The assisted suicide Bill Committee scrutinising Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill met for its sixth week of sittings last week to continue its line-by-line scrutiny of the Bill.
On 18 and 19 March, MPs on the Committee rejected amendments that would have ensured that hospices and care homes could have opted out of assisted suicide taking place on their premises.
After removing the flagship High Court judge safeguard the previous week, MPs also voted to introduce Assisted Dying Review Panels (NC21).
No protection for hospices that refuse to permit assisted suicide on their premises
Over the course of the two-day debate, MPs voted against protections for hospices and care homes that may not wish to have assisted suicide performed on their premises, as well as voting against strengthening protections for individual medical professionals who do not wish to be involved in assisting in the suicide of their patients.
Rachael Maskell introduced an amendment (441) to prevent “there being any obligation on a care home or hospice… to permit the provision of assistance under the Act on their premises”. The amendment was defeated 17 votes to 4.
Pro-Bill MPs on the Committee also voiced opposition to New Clause 23, which sought “to protect hospices from further funding pressures arising specifically from the Bill, because there is a risk that public funding becomes dependent on offering assisted dying”, as Rebecca Paul MP explained.
“The new clause would ensure that public authorities could not make funding conditional on the provision of assisted dying, and could not subject care homes or hospices to any other detriment merely on the grounds that they do not permit such assistance to take place on their premises”, she added. A formal vote on New Clause 23 will be held towards the end of the Committee Stage.
MPs rejected Danny Kruger’s amendment (480), which, as he explained, provided “a non-exhaustive list of activities that would be protected. The list was roughly adapted from the legislation in Victoria, Australia, so I hope Members can see that I am following precedents from elsewhere”.
“The amendment would ensure that all professionals—indeed, all individuals —are properly protected and would not become involved in assisted dying if they did not want to”.
Paul argued that the “institutional opt-out”, which permits care homes and hospices to refuse to allow assisted suicide on their premises, is “standard practice in US states that have adopted assisted dying”.
“Without this amendment, we are looking at a legal and ethical minefield. If a hospice has a policy of helping with assisted dying requests and a staff member refuses to refer a patient to a doctor, can that staff member be sacked, or are they protected by clause 23? Surely we want to avoid the situation arising in the first place, by ensuring that employers can make clear their requirements on this front at the hiring stage”, she said.
Quoting from the Association for Palliative Medicine, Paul also warned of an “exodus of skilled and valuable health and social care practitioners” if organisations are compelled to permit assisted suicide on their premises.
Speaking in support of both amendments, Kruger argued that “it is important to acknowledge the rights of the community as a whole, and particularly the organisation or individuals responsible for overseeing the service. I am thinking explicitly of hospices or care homes, where many people end their days; it is imperative that we give the operators of care homes and hospices the explicit opportunity in law to state that they do not facilitate assisted dying on their premises”.
Labour MP Naz Shah defended the clause to prevent hospices being financially penalised for refusing to permit assisted suicide on their premises, saying “The new clause would also provide that no public authority can make its funding for a regulated care home or hospice dependent on the care home or hospice agreeing to provide assisted dying or to allow assisted dying to take place on its premises”.
“All the amendments have the same goal: to ensure that the Bill does not harm this country’s hospices”.
“Many people would be entirely willing to enter a care home or hospice if they thought they might receive assisted dying there, but others already fear that they might be pressured into taking assisted dying if they enter palliative care. They may be wrong to fear that, but they do”, she continued.
“Hospices should be able to say clearly to their patients that they do not allow assisted dying to take place on their premises. The dedicated professionals who work in hospices and who deeply object to people being helped to die with lethal drugs must also be protected. They should be free from having to work on premises where something they might disagree with happens”.
Amendments rejected
Under the assisted suicide Bill, in the act of assisting in suicide, a doctor may “assist [a] person to ingest or otherwise self-administer the substance” that will cause their death.
Danny Kruger introduced an amendment (463) to remove this line, arguing that there is a blurred line between [euthanasia and assisted suicide]”.
