Sponsor of the assisted suicide Bill, Kim Leadbeater, has refused to introduce safeguards to prevent doctors from bringing up assisted suicide with their patients unprompted, despite concerns raised by witnesses last week that such an action could itself be a form of coercion.
As the Terminally Ill Adults (End of Life) Bill makes its way through Committee Stage, Leadbeater has tabled a series of amendments concerning the role of doctors in the assisted suicide process including additional training requirements for medical practitioners around assessing capacity and coercion, the need to produce a report for each applicant, assessing both mental capacity and the potential of patients being pressured into taking the decision, and a requirement that doctors cannot raise assisted suicide with a patient in isolation from other palliative care and treatment options.
However, critics have pointed out that these amendments are “very insubstantial”. As journalist Dan Hitchens has pointed out on X, the amendment that prevents doctors from raising assisted suicide with a patient in isolation from other options reiterates what is already present in the Bill.
2020 guidance from the General Medical Council also says that doctors “must give patients the information they want or need to make a decision”, which includes treatment options and “the nature of each option, what would be involved, and the desired outcome”.
The Bill, in its current form, requires the medical practitioner to explain and discuss “any available palliative, hospice or other care, including symptom management and psychological support”. However, if there are no palliative, hospice or other care options “available”, there is no obligation to pursue or refer for these care options. Leadbeater’s amendment does nothing to change this.
During the assisted suicide Bill Committee hearing last week, palliative care doctor Rachel Clarke told MPs about the potentially coercive nature of doctors even mentioning assisted suicide to a patient.
“If, for instance, you say to a vulnerable patient who has just been told they have a diagnosis of terminal cancer, “Have you thought about assisted dying?”, I would suggest that stating it broadly like that is a form of pressure and that you are potentially unintentionally coercing that patient. The very act of raising assisted dying in that way will make that vulnerable patient think, “God, is this doctor telling me that my life is not worth living any more?”, she said.
Detailed report
Despite news reports that under one of Leadbeater’s amendments “[d]octors will need to produce a detailed report into every applicant”, for assisted suicide, there is no mention of a “detailed report” anywhere in any amendment. Leadbeater’s amendments merely stipulate that the coordinating doctor and the independent doctor must make “a report” that confirms they have followed the regulations.
Hitchens commented that it was “[n]ot clear what this adds except paperwork”.
Training
Leadbeater has also introduced an amendment that would require the coordinating doctor in an assisted suicide to undergo training that would include assessing capacity and coercion.
However, the training involved is left unspecified by the amendment. During the Bill Committee sessions last week, one of the Australian doctors, who has personally “assisted” in the deaths of at least twenty of her patients, boasted of what she called “very stringently developed, and very rigorously tested” training for a doctor who wishes to be involved in the assisted suicide process. The Australian Centre for Health Law Research at the Queensland University of Technology developed an “online training package that takes at least a day to complete”.
During one of the sessions, Dr Rachel Clarke said “It is my clinical experience that not only are the majority of doctors not necessarily trained in spotting coercion explicitly, but they are often not trained explicitly in having so-called advance care planning conversations with patients around the topic of death and dying, and how a patient would like the end of their life to proceed”.
President of the Association for Palliative Medicine, Dr Sarah Cox, said “I would say that you cannot always identify coercion. You can identify it when it is very obvious and extreme, but when it is very subtle, we cannot always identify it. After the event, there is nobody to tell us about coercion, so it is very difficult to monitor”.
Emeritus Professor of Psychiatry, Allan House, told the MPs he is “familiar with meeting people who have a severe and life-limiting physical illness and say that they want to end their life. In the assessment, the starting point is trying to understand why. That can mean circumstances – external factors. Some of those have been aired during the public debate about all this. They include things like limitation of available resources, symptom control, poor housing and financial insecurity. There is also the question of the baleful influence of third parties. There are then the internal factors that we could call something like state of mind—feelings of personal worthlessness or burdensomeness, loneliness and isolation”.
The assisted suicide Bill will undergo its next stage of public scrutiny on 11 and 12 February.
Spokesperson for Right To Life UK, Catherine Robinson, said “Leadbeater’s amendments appear to be little more than window dressing. She has steadfastly refused to introduce safeguards to prevent doctors from introducing the topic of assisted suicide with their patients unprompted in direct contradiction to advice from experts who warned her about how this could be potentially coercive”.
“Leadbeater’s Bill is dangerous and fundamentally flawed. A few completely inadequate tweaks will not change that. It is almost certain that the safeguards will not protect everyone who does not really wish to die or who has been pressured into assisted suicide. MPs must reject it at Third Reading”.
