1. Assisted Dying Bill Update
2. Care Not Killing Update
3. Mental Capacity Act Update
4. The use of Morphine
5. Kelly Taylor
6. Palliative Care Bill
7. Medical Profession
1. Assisted Dying Bill Update
Lord Joffe's Assisted Dying for the Terminally Ill Bill was defeated at its 2nd reading in the House of Lords on 12 May 2006 by the significant margin of 148 to 100. This was the third of three assisted dying bills introduced by Lord Joffe in three years and was attempting to legalise assisted suicide in England and Wales. When the British Medical Association (BMA) reversed its neutral stance on euthanasia six weeks later on 29 June 2006 it was clear that Lord Joffe's plan to reintroduce his bill at the earliest opportunity would have very little chance of succeeding.
It has therefore been no surprise that we have seen no fresh attempt to legalise assisted suicide or euthanasia in Britain since, and are now unlikely to do so in this parliamentary session. However we do expect to see another bill, probably brought forward by someone other than Lord Joffe in the House of Lords, when the next parliamentary session starts this autumn.
In the meantime the pro-euthanasia lobby has been very active in fundraising and in maintaining a steady flow of euthanasia stories in the media. Watch this space.
There has also been further bad press for Ludwig Minelli's Dignitas suicide clinic in Zurich, Switzerland, which was recently described by relatives of a British citizen who had died there as resembling a backstreet abortion clinic.
The Government remains officially neutral on assisted dying, but a recent statement by Lord Warner, Health Minister in the Lords at the time of the May 2006 debate on Lord Joffe's Bill was rather concerning.
On 25 January 2007, in response to Baroness Gardner of Parkes debate on 'Health and Care in the Community', Lord Warner made the following statement: 'The public will insist that any future Government continue to pursue choice. It needs to be continually nurtured and promoted, against some professional resistance. We need to move into new areas, including end-of-life care and how we can leave this world with dignity, at a time and place of our choosing.' When asked to clarify his comments by Lord McColl, he said, 'I think in the coming months we will have plenty of time to expand on that particular subject.' (Hansard, 25 January 2007, 3.45pm, Col 1271)
2. Care Not Killing Update
We have had a very successful first year of operation and celebrated our first anniversary on 31 January 2007. The alliance, which now consists of 44 member organisations, is widely acknowledged, not least by the opposition, to have played a major role, both in defeating Lord Joffe's last Bill, and in overturning the BMA's neutral stance on euthanasia.
During 2006 we produced and distributed 500,000 leaflets and 12,000 DVDs, coordinated a major letter writing campaign to members of the House of Lords and collected over 100,000 signatures in a petition against Lord Joffe's Bill. In addition our spokesmen appeared in many media reviews on all major television and radio stations and were quoted extensively in the national press.
The fact that this was achieved on an annual budget of less than £50,000 gives testimony to the hard work of volunteers who worked evenings and weekends on alliance activities, whilst maintaining their full time day jobs.
3. Mental Capacity Act Update
The Mental Capacity Act 2005 provides a statutory framework for people who lack the mental capacity to make their own decisions. It sets out who can take decisions, in which situations, and how they should go about this. It also enables people to make provision for a time in the future when they may lack capacity to make some decisions. The Act received Royal Assent on 7 April 2005. Some of the Act is due to come into affect in April 2007 and the rest commences in October 2007.
A guide for people making decisions on behalf of those who lack the capacity to do so was laid in Parliament on 22 February by Constitutional Affairs Minister Cathy Ashton. The Mental Capacity Act Code of Practice sets out good practice and covers an extensive range of different decisions that might need to be taken.
The Mental Capacity Act requires a range of people to 'have regard' to the code, for example anyone acting in a professional or paid role in relation to someone who lacks capacity. More than 160 individuals and organisations responded to a consultation on the Code of Practice in October last year. CNK's own submission is available on this website.
The most controversial part of the Act allows for advance refusals of food and fluids, and concerns have been expressed that, in the wrong hands, these could be abused by those seeking to end the lives of mentally incapacitated people who have 'become a burden'.
There are safeguards in the Act, but it remains to be seen what effect they will have when it comes into force. The Kelly Taylor case (see below) is one example of how some might attempt to abuse the provisions of the Act by putting pressure on doctors to sedate and dehydrate people in accordance with suicidally motivated advance directives.
Further information about the Mental Capacity Act is available on the DCA website http:
4. The Use of Morphine
We remain deeply concerned that some media reports are giving the misleading impression that doctors are administering morphine to dying patients in the knowledge that it will kill them.
The latest of these came on Radio Four's 'Thought for Today' on 23 February, when the Rev Dr Alan Billings, Director of the Centre for Ethics and Religion at Lancaster University, addressed the case of Kelly Taylor, a 30 year old woman, who is currently seeking legal permission to be heavily sedated with morphine and then dehydrated until she dies.
