Expert panel proposes framework to underpin any future change in law on assisted dying for terminally ill people
The Commission on Assisted Dying will today (Thursday) publish 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.
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.
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.
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.
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 physically 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.
The Commission recommends that if Parliament were to decide to adopt assisted dying legislation in the future, this should include the following eligibility criteria:
- The person concerned is aged 18 or over and has a diagnosis of terminal illness
- The person is making a voluntary choice that is an expression of his or her own wishes and is not unduly influenced by others
- 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
The Commission recommends that any future legislation should also include the following safeguards to ensure that potentially vulnerable people were protected:
- 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.
- 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;
- Safeguards to ensure that the eligibility criteria are met
- Safeguards to ensure that the person has a settled intention to die
- Safeguards to ensure the safe storage and transportation of lethal medication
- Safeguards to ensure the person has a reliable and supported assisted death
- Safeguards to ensure that assisted deaths are reported correctly
- Monitoring and regulatory oversight by a national monitoring commission with powers to investigate suspected non-compliance.
The full report from Commission on Assisted Dying proposes an approach that could be taken to assure these issues were addressed in assisted dying legislation in an appendix to the report, a copy of which can be obtained on request from Demos.
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
- Each person should be entitled to core rights in end of life care
- Good quality end of life care should be available in all settings
- An end to all forms of discrimination in end of life care, whether these are based on geographical location, physical condition, ethnicity or wealth
- More choice in how people die and clear and accessible information
- Effective support and protection for more vulnerable people
Notes to editors:
How such a framework might work:
Person A, who has been diagnosed with cancer and has a prognosis of 9 months, could be eligible for assisted dying (if he/she meets the other eligibility criteria).
Person B, who has been diagnosed with Motor Neurone disease and has a prognosis of 3 years, would not be currently eligible for assisted dying in the proposed framework. However, he/she could be eligible for an assisted death (if the other eligibility criteria are met) when he/she has a prognosis of 12 months or fewer to live.
Person C, who has a significant physical impairment, such as ‘locked in syndrome’, but is not ‘terminally ill’ (e.g. likely to die within 12 months), would not be eligible for an assisted death.
Person D, who has a significant physical impairment and has also now been diagnosed with cancer with a prognosis of 9 months, could be eligible for an assisted death (subject to the other eligibility criteria being met).
Person E, who has dementia but is otherwise physically healthy, would not be be eligible for assisted dying in the proposed framework. This is because while dementia is considered to be a ‘terminal illness’, a person with dementia who had a prognosis of 12 months or fewer would be unlikely to have sufficient mental capacity to meet the eligibility criteria.
Person F, who has recently been diagnosed with dementia and then develops a concomitant terminal illness (e.g. cancer), might be eligible for assisted dying if he/she retains mental capacity (subject to the other eligibility criteria being met).
A copy of the final report from The Commission on Assisted Dying can be requested from Demos. Commissioners are available for comment and interview. Contact:
Beatrice Karol Burks
Beatrice.burks@demos.co.uk
020 7367 6325
079 2947 4938
The report will be available to download from www.demos.co.uk and www.commissiononassisteddying.co.uk from 00:01h Thursday 5 January 2012.
The Commission on Assisted Dying was convened to take a fresh look at the current approach to assisted dying in England and Wales. This included considering whether the current legal and policy framework on assisted dying is fit-for-purpose and investigating what a framework for assisted dying might look like, if such a system was to be implemented in the UK.
The Commissioners have spent the past year considering evidence on these issues from over 1,300 sources including members of the public, experts and practitioners, focus groups, investigative research, commissioned reports and international visits.
It was not the purpose of the Commission to decide whether the law should be changed to make assisted dying legally possible and Commissioners maintain that it is for Parliament to decide on behalf of the people whether it is in the interest of the British public to provide a safeguarded system for assisted dying for a strictly defined group of people.
Evidence brought before the Commission on Assisted Dying has lead 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
- The absence of a robust scheme of safeguards
- The absence of a factor based on suffering or a medical condition
- The lack of clarity for health and social care professionals
- The reliance of amateur assistance
- The discrimination against people who not have the capacity to end their own life
- The impact of friends and family being treated as ‘suspects’.
The Commission on Assisted Dying is made up of:
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.
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.
Lord Ian Blair of Boughton Cross Bench Peer and former Commissioner of the Metropolitan Police.
Sir Graeme Catto President of the College of Medicine and former President of the General Medical Council.
Dr Carole Dacombe Medical Director, St Peter’s Hospice.
Dr Stephen Duckworth Founder and former Chief Executive of Disability Matters Limited and board member of the Olympic Delivery Authority.
Penny Mordaunt MP Conservative Member of Parliament for Portsmouth North.
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.
Dame Denise Platt DBE Member of the Committee on Standards in Public Life.
The Reverend Canon Dr James Woodward Anglican priest and Canon of St George’s Chapel, Windsor.
Baroness Barbara Young of Old Scone Life Peer in the House of Lords and Chancellor of Cranfield University.
Commissioners were agreed on the framework proposed with the exception of the Rev. Cannon Dr James Woodward who, while supporting the process carried out by the Commission, sees a need for further public debate on the issue.
