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Assisted dying assisted suicide Euthanasia

Assisted Suicide Post Brief 47

This is a summary of a report on Assisted Dying compiled for the UK Parliament. Zeynab Al-Khero a researcher for Not Dead Yet UK, contributed to the report.

If you want to read the complete report, click this link  Assisted Dying Report

Summary

There is no consensus on which terminology to use when debating the issue of whether people should be legally permitted to seek assistance with ending their lives. A range of terms are used internationally, and the choice of term often reflects underlying views on the debate. The terms used in this briefing are not intended to endorse or reflect any particular stance on the debate about changing the law.

‘Assisted dying’ refers here to the involvement of healthcare professionals in the provision of lethal drugs intended to end a patient’s life at their voluntary request, subject to eligibility criteria and safeguards. It includes healthcare professionals prescribing lethal drugs for the patient to self-administer (‘physician-assisted suicide’) and healthcare professionals administering lethal drugs (‘euthanasia’).

It is an offence (in England and Wales) to assist or encourage another person’s suicide under section 2(1) of the Suicide Act 1961. Euthanasia is illegal across the UK under the Homicide Act 1957 and could be prosecuted as murder or manslaughter.

This POST brief provides a brief overview of assisted dying, including ethical debate and stakeholder opinion. It examines how assisted dying functions within health services in countries where it is a legal option, focusing on jurisdictions where most data are available on outcomes: Belgium, Canada, the Netherlands, Oregon (United States), Switzerland and Victoria (Australia). It also covers evidence and expert opinion on key practical considerations that are raised in the context of assisted dying.

Further information on the criminal law on assisted suicide (a subset of assisted dying), human rights challenges and previous parliamentary activity is provided in the Commons Library briefing on The law on assisted suicide.

Key points

Key ethical debate centres on autonomy and the protection of vulnerable groups. Robust data on UK public perspectives on assisted dying and variations between different groups are limited. Public understanding of the term ‘assisted dying’ is low in the UK, but some recent UK polls and surveys suggest that a majority of the UK public support some form of assisted dying.

Several medical bodies are opposed, while others have moved from opposing assisted dying to a position of neutrality, meaning that they neither support nor oppose a change in UK law.

No medical Royal College has expressed support for changing the law on assisted dying in the UK.

At the time of writing, some form of assisted dying is legal in at least 27 jurisdictions worldwide. Legislation on eligibility and governance of assisted dying varies:

  • In almost all jurisdictions, it is restricted to adults (including Canada, Oregon, Switzerland and Victoria), while in a few it can also include children with parental consent (including Belgium and the Netherlands).
  • In some jurisdictions, assisted dying is restricted to people with a terminal illnesses (including Oregon and Victoria). In others, it can also be accessed by those experiencing “constant and unbearable” suffering that cannot be relieved but who are not terminally ill. This can be restricted to suffering arising from serious physical illness only (including Canada until 2023), or also include those whose suffering arises from psychiatric illness (including Belgium, Canada from 2023 and the Netherlands).
  • In many jurisdictions where it is a legal option, assisted dying is provided as part of the healthcare system; in Switzerland, it is not part of the healthcare system.
  • Recent official data show that use in different jurisdictions varies. For example, recorded deaths from assisted dying were 0.59% of the total deaths in Oregon in 2021 and 4.2% of the total deaths in the Netherlands in 2019. Research suggests that there is underreporting of assisted dying in some jurisdictions where it is a legal option. Official figures show increasing use over time.Research and stakeholders highlight a range of key practical considerations in the context of assisted dying. Many of these issues are interrelated and are raised in ethical debates:
  • There are different perspectives on whether it is difficult to prevent incremental extension of legislation and eligibility criteria once assisted dying is legalised and whether this is perceived as a concern or as removing barriers to access.
  • Determining prognosis of terminal illness can be difficult and there is debate on how to evaluate whether suffering is “constant and unbearable”. For patients with mental disorders, debate also focuses on how to assess whether suffering is irremediable or whether it could be relieved over time.
  • Assessing patients’ mental capacity for assisted dying requests is complex and can be particularly challenging where the person has psychiatric disorders, such as severe depression, which can impair decision-making capacity. There is also debate on who is best placed to assess capacity and identify potential coercion. The practice of relying on advance directives to authorise euthanasia and the use of assisted dying in those aged under 18 years is controversial.
  • There are limited empirical data on the impact of assisted dying on vulnerable groups, including older people and people with disabilities, in jurisdictions where it is legal. Available studies do not report evidence that assisted dying has a disproportionate impact on vulnerable groups. However, concerns about potential abuses in some jurisdictions have been reported in academic literature and several studies have called for detailed monitoring of assisted dying practice and further research.
  • There is debate on whether assisting dying is compatible with the role of healthcare professionals. Research on the effects of their involvement in assisted dying on healthcare professionals in jurisdictions where it is a legal part of healthcare suggests that healthcare professionals have a range of experiences, both positive and negative.
  • None of the drugs used for assisted dying are approved by a regulatory authority for medicines for a lethal purpose. There is not consensus on the most effective drug or drug combination for ending a human life and specific drugs, doses and monitoring vary.
  • There is very limited research on the social and cultural impact of legalising assisted dying.
  • There is debate on whether legalising assisted dying has an adverse or beneficial impact on palliative and end of life care (P&EOLC) resources and services. Evidence is mixed and suggests that the relationship between P&EOLC and assisted dying is varied and that impacts in any jurisdiction may not be the same as in other jurisdictions, even within the same country.
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Assisted dying assisted suicide

