical treatment, then “doctors would have a duty to raise it as an option for all patients who were eligible”. If it is classified as a medical treatment, then there could be potential for accusations of negligence if doctors failed to raise it.
The Royal College of Psychiatrists (RCP) made several recommendations for improving the bill. These included: an explicit provision within the bill which excludes the physical effects of mental disorders as the basis for eligibility; clarifying that assisted suicide is not a treatment; having an opt-in register of psychiatrists who are willing to make assessments for assisted suicide; ensuring that medical membership of the panel includes medical expertise that reflects the needs of the patient and that where a psychiatrist is a member of the panel they should not be the only medical professional on the panel; giving the panel powers to call for evidence in more complex cases.
A coroner should investigate every death by assisted suicide
Former Chief Coroner for England and Wales, Thomas Teague, argued that all ‘assisted deaths’ are “both in law and in reality, deaths by suicide” and that therefore they should be investigated by a coroner. He said: “Removing this safeguard would render assisted deaths unique among intentionally procured fatalities in being exempt from automatic judicial scrutiny.” He argued that: “re-categorising assisted deaths . . . as natural deaths may have the unfortunate and unintended consequence of . . . making it easier for persons who want, for example, to exercise coercion, pressure or deception, to do so.”
Palliative care is not available for all
Hospice UK gave evidence that this bill is progressing “against a backdrop of persistent inequity in palliative and end-of-life care.” 1-in-3 people who would benefit from palliative care are unable to access it. Hospice UK said that this pressure on hospices “provides a precarious foundation for the introduction of assisted dying”. Indeed, “it would be a grave moral and practical failure if a single person in future felt compelled to seek an assisted death due to a lack of available palliative care.”
The Equality and Human Rights Commission also noted the lack of availability of palliative care, stating that this could mean that the bill would be in violation of Article 2 and 3 rights of the European Convention on Human Rights.
No safe drug for assisted death
Professor Katherine Sleeman pointed out that there is no “drug or substance that is agreed to bring about death safely (i.e. without complications) and effectively (i.e. quickly without failure).” There is no scientific consensus on this important issue. In Oregon, complication rates have been as high as 15%, and the time from ingestion to death ranges from 7 minutes to 26 hours. Common practice is to first administer a general anaesthetic, and then a neuromuscular blocking agent to eliminate muscular spasms which may be interpreted as signs of distress by relatives. These points are not addressed in the bill.
Not good law
Professor Alex Ruck Keene KC, known as the leading legal expert on mental capacity and the Mental Health Act, argued that “The bill is not good law.” He pointed out that the bill lacks clarity, lacks coherence, lacks effectiveness, and lacks accessibility. He said he had set out a series of amendments to remedy these defects.
Along similar lines, barrister and pharmacist Greg Lawton argued that the bill is “inadequately drafted, and in parts antithetical to the UK constitution.” He noted that “the bill has changed radically since its second Commons reading”, and that it has not been consulted on to any appropriate degree. Frankly, he said, “the bill appears to be the product of ‘making it up as you go along’.”
Other objections
The British Geriatric Society said that “there are inadequate safeguards within the bill to protect older people, and there are no specific safeguards focussed on older people.”
Concerns were raised by Professor Martin J Vernon about the lack of certainty around prognosis.
The mental health charity Mind raised concerns about the lack of distinction between terminal illness and certain mental health conditions, and the potential widening of eligibility.
Baroness Grey-Thompson pointed out that there is no DDPO (Deaf and Disabled People’s Organisation) that supports this bill, and that “checks for coercion are inadequate”.
The EHRC’s Alasdair Henderson, when asked about the possibility of legal challenge to expand eligibility, said that this cannot be excluded and that there is no obvious reason to discriminate against people who have longer than 6 months left to live contrary to Article 14. He argued that Parliament cannot guarantee that it will not be expanded by the courts.
Baroness Berridge questioned Kim Leadbeater MP who is sponsoring the bill about the definition of ‘pressure’. The bill would create a new criminal offence of ‘pressuring’ someone to have assisted suicide. The concern is that there is no legal definition of the word ‘pressure’ in the bill or elsewhere in existing criminal law.
Lord Falconer, who is also sponsoring the bill, conceded that concerns raised by the Delegated Powers Committee did require changes to the bill. As it stands, the bill gives the Secretary of State the power to amend primary legislation. The Delegated Powers Committee described this as “highly inappropriate”. Lord Falconer said that he would be tabling proposed amendments in relation to this.
Joint Committee on Human Rights scrutinises the bill
Separately, on Wednesday, the Joint Committee on Human Rights held an evidence session on how the bill would affect the human rights of disabled people.
Disability campaigner Liz Carr was outstanding. She said:
“The one safeguard that there currently is, that I feel safe with, . . . is that assisted suicide remains a criminal act. Once it becomes a medical treatment, then that’s when it terrifies me, because it happens behind closed doors and is based on medical subjectivity.”
Baroness Hollins, Emeritus Professor of Psychiatry of Learning Disability, said: “Psychiatrists do not believe they have the skills to determine capacity for [seeking assisted suicide].”
Shockingly, Dr Henry Marsh chuckled when recollecting his earlier comment about “sacrificing grannies”, but then went on to justify this by saying: “The principle is there is always a cost. . . You justify that risk by saying more people benefit. It sounds rather inhumane and utilitarian.”
Multiple concerns with a badly drafted bill
The upshot from all this evidence hearing is that there are many and varied serious concerns about this bill. Hence the huge number of amendments proposed.
As Liz Carr said, the only safe option is not to change the law.
Please continue to pray with us that this bill does not pass into law and that peers listen to the various concerns raised. Do write to a peer to point of some of these concerns too.