In the broadcast, Rev Billings referred to the so-called 'double effect' of high doses of morphine – a misconception that has become pivotal in Kelly's case. He said, 'Every day we allow doctors to end the lives of some people by making a distinction between intention and outcome. A doctor increases the morphine of a terminally ill person in great pain to the point where they die. The morphine kills. That's the outcome, but the doctor is not thought culpable because his intention is the relief of pain, not the death of the patient.'
Rev Billings here was expressing two popular misconceptions about morphine: that it frequently ends the lives of terminally ill people, and that it causes sedation when given in doses necessary to relieve pain. We strongly refute the statement that doctors are ending lives by giving their patients large doses of morphine to control pain.
Morphine, if deliberately given in very high doses to people who are not in pain, does cause respiratory depression and death. It was indeed the drug used by Dr Shipman to kill his victims, and this has undoubtedly heightened public anxiety about its use. However, when correctly used to relieve pain in a patient who is terminally ill, morphine should never cause death. By contrast it usually lengthens life and improves its quality. This is because the therapeutic dose of morphine, which relieves pain, is virtually always well below the toxic dose which ends life and because the relief from pain which it brings removes stress factors in the patient's condition. In addition, toxic doses risk causing increased agitation in some patients- hardly what is intended by those advocating this approach. In modern medicine, and especially in palliative medicine, doctors can kill the pain without killing the patient.
So-called 'terminal sedation' is very rarely necessary; and when it is, it is used to control severe agitation, rather than physical pain, in patients whose conscious level is diminished by their illness. Even when used for the management of agitation, it is very seldom necessary to sedate any patient continuously until they die, but usually only for periods of 12 or 24 hours at a time. Whatever the circumstances, morphine is not the drug of choice used for this sedation since sedation wears off rapidly, which is good for patients taking it for pain relief, but it makes it a poor sedative.
Transcript of Thought for Today 23rd February 2007
5. Kelly Taylor
Kelly Taylor is a 30 year old woman who is currently seeking legal permission to be heavily sedated with morphine and then dehydrated until she dies.
Kelly suffers from Eisenmenger's Syndrome, a congenital heart condition, and has been given less than a year to live. She claims that her palliative care has not been effective. In the past she has made attempts on her own life, most notably by trying to starve herself, but found this too distressing. She now wants doctors to increase her medication to induce a coma-like state, and then to allow her to die from dehydration, so alleviating the discomfort that accompanies starvation and dehydration.
If Kelly's lawyers were successful in their case, it would create a legal loophole whereby doctors could sedate people until they were unconscious, and then dehydrate them to death. The potential for abuse of such a provision would be monumental and we believe the High Court should strongly reject it.
This is a very sad case, but one that highlights the need for nationwide access to gold-standard palliative care to all who need it. To this end we are strongly supporting Baroness Finlay's Palliative Care Bill (see below), which received an unopposed Second Reading in the House of Lords on 23 February.
Requests for euthanasia are in fact extremely rare when patients' physical, social, psychological and spiritual needs are properly met, and many patients who initially request to die withdraw their requests if they are properly cared for. Evidence from Belgium shows that almost all applicants for legalised euthanasia withdraw their applications after receiving palliative care Our key priority must therefore be to make the best care most readily available to care for people until they die, and this is what Baroness Finlay's bill is attempting to do. Assisted living, rather than assisted dying. There are of course a small number of people, like Kelly, who – despite having access to good palliative care – still want euthanasia. The question that faces us as a society is whether the law should be changed to make allowance for them. We believe that such a change in the law would put a much larger group of vulnerable people – those who are elderly, disabled, depressed or mentally incapacitated – at risk of being placed under pressure to request early death so as not to be a burden on relatives, carers, or a society short of resources.
Kelly Taylor Story – http:
6. Palliative Care Bill
Baroness Ilora Finlay's Palliative Care Bill, which seeks to make good quality palliative care more widely accessible in England and Wales, had an unopposed second reading in the House of Lords on Friday 23 February. The bill will now proceed to a Committee of the Whole House and thence to a Third Reading. If it passes a Third Reading, then it will proceed to the House of Commons, but only if it is granted time by the Government.
The full debate can be read on Hansard. The bill itself is available on the Parliamentary website.
7. Medical Profession
As reported above the British Medical Association voted by a two thirds majority to reverse its neutral stance on euthanasia and assisted suicide at its annual representative meeting (ARM) in June 2006.
The current policy is therefore that the BMA:
- believes that the ongoing improvement in palliative care allows patients to die with dignity;
- insists that physician assisted suicide should not be made legal in the UK;
- insists that voluntary euthanasia should not be made legal in the UK;
- insists that non-voluntary euthanasia should not be made legal in the UK; and
- insists that if euthanasia were legalised, there should be a clear demarcation between those doctors who would be involved in it and those who would not.
This means that all major medical groups are now opposed to any change in the law. This has not been widely publicised in the media, but references are as follows:
Oral and Maxillofacial surgeons
Royal College of Psychiatrists
Royal College of General Practitioners
Care Not Killing steering group
