The new Assisted Dying for the Terminally Ill Bill (Joffe Bill)

Lord Joffe's new Assisted Dying for the Terminally Ill Bill had its first reading (announcement of publication but no debate) in the Lords on 9 November. This is the third 'assisted dying' bill tabled in the Lords in as many years. If passed it will 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'. Put simply it seeks to legalise physician assisted suicide (PAS), but not euthanasia, along the lines of the Oregon Death with Dignity Act.

The introduction of this new Bill follows the debate on Lord's Joffe's previous bill of the same name, which led to a House of Lords Select Committee. As noted in previous updates the Select Committee reported in April and their report was the subject of a nine hour debate in the House of Lords on 10 October.

The new bill is now available on the UK Parliament website at www.publications.parliament.uk/pa/ld200506/ldbills/036/2006036.htm.

The previous 2004 bill, on which the Select Committee Report was based, is still available for comparison at www.publications.parliament.uk/pa/ld200304/ldbills/017/2004017.htm.

How does the 2005 bill differ from the 2004 bill?

In general it has been modified to introduce more 'safeguards' against abuse. There are a number of minor changes in the numbering of paragraphs and layout but the major changes are as follows:

  1. The new bill legalises physician assisted suicide but not euthanasia (ie. It is an Oregon Bill not a Netherlands Bill) However there is a provision for self-administration of drugs by infusion for patients for whom the oral route is impossible or inappropriate'
  2. The bill applies now only to Wales and England and not Scotland as before
  3. Although the doctor must still prescribe the lethal drugs, another member of the healthcare team may now assist him in helping the patient to commit suicide (so by implication the doctor need not be present)
  4. Terminal illness has now been redefined as 'likely to cause death within six months' rather than 'a few months'
  5. The initial request for assisted suicide must now be made in writing and not just verbally
  6. Dissenting doctors now have no legal obligation to refer the patient requesting PAS to another doctor (but must forward the case notes on request)

More minor changes are as follows:

  1. The term 'competent adult' has been replaced by the term 'adult who has capacity' presumably to match the wording of the Mental Capacity Act which has received royal assent in the intervening period.
  2. A psychologist, and not just a psychiatrist, may now certify a patient as having capacity when referring doctors are in doubt.
  3. A specialist in palliative care (doctor or nurse) must now visit the patient to 'inform (them) of the benefits of the various forms of palliative care' rather than simply 'discuss the option of palliative care'
  4. The declaration form (which is filled out to authorise PAS) has now disappeared from the bill itself and will be 'prescribed by regulations made by the Secretary of State'.
  5. Of the two witnesses to the declaration, the first can be either a solicitor of public notary, and the second witness now need neither know the patient nor have his identity proven to him before witnessing the declaration.
  6. If the patient revokes a declaration then, in addition to a note being put in his file to this effect the original declaration must now be 'removed from the patient's medical file and destroyed'.
  7. The (silly) reference to patients having a legal right to receive pain relief has been removed
  8. Patients must now be 'registered for primary health care in England and Wales for a period of at least twelve months' rather than just being resident there for that period.

What happens now?

The bill will next come for a second reading where there is a debate on the principle of the bill but (by Lords convention) no vote. The date for this has not yet been announced but will appear on the Lords website.

With Lord Joffe currently out of the country it is now extremely unlikely that the second reading will be before the New Year. Following the second reading the bill will go to a 'Committee of the Whole House' where amendments can be tabled and debated and then to a report stage and third reading where a vote is taken. If the vote passes its third reading it will then pass to the House of Commons, if granted parliamentary time, where it will undergo three further readings before, if passed, obtaining royal assent. The best chances of defeating the bill are therefore:

  1. At committee stage by the tabling of 'wrecking amendments' to change it beyond recognition.
  2. At third reading by a simple majority vote in the Lords
  3. Through it not being granted parliamentary time in the Commons (because of the pressure of government business – this is quite likely)
  4. In the Commons at second reading where, unlike the Lords, there is a vote
  5. At third reading in the Commons.

The government are currently taking a neutral stance on the bill, so any vote would be a conscience vote. Ideally we would hope for a massive defeat in the Lords in the early New Year. The worst-case scenario would be that the bill passes a third reading in the Lords and then traverses the Commons. This could possibly happen next year but the government currently sound unlikely to grant parliamentary time. Whatever the outcome, even if this bill is defeated the relentless pressure for new legislation will continue.

The Scottish Right to Die for the Terminally Ill Bill (Purvis Bill)

We reported in the last update that MSP Jeremy Purvis had published the responses to his consultation on his 'Dying with Dignity' Consultation – see www.jeremypurvis.org/consultation1.htm.

Jeremy Purvis's final proposal for a bill 'to allow for a mentally capable, terminally ill adult the right to receive medical assistance to die' was lodged on 25 October 2005. Under the rules which regulate Members' Bills, a proposal of this kind must attract 18 supporters (including members of at least half of the political parties or groups represented on the Parliamentary Bureau) within one month if it is to continue through the legislative process. Thankfully Jeremy Purvis's proposal attracted only five supporters within the allotted time period. This means that his proposed Right to Die for the Terminally Ill Bill will not proceed.

Theoretically Jeremy Purvis could lodge a proposal 'in the same or similar terms' once 6 months has passed. (This is stated in rule 9.14.12 of the Standing Orders of the Scottish Parliament, which is accessible at www.scottish.parliament.uk/business/so/sto-4.htm.) However it looks very unlikely that a second submission will be considered in the near future because:

  1. His (Lib Dem) Party is not very pleased with him going alone in this
  2. Scotland has a Parliamentary election in 2007 and nobody wants to 'rock the boat' in this after the nightmare of Section 28 (teaching homosexuality in schools) for the government in Scotland.