The Mansfield case (Guardian, 23 July) -Should never be a reason to change the law on assisted suicide in the UK.

A man who slit his wife’s throat “in an act of love” and tried to kill himself has been found not guilty of murder after a judge accepted the couple had made a suicide pact.

Mr Mansfield called for a change in the law on assisted dying: “I’d just like to say, the law needs to change. Nobody should have to go through what we went through. Unfortunately, today, my wife is not here. She shouldn’t have had to die in such barbaric circumstances. That was what we had to resort to.”  Guardian Story link

Not Dead UK says, “The Mansfield case (Guardian, 23 July) should never be a reason to change the law on assisted suicide in the UK. This was not an act of compassion, it was an irrational and horrific response of someone who desperately needed mental health support. The current system works as an effective deterrent to some who may want to end the life of a vulnerable person for reasons which are currently unlawful. It is crucial to protect and support all people in that situation. What this story tells us is that Mr Mansfield and his wife did not receive this help. 

Unfortunately, those who support assisted suicide are using this horrific tragedy to promote a need for a change in the law. But this will not help those people and their loved ones who are in desperate need of both timely physical and mental health care, not an assisted death. We at Not Dead Yet UK find using this tragic case to promote assisted suicide is disturbingly unethical”.

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Assisted dying assisted suicide Disability

Assisted suicide should never be seen as a treatment plan.

The Office for National Statistics (ONS) latest data has revealed that terminally ill people are twice as likely to take their own lives than those in the general population who are not terminally ill. Some would examine this and say, let’s change the law on assisted suicide to make it easier for this group to kill themselves. On the other hand, many public bodies, including those in the disability sector, palliative care doctors, parliamentarians, and the judiciary, are implacably opposed to changing the law on assisted suicide. Instead, they argue that more needs to be done to support dying and vulnerable people by providing universal access to treatment for their physical and psychological needs.

The cohort examined in the ONS study were predominantlyONS logo people with a new diagnosis of a physical illness such as heart disease, and studies confirm that people are at the highest risk of suicide at diagnosis. Opponents of assisted suicide are deeply concerned about whether patients are assessed for any mental illness and if any specialist support is offered at the point of diagnosis. They suggest that appropriate supportive interventions at diagnosis may help alleviate suicidal thoughts.

If we now imagine that the study focussed on young people with eating disorders, not older people with heart disease. The findings might be similar, but there would be an outrage if the solution to these findings were to legalise assisted suicide. Instead, there would be a demand for better mental health support. Why, therefore, should older people with terminal conditions be treated differently?

Baroness Campbell of Surbiton, Founder of Not Dead Yet UK (NDYUK), says, “We know we have the ability, technology, and medical expertise to help people live and offer them a comfortable, dignified death. Sadly, this option is not available to everyone, as high-quality health, social and palliative care are in short supply”.

People diagnosed with a terminal illness or born with a terminal illness need to feel protected, cared for and supported. If we change the law on assisted suicide, we suggest the opposite, that terminally ill people are expendable, and their lives are less valuable.

Baroness Finlay of Llandaff has successfully campaigned for a law to ensure that palliative care should be offered throughout the country. This could mean that appropriate end of life care becomes more widely available, which should help reduce the incidence of suicide.

