Assisted Dying/Assisted Suicide – Recent Parliamentary Report and Bill

At whiteballoon we believe the more knowledge, understanding and information we have about issues confronting society, the better able we are to make informed decisions and choices. The purpose of this blog is to draw your attention to the recent Second Report of Session 2023-2024 on Assisted Dying/Assisted Suicide by the Health & Social Care Committee on the extremely important and emotive subject of Assisted Dying/Assisted Suicide (AD/AS), and the new Assisted Dying for Terminally Ill Adults (Scotland) Bill introduced by the Scottish Parliament.

Health & Social Care Committee Second Report on Assisted Dying/Assisted Suicide

On 20th February 2024 the Health & Social Care Committee, as ordered by the House of Commons, published their Second Report of Session 2023 -2024 on Assisted Dying / Assisted Suicide. The report states:

“Our aim for this report is for it to serve as a basis for discussion and debate in future Parliaments. We have therefore endeavoured to bring together a comprehensive and up-to-date body of evidence relating to this difficult, sensitive, and yet crucial subject. The debate on AD/AS is not new, and our report is not intended to provide a resolution to it, but we do hope that it will be a significant and useful resource for future Parliamentarians.”

The main focus of this enquiry was the health-related aspects of Assisted Dying/Assisted Suicide, rather than the legal dimension, and it’s geographical area of focus was primarily England and Wales.

What is the Health and Social Care Committee?

The Health and Social Care Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health & Social Care. It is made up of MPs from all the main political parties.

What is Assisted Dying/Assisted Suicide (AD/AS)?

Assisted dying/assisted suicide in the context of this report describes giving legal permission for a person to seek assistance from a physician to end their own life.

Laws and regulations relating to AD/AS vary throughout the UK, but in England and Wales the Suicide Act 1961 states that it is an offence for a person to act in a way which is “capable of encouraging or assisting the suicide or attempted suicide of another person,” and to act in a way which was “intended to encourage or assist suicide or an attempt at suicide”.

When deciding what terms to use when discussing AD/AS, the Committee acknowledged that the terminology used in the debate can itself be controversial. They wanted a term that was both neutral and inclusive, and settled on “Assisted Dying/Assisted Suicide”.

What Was the Purpose of the Report?

The report’s focus was on the human element of health and social care (including end of life and palliative care) and it described its terms of reference as:

  • To what extent do people in England and Wales have access to good palliative care?
  • How can palliative care be improved, and would such improvements negate some of the arguments for assisted dying/assisted suicide?
  • What can be learnt from the evidence in countries where assisted dying/assisted suicide is legal?
  • What are the professional and ethical considerations involved in allowing physicians to assist someone to end their life?
  • What, if any, are the physical and mental health criteria which would make an individual eligible to access assisted dying/assisted suicide services?
  • What protections could be put in place to protect people from coercion and how effective would these be?
  • What information, advice and guidance would people need in order to be able
    to make an informed decision about whether to access assisted dying/assisted
    suicide services?
  • What capabilities would a person need to be able to consent to assisted dying/
    assisted suicide?
  • What should the Government’s role be in relation to the debate?

It is important to note that the purpose of the report was not to provide definitive answers to these questions, but to present a balanced overview based on a comprehensive and up to date body of evidence.

What Research, Information and Evidence Did the Report Draw Upon

The Committee canvassed information and evidence from interested parties and received more than 68,000 responses to their online form, and over 380 pieces of written evidence.

They also looked at cases challenging the law as it stands in England and Wales and examined recent debates and bill proposals in the UK Parliament and in other legislatures in the UK and beyond.

In addition, the Committee looked at how the legal framework has developed in international jurisdictions where AD/AS is currently legal, and the trends and research on AD/AS in these places. Section 2, International Examples, has a map showing where AD/AS is currently legal in some form, and goes on to look at the basis on which it is permitted in each area.

The report also summarises evidence and research on the experience of health and care professionals internationally, as well as the views of representative bodies here in the UK. 

Finally, the Committee heard from experts in palliative care in order to explore the the role that palliative and end of life care play, particularly in the context of understanding whether improving this care could eliminate suffering altogether.

The report highlights that:

“Throughout our inquiry, a common theme across the evidence was the pursuit of the very best end of life care, and what many witnesses called “a good death”, where the person dying was cared for with compassion and high-quality care and provided with as much agency and choice as possible. However, there is a spectrum of views on how to best achieve this.”

Key Considerations Raised in the Report

In the written evidence, the main concerns expressed by those opposed to, or concerned about, the legalisation of AD/AS were that:

  • the eligibility criteria will inevitably be extended,
  • it is not possible to prevent abuse/misuse, even if AD/AS is introduced for a very specific group of people (for example people with a terminal diagnosis of less than 6 months), and
  • palliative and end of life care will be negatively impacted as a result of introducing AD/AS.

As well as considering submissions and evidence from concerned parties and others within the UK, the Committee looked at evidence from countries in which some form of AD/AS is already permitted to see whether, in practice, these concerns might be justified.

Online submissions from UK participants were also an important contribution to the Committee’s debate. Question 2, “Which of the following factors are most important to you when considering the issue of assisted dying? Please select up to three, in order of importance.”, highlighted several areas of concern for contributors.

The top 3 considerations for those who stated that they ‘broadly agree’ with the law as it stands (which does not permit AD/AS in the UK) were:

  • Risk of coercion of vulnerable groups (66%)
  • Risk of devaluing lives of specific groups (56%)
  • Sanctity of life (53%)

The top 3 consideration for the people who stated that they ‘broadly disagree’ with the current law (and therefore propose that AD/AS should be available) were:

  • Reduce suffering (94%)
  • Personal dignity (86%)
  • Personal autonomy (68%)

In addition, the Committee heard evidence from doctors and other healthcare professionals concerned about the impact of AS/AD on those who would provide this service, or who may wish to opt out of doing so.

One of the strengths of this Report is the interesting and insightful contributions from a wide variety of professionals, patients, their families and carers. Their perspectives on different aspects of this issue help us to understand the many different ways the AD/AS can affect those involved.

Assisted Dying/Assisted Suicide is a deeply complex and emotive subject and the above is just a brief summary of the material and evidence covered in this important document. For anyone wishing to start to get to grips with the pros, cons, and possible unintended consequences of legalising AD/AS, we urge you to read the full report here.

Scottish Parliament Assisted Dying for Terminally Ill Adults (Scotland) Bill

On 27th March 2024, the Scottish Parliament introduced an Assisted Dying for Terminally Ill Adults (Scotland) Bill. This Bill is ‘An Act of the Scottish Parliament to provide for the lawful provision to terminally ill adults of assistance to voluntarily end their own lives; and for connected purposes’.

This Act sets out the definition of terminal illness, which is that ‘For the purpose of this Act, a person is terminally ill if they have an advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death’.

It also sets out the eligibility criteria, which is that they ‘are ordinarily resident in Scotland and have been so resident for at least 12 months before the date of the first declaration’, ‘are registered as a patient with a medical practice in Scotland’ and ‘have capacity to request that assistance’. The Act then goes on to define what ‘capacity’ means in this instance.

For those who are interested, we recommend reading the full Act plus the accompanying Explanatory Notes and other Documents.

Summary

Assisted dying/Assisted suicide has the potential to touch every one of us. Being better informed helps us all to engage in this extremely important debate and to be active participants in shaping the direction of future UK law in this area.

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