“I am afraid my strong belief is that the reason why euthanasia has not been proposed in the Bill or by the campaign, which has been led by an organisation that used to call itself the Voluntary Euthanasia Society, is because the campaign has concluded that such a Bill would not pass Parliament and believes—I think correctly—that Members of Parliament and members of the public would object to euthanasia. But the logic of the Bill and of the campaign is actually for euthanasia, if one believes genuinely in autonomy, in equal rights and in not discriminating against people who are physically unable to perform the act themselves”.
He went on: “if the person found it difficult to raise a cup to their lips, the nurse would help them. Indeed, if they found it difficult to perform an injection, it would be expected that that would be done by the nurse or doctor anyway. But here we are setting up a strange new method of administering a so-called treatment in which the patient has to perform the physical act themselves”.
“It is apparent from the clause that it is very unclear what assistance actually looks like, so yes, I absolutely imagine that if the patient were struggling to raise the cup to their lips, a nurse or doctor who was present at the final act in an assisted suicide would help them to do so”.
“Similarly, if the patient were finding it difficult to put their finger on the syringe, it would be appropriate—normally, one would expect—for the medical professional to lift the patient’s finger and put it in the right place. What happens next? Do they then apply a little pressure if the patient is finding it difficult to depress the plunger on the syringe? If the cup is at the lips, do they tip it up and let gravity take its course? These very complicated questions about where assistance ends and autonomy begins are, I am afraid to say, impossible to specify in the Act; therefore, it is apparent that we have a grey area”.
The amendment was rejected 18-3.
The Committee refused to support an amendment (435) requiring emergency medical care if an assisted suicide fails and requiring doctors to revive patients in such a scenario. Minister Stephen Kinnock suggested that to do so may be a breach of the “European convention on human rights—the right to family and private life—if the person has indicated that they do not wish to be referred to emergency services or do not wish to be resuscitated”.
The Committee rejected an amendment (436) requiring the doctor attending during an assisted suicide to make “‘a detailed record’ if the person suffered complications. They would then have to declare that the person had suffered complications, on the final statement concerning that case. Finally, they would have to make a report, to both the chief medical officer for either England or Wales and the voluntary assisted dying commissioner”.
Danny Kruger was keen to make clear, in the event that an assisted suicide attempt failed, what the doctor should do. He tabled an amendment (464), which required that in cases where the assisted suicide is failing, the doctor “must not do anything with the intention of causing the person’s death, and […]must seek to revive the person”.
Kruger said “there are three choices in the event of failure. The first is to ignore the plain signs of distress, of things going wrong and of the patient suffering, which is clearly a failure of the doctor’s duty of care. The second is to expedite the death, which we have decided would be illegal under the Bill. Therefore, the only option is to revive the patient and escalate treatment, rather than actively or passively facilitate their death”.
“I hope Members will agree that, on the rare occasions when assisted suicide goes wrong, it is right that the patient is immediately revived and taken to hospital, or for the doctor to take whatever action is necessary”.
An attempt (466) to ensure assisted suicide drugs could only be used if there was a scientific consensus that they do not cause a painful death was rejected 15 votes to 7.
Inside and outside the Committee
The Committee day of Tuesday 18th ended in controversy after Naz Shah, a Committee member with a hearing disability who had repeatedly spoken to Kim Leadbeater about the difficulty of late and lengthy Committee sessions, had to leave early after Leadbeater kept the Committee sitting into the evening. She said “I apologised to the members of the assisted dying bill committee tonight as I had to leave early. I didn’t want to but had to because my hearing aids need to recharge after 15 hours use and without them I cannot hear or take part in the committee”.
On the same day, away from the Committee, the pro-assisted suicide pressure group Dignity in Dying won the ‘Digital Campaign of the Year’ at the Pagefield Awards. They received the award ahead of fellow nominees CALM, a suicide prevention group and anti-domestic abuse charity Women’s Aid.
The award was introduced online with the claim that “Campaigning has the power to change minds, influence policy, and even save lives”, even while the winning organisation campaigns to end lives.
At the same event, Kim Leadbeater won ‘Political Speech of the Year’ for her assisted suicide Bill Second Reading speech, a speech after which she had to apologise to MPs for misleading them by incorrectly claiming widespread judicial backing for her Bill.