When I think about the future and how we care for terminally ill people, I want to see a world where everyone has access to the support they need, where the dying feel valued and are treated with kindness and respect. Assisted suicide should never be seen as a treatment plan.

Zeynab Al-Khero Researcher NDYUK

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Assisted dying assisted suicide Disability

Thank You

This year you have helped NDYUK successfully defeat the latest House of Lords Private Members Bill to bring in assisted suicide legislation, plus a lethal amendment to the Health and Care Bill which attempted, to force the government to introduce Assisted Suicide (AS) legislation in their name. These campaigns which resulted in 2 major rejections, marked the twelfth time that proposals for AS have failed to be passed by Parliamentarians!

On a positive note, the Government adopted Baroness Ilora Finlay’s amendment to the Health and Care Bill which makes palliative care a universal right, to be commissioned as a core service of the NHS. This is a vital step towards the model of care we have campaigned for at the end of life that is desperately needed.

But the dangers of assisted suicide, have not gone away, and the proponents of Assisted Suicide continue to campaign for a change in the law. They are using “increased public support and growing numbers of countries successfully legalising Assisted Dying around the world”, as a basis for an argument for a change in the UK.

NDYUK is the only organisation of disabled people campaigning effectively to prevent such a law from threatening the lives of disabled people. We want to stop further risks of disabled people becoming suicidal, often due to the lack of support for them to lead dignified lives without pain. We recognise that thousands of disabled people are already on the edge due, to social care cuts, the galloping rise in the cost of living and day-to-day experiences of discrimination. So…

Wooden post with a pink post it note saying "you are important"Please help us to continue to fight against future attempts to bring in assisted suicide legislation, which must surely be the deepest threat to the lives of disabled people in the UK and questions our right to thrive with dignity, purpose and ambition.

You can help by:

  • Becoming a member and supporter of the NDYUK campaign;
  • Offering to write articles on the issue of assisted suicide for NDYUK when requested;
  • Donating to the campaign (details on the donations page);
  • Promoting NDYUK news on social media;
  • Spreading the word.

The NDYUK network committee cannot work effectively without you. We want to thank all our members for all the essential voluntary help you have given over the years to resist legalising assisted suicide in this country. Without you, we would have been in a very different place today.

We look forward to continuing to hold our stance for as long as it takes, please continue to support the campaign and persuade others to sign up.

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Assisted dying assisted suicide Disability Euthanasia

Watch out for assisted suicide by the back door

Ahead of the debate on amendments to the Health and Social Care Bill in the House of Lords, Baroness Jane Campbell reflects on the dangers of new legislation which could  introduce assisted suicide by the back door.’

Few would argue there’s an awful lot to be worried about at the moment. As disabled people, we have a particular focus on a number of things, whether it’s the unwillingness of the government to support us during the pandemic, difficulties getting the health and social care we need and an increase in the costs of living that are making tight budgets even tighter.

This week the House of Lords is back debating the Health and Social Care Bill, which has many implications for disabled people but now has a new threat – assisted suicide by the back door.

The Conservative peer Lord Forsyth has thrown a googly into proceedings by tabling an amendment to the bill which would see draft legislation to allow terminally ill people to end their lives with medical assistance.

Lord Forsyth

This is a cynical attempt by those in favour of changing the law on assisted suicide to attach a rider to new legislation which has the backing of the government. This is at a time when there is already an Assisted Dying Bill before the House of Lords, which is now waiting in the queue for thorough scrutiny.

It is wrong to use parliamentary procedure to try to impose new legal requirements on the (quite literally) life and death issue of assisted suicide into the substance of other legislation.

A debate about assisted suicide needs a detailed and rigorous approach. We need thoughtful and informed debate, with evidence from experts from across the opinion spectrum and an understanding of the impact of assisted suicide legislation from other countries. We need to carefully examine how people are treated at the end of their lives in this country, what options should be available to them and why it is people are often not getting the palliative care they need. 

It is a controversial issue about which most of us have strong opinions. Last year the British Medical Association became neutral on the matter by a wafer-thin majority. Palliative care doctors argue strongly that the current law should remain as it is. The recent debate in the House of Lords saw a near 50/50 split of those in favour and those against. 

In the meantime, legislators need to listen carefully to disabled people. We are concerned that changes to the law which open the door to assisted suicide will lead to pressure on us to take the lethal (and cheap) way out.