In the lead up to this decision the Scottish Parliament Cross-Parliamentary Group on Palliative Care had met on 16 November. There were about forty people present – including representatives from patients' groups, senior palliative care clinicians- both nurses and doctors, academics, psychologists, chaplains and ethicists.

Many expressed concern about the misinformation given by MSP Jeremy Purvis publicising the results of his consultation (see last e-Bulletin), contemplating the legalisation of Euthanasia/Assisted Dying. It was pointed out to Mr Purvis that he had asked narrative questions, but presented the results numerically. He stated that of the 616 responses, 56% were in favour, 33% against and banner headlines in most Scots papers proclaimed 'MSP says majority of Scots want right to die'. However some of these responses came from individuals and others from large organisation or groups of organisations.

It was very concerning that some of the respondents who were marginalized by this misleading counting process were those who work closely with dying people, several of whom had taken a great deal of time, thought and preparation in their responses. These included The Scottish Partnership for Palliative Care (SPPC), an umbrella body for 53 organisations, including all Health Boards, Hospices and many community teams caring for the dying representing thousands of people. SPPC had held a Day Conference on the Purvis proposals and came down resoundingly against.

Other major organisations opposing Euthanasia/Assisted Dying included Marie Curie Cancer Care, the British Geriatric Society (Scotland), the Christian Medical Fellowship in Scotland, the Nurses Christian Fellowship. These are all professional organisations each representing at least 100-200 individuals, many of whom have great experience and expertise in the care of the dying, in a similar manner to SPPC.

New Parliamentary Group

An All-Party Parliamentary Group on Dying Well has been formed. Its purpose is educational - to address current misconceptions about end-of-life care, including the role, use and misuse of different drugs, the nature of euthanasia or assisted suicide, the present state of UK law in this matter, the ethical constraints within which doctors operate, and how these would be affected if the law were to be changed in the light of experience of countries which have gone down this road. It plans to produce briefing material and to hold open lectures by specialists in their fields. This will provide some opposition to the VES-sponsored All-Party Group on Compassion in Dying. Frank Field MP has agreed to be the Chairman.

The medical profession

The BMA decision to adopt a neutral position on assisted dying at June Annual Representative Meeting remains the low point of the last year; but there have been plenty of encouragements since then in terms of growing medical opposition to euthanasia.

As reported in the last e-Bulletin, the Association for Palliative Medicine and the Royal College of General Practitioners made strenuous efforts to establish their members' views. The APM survey found that over 90% of palliative medicine opposed a change in the law and in like manner RCGP members and faculties gave overwhelming support to a statement on assisted dying for the terminally ill opposing any change in legislation.

This autumn one of our associates wrote to the Presidents of the Royal Colleges to ask about the positions on the Joffe Bill and to enquire whether they were intending to consult members. Well over half replied and in particular the Royal College of Anaesthetists and the Royal College of Surgeons of Edinburgh confirmed their opposition to any change in the law. The Royal College of Psychiatrists is currently consulting its membership and the Royal College of Physicians, which was previously neutral, is now considering a wider consultation. Some Colleges (eg Pathologists and Dentists) have decided not to take a position on the Bill.

However it is increasingly evident that the majority of grassroots doctors remain opposed to any change in the law. In addition to the recent spate of letters to the British Medical Journal reported in the last e-Bulletin (which were 95% opposed to euthanasia – see bmj.bmjjournals.com/cgi/eletters/331/7518/0-g), read a later contribution by Dr John Chambers – see bmj.bmjjournals.com/cgi/eletters/331/7520/843#118791.

The internet discussion forum www.doctors.net.uk (dnuk), to which over 110,000 UK doctors belong, has conducted an on-line poll on a variation of the RCGP Statement as follows:

With current advances in palliative care a change in the law to allow euthanasia or physician-assisted suicide is not necessary.

Of over 2,000 who responded (the largest response on record for dnuk) 69% voted in favour and 31% against. This is yet further confirmation that the majority of doctors on the frontline are opposed to a change in the law.

Other notable events

  1. We understand that the Voluntary Euthanasia Society (VES) changed its name to 'Dignity in Dying' at its annual meeting in November. In addition they extended their activity to Scotland. These events have not yet been publicly reported.
  2. Developments in Switzerland - www.timesonline.co.uk/article/0,,13509-1867270,00.html
  3. Encouragement from Australia - The passage of the Andrews bill, which overturned the Northern Territory euthanasia bill, relied upon an enormously successful Australia wide letter writing campaign, which received a lot of support in the churches, especially Catholic churches.
  4. The Oregon Medical Association's 1997 policy position in opposition to Oregon's physician assisted suicide law has not changed. That opposition was re-affirmed at the 1 May 2005 annual meeting of the OMA House of Delegates.
  5. In reaction to laws and proposals in Britain and other countries for euthanasia and assisted suicide, a group of Canadian doctors and lawyers have released a statement condemning these practices. The statement gives a detailed account of the moral and ethical objections to euthanasia and the danger to patients in countries where physician-assisted suicide has been legalised. The statement warns that legalising euthanasia would damage the doctor-patient relationship, have an adverse effect on palliative care and put vulnerable patients at risk of euthanasia without their consent. See catholiceducation.org/articles/euthanasia/eu0037.html.