Lord Joffe's revised Assisted Dying for the Terminally Ill Bill[1] has its second reading the House of Lords (debate but no vote) on Friday 12 May. The Bill has taken on only four of the Lords'Select Committee's ten recommendations[2] and seeks to enable 'an adult who has capacity and who is suffering unbearably as a result of a terminal illness to receive medical assistance to die at his own considered and persistent request'; in effect to legalise physician assisted suicide (PAS), but not euthanasia, along the lines of the Oregon Death with Dignity Act.[3]
Advocates of the bill have been quick to point out the so-called 'safeguards'within it. It's only assisted suicide, only for adults, only for those with 'six months to live', only for unbearable suffering and only for those who make a 'persistent and considered'request. They further emphasise the option of palliative care, the need for signed consent, assessment of mental competence, the two-week waiting period and the detailed documentation.
They fail to point out however that: assisted suicide is euthanasia by intention and often unsuccessful leading to the need for the doctor to step in with a lethal injection; assessments of 'Gillick competence'will extend the Act to children; prognosis in terminal illness is difficult to define and can be altered dramatically by treatment; suffering has been completely subjectively defined contrary to the advice of the Select Committee; individual cases are not to be reviewed independently until after the key witness (the patient) is dead; the evidence from Oregon and the Netherlands proves that relying on doctors'self-reporting is notoriously unreliable; requests for assisted suicide can be profoundly influenced by fear of being a burden (impossible for those without personal knowledge to assess), depression (no psychiatric referral is necessary) and experience of palliative care (only 'advice about' but not 'experience of' is required).
Furthermore the Bill contains within it the seeds of its own extension. If we are allowing assisted dying for reasons of compassion, then why deny it to patients who are suffering unbearably but not terminally ill? If we are allowing it for reasons of autonomy, then why not grant it to anyone who wants to make the choice? Such inconsistencies will be ripe for challenges under the Human Rights Act the minute that assisted suicide is established as a therapeutic option for anyone at all.
Lord Joffe is to be commended at very least for his honesty in giving evidence to his own Select Committee: 'We are starting off, this is a first stage... I believe that this Bill initially should be limited, although I would prefer it to be of much wider application… But I can assure you that I would prefer that the law did apply to patients who were younger and who were not terminally ill but who were suffering unbearably, and if there is a move to insert this into the Bill I would support it.'[4]
Don't be fooled by the 'it's only' safeguards. It's only the beginning.