Instead of the thoughtful analysis needed, we get a distracting amendment from Lord Forsyth to government-sponsored legislation which allows for nothing of the kind. This type of political hijacking is unhelpful and unwarranted, and a waste of parliamentary time.

The Health and Social Care bill is an important piece of law that will impact services delivered to disabled people and incorporate a massive shakeup to the way our NHS is organised. It will also see the biggest changes in how people and their families have to pay for social care services that we have seen for decades. It will not only affect millions of disabled people. It will affect the vast majority of those who live in this country.

Parliament should spend its time and resources on scrutinising this bill in the appropriate way. We should not have to deal with the distraction of politicians attempting to manipulate the way Parliament works. Trying to sneak in such a fundamental change in the way we consider the end of life issues is wrong. I hope that Lord Forsyth will reconsider and withdraw his amendment.

Jane Campbell is a crossbench peer and co-founder of Not Dead Yet.

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Assisted dying assisted suicide Euthanasia Mental Health

Euthanasia and Psychiatric issues

Research findings from Holland

A recent research report published in Holland that focussed on euthanasia and people managing mental health conditions reveals some worrying findings.


Summary
Of patients requesting an assisted death:

  • Most were aged 21-60, some as young as 12 (p27)
  • Most were women (60% vs 40%), especially in the 41-50yr age group, a higher proportion than the population. (p28)
  • 40% had a low educational level, compared with 29% of the population.(p28)
  • There were more single people (70% compared with 48% in the general population) (p30)
  • Depression was the commonest diagnosis (26.6%)(p35)
  • In men under 30yrs, ‘Neurological developmental disorder eg. autism spectrum disorder, was the commonest diagnosis (p36)
  • Of the women under 30yrs three women changed their minds immediately before being given the IV drug.(p37)
  • In women under 30yrs, ‘depressive mood disorder’ was the commonest diagnosis, with a ‘neurological behavioural disorder’ as a diagnosis in five..(p38)
  • ‘Personality disorders’ were the commonest psychiatric ‘co-morbidity’.(p47)
  • 20-50% of individuals had chemical dependency issues.(p47)
  • 48 men (48/788 – 6%) and 235 women (235/788)- 29.8%) women reported previous sexual abuse.(p49)

Follow this link to go to the full report. https://bit.ly/340CLkc

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Assisted dying assisted suicide Disability Meacher Bill

Assisted Suicide by the backdoor

Proposed amendments to the Health and Care Bill could change the law on assisted suicide.

Attempts are being made to introduce new clauses in the Health and Social Care Bill currently being debated in the House of Lords that would allow assisted suicide. One amendment is proposed by Baroness Meacher and the other by Lord Forsyth of Drumlean, Lord Falconer of Thoroton and Lord Warner. The clauses are reproduced below.

We understand that introducing clauses in this way is frowned upon by most Peers so it is possible that they will not be accepted. Nonetheless, it is yet another example of the lengths that our opponents will go to change the law on assisted suicide.

Here are a few of the essential points to be made regarding the amendments to the Health and Care Bill.

This is a Health and Care bill and therefore it should not be used to change the criminal law.

It is inappropriate to use amendments in this bill to open the door to assisted suicide when there is already an assisted dying bill in the House of Lords awaiting the committee stage.

The amendments made in the Health and Care Bill do not take into account the experience of other jurisdictions that have legalised assisted suicide and they contain no safeguards.

We urged the House of Lords to reject these proposed amendments.


Clause 69

BARONESS MEACHER

203 Page 62, line 19, at end insert—

“(1AA) The regulations must make provision—

(a) for anyone with a diagnosis of terminal illness to be offered a conversation about their holistic needs, wishes and preferences for the end of their life, including addressing support for their mental and physical health and wellbeing, financial and practical support, and support for their social relationships,

(b) that, where that individual lacks capacity for such a conversation, it is offered to another relevant person, and

(c) that for the purposes of section 12ZB a relevant authority must have regard to the needs and preferences recorded in such conversations in making decisions about the procurement of services.”

297 Insert the following new Clause—

“Assisted dying

(1) The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill to permit terminally ill, mentally competent adults legally to end their own lives with

medical assistance.

(2) In preparing the draft Bill and any accompanying documents and in making arrangements to lay them before Parliament, the Secretary of State must take account of the need—

(a) to respect that this is a matter of conscience, and

(b) to enable Parliament to consider the issue.”

