I had been hoping to speak in the debate on the Assisted Dying Bill, which has just taken place. However, owing to the number of colleagues wishing to speak, I was not called before “time was up”.
However, I have voted against the Bill now, and it has been defeated. Below is the text of the speech I had hoped to give, which sets out my thinking on this difficult and emotive subject. The correspondence I received from constituents was overwhelmingly in agreement with my own view, but I respect the views of those who disagree. End of life care for the terminally ill is something so many of us have painful personal experiences of, and I am pleased that the debate has been conducted in a respectful way.
Here is my speech:
When I first heard about this private member’s Bill on Assisted Suicide, my first instinct we immediately to say no. I am sure that others here felt exactly the opposite and support it. However, I don’t think that instinct is necessarily a good way to make laws.
I think my major concern with this Bill is its lack of safeguards and the message it sends out to people in the community.
Firstly: There is no guarantee that even a terminally ill patient is in the last six months of life. There are numerous examples of people at their lowest, thinking about death, who have rallied and had several more months, if not years, of worthwhile life. Even sufferers of debilitating conditions can live for a long time with a terminal illness and spend valuable time with their families. Too many of my friends have died not to realise that even precious extra months are important.
I am concerned about this Bill’s effect on Doctors. The BMA and other organisations have written to all of us laying out their views. Section 3 of the Bill states that a suitably qualified registered medical practitioner –the attending doctor – must be satisfied that the patient is terminally ill, which can be a clearly arrived-at diagnosis, but cannot judge exactly when they are going to die as I have mentioned before.
More importantly, the attending doctor has to ensure that the patient has the capacity to make the decision to end their own life - how does the doctor recognise this, are we expecting the doctor to know them before the illness so they can judge whether they are still in their right mind? Has the attending doctor had sufficient psychological training to evaluate whether the patient has competency? The independent doctor will be in an even greater position of uncertainty than the attending doctor.
In Oregon out of 752 cases since 1997 only 44 have been referred for psychiatric evaluation. This trend has gone down, there were none in 2009. The independent doctor or the judge presumably has no knowledge of the patient previously as they are only bought in to confirm.
How does the attending doctor satisfy themselves that the intention to end one’s life has not been bought about by coercion or duress? It is not just the external pressure from relatives but internal pressure that people feel. “I don’t want to be a burden is a very common theme” – in Oregon 38% feared being a burden, 61% in the state of Washington.
This Bill really relies on one doctor, the attending doctor, to make the assessment. The independent doctor and judge are just the rubber stamps and they do not have enough knowledge of the patient, I believe, to make this a safe judgement. That puts an intolerable pressure on the attending doctor and as the BMA state ‘a profound and detrimental effect on the doctor-patient relationship, even where medical involvement is limited to assessment, verification or prescribing’. In fact, going back to the Oregon example again, the law has led to patients ‘doctor shopping’ for willing participants who have minimal to no knowledge of their past. In 2008 50% of patients requesting suicide were assisted to die by a doctor who had been their physician for eight weeks or less.
The other point I would like to make is what message does this send out. Is this the ‘thin edge of the wedge’ as one constituent described it to me? Do the proposers of this Bill want to go further and extend it so we could have a Dignitas system here? This Bill puts a huge burden on vulnerable people, people with disabilities, people who feel that they are spending their children’s inheritance by having nursing care and so forth. The Royal College of Surgeons put it very well ‘The right to die may become the responsibility to die, making vulnerable people even more vulnerable’.