Member’s explanatory statement

This amendment ensures that the scope of the regulations as to patient choice includes those at the end of life.

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Assisted dying assisted suicide Disability Meacher Bill

The Campaign is Not Over.

As you know, the House of Lords debated the Meacher’s Bill a week or so ago.

No vote was taken, and we still believe that it will be lost without the government backing the Bill.

It is possible, however, that the Bill could go to a Committee Stage.

We are preparing to draft amendments to ensure that we are ready for any eventuality. We will keep you informed as things become more apparent over the next few days.

In the meantime, thank you for all the support you’ve given us over the past weeks. We have greatly appreciated it.

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Assisted dying assisted suicide Disability Do Not Resuscitate Meacher Bill

House of Lords Debate over

The end of a very long day and a long debate.

Although it is early days it would seem that the latest attempt to change the law on Assisted Suicide will not make it through all the processes needed for the Meacher Bill to become law. This is not a great surprise as senior figures in government have indicated that it will not be supported.

Before we start cracking open the champagne bottles it’s important to recognise that this is just another step in a very long journey. The Bill may have further to go and will return in a different form perhaps, so we will once again have to deploy all of our resources to resist it.

Your continued support over the coming months will be crucial.

Now is the moment to say thank you to all of you who have helped us to get our points across and by so doing ensure that the voices of disabled people are heard.

Finally here is a link to Baroness Jane Campbell’s article in today’s Guardian which summarises our concerns.

https://bit.ly/2ZhROnv

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Assisted dying assisted suicide Disability Meacher Bill

We would not take patients’ lives’

Medics write a letter to Health Secretary against Assisted Suicide Bill which would let clinicians provide legal drugs for terminally ill people

By Christopher Hope,  CHIEF POLITICAL CORRESPONDENT and Maighna Nanu Daily Telegraph

Nearly 1,700 doctors have written to Sajid Javid to oppose weakening assisted suicide laws, saying they will refuse to help patients take their own lives.

The intervention comes ahead of Friday when peers are expected to pass a Private Members’ Bill through the Lords which would allow doctors to provide lethal drugs to terminally ill people who want to end their lives.

Boris Johnson, the Prime Minister, and Mr Javid are understood to be against weakening the law – but the peers’ Bill is expected to go to the House of Commons within months when it will probably be put to a free vote of all MPs.

‘Enormous’ shift ‘should not be minimised’

The letter – signed by 1,689 doctors and sent to the Health Secretary on Tuesday – said: “The shift from preserving life to taking life is enormous and should not be minimised.

“It is impossible for any government to draft assisted suicide laws which include legal protection from future extension and expansion of those laws.”

They added: “Any change would threaten society’s ability to safeguard vulnerable patients from abuse, it would undermine the trust the public places in physicians, and it would send a clear message to our frail, elderly and disabled patients about the value that society places on them as people.

“Far from one person’s decision affecting no one else, it affects us all. Some patients may never consider assisted suicide unless it is suggested to them.

“The cruel irony of this path is that legislation introduced with the good intention of enhancing patient choice will diminish the choices of the most vulnerable.”

Signatories include Professor Johann de Bono, a professor in experimental cancer medicine at the Institute of Cancer Research; Prof David Galloway, the former president of the Royal College of Physicians and Surgeons of Glasgow; and Rob George, professor of palliative medicine at King’s College London.

They conclude: “We would not take patients’ lives – even if they asked us to – but for the sake of us all, and for future generations, we ask that the law remains unchanged.”

Concerns dismissed by Baroness behind the bill

It comes after the British Medical Association, the biggest union of doctors, dropped its opposition to assisted dying last month and adopted a neutral stance.

Baroness Meacher, pictured here speaking in the House of Lords, is the peer behind the Bill

The doctors’ concerns were brushed aside by Baroness Meacher, the peer behind the Assisted Dying Bill, who said: “It is always easy to find a list of people to support any position.

“More significant is that the BMA last month ended its opposition to assisted dying following their survey of their members showing a majority of doctors in favour of assisted dying.”

The Royal College of Physicians said it was neutral on the issue in 2019.

Recent research from the pro-assisted suicide campaign Dignity in Dying found that up to 6,500 terminally ill people try to take their own lives every year because of a ban on assisting their death.

Mr Javid declined to comment.

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