Welcome to another blog post!
Today’s post is going to be a different one from me. I’ve delved into aspects of my degree before on this blog. I’ve talked about influential cases in english law, miscarriages of justice examples and a few more areas. However, this will be the first post that is catered to my LLM degree in Medical Law and Ethics.
During my degree, I had to do a dissertation and I actually picked the Terminally Ill Adults (End of Life) Bill. In this post, I’m basically going to be doing a cut down version of my dissertation. I should specify now that my dissertation was over 10,000 words. Therefore, when I say this is a cut down version, I mean it.
In my dissertation, I discussed the history of assisted dying, the different ethical principles, how the law currently deals with assisted dying and more. I want this post to focus purely on the bill and its criticisms. I have no idea how long this post will be but I imagine you might want to grab a snack. Let’s get to it!
What is Assisted Dying?
Assisted dying is the killing of a person in order to end their suffering or prolongation of life from which they can no longer benefit from. The bill itself defines assisted dying as being able to ‘on request, be provided in England or Wales with assistance to end their own life.’
Some of you may be wondering why this is a highly controversial thing. Others of you may be looking at this and thinking ‘why on earth would this ever be legal?’ This is where different ethical principles come into play, particularly autonomy and the sanctity of life. I won’t go too much into these now as they will come up throughout this post.
The Background of the Bill
Before I delve into this bill itself, I wanted to look at how it got introduced. This bill was introduced by Kim Leadbeater, a Labour MP. She announced in 2021 that she would be introducing a private member’s bill on assisted dying.
Private Member Bills are public bills introduced by MPs and Lords who are not government ministers. As with other public bills their purpose is to change the law as it applies to the general population.
Leadbeater stated that this bill would give individuals that are dying the autonomy and dignity to choose at the end of their lives whether they want to die under strict criteria. She argued the current law was not clear and wanted to give dying people a choice of how to die.
I should point out that there have been numerous attempts to reform the law before this bill came to fruition. Of course, none were successful and this bill is arguably the one that has been most positive. At the time of publication of this post, the bill is in the committee stage of the House of Lords. This means there are only four steps left, including the committee stage, until the bill reaches royal assent and officially becomes law.
Content of the Bill
Let’s have a look at the content of the bill itself. Discussing this will soon make it obvious as to why this is a very controversial bill that could become legislation.
Like my dissertation, I will discuss the content in numerical order. Frustratingly, there is a lot of jumping back and forth throughout the bill as different clauses relate to each other. Doing it like this will allow for simplicity as I don’t want to confuse the daylights out of you!
Another thing to note is I will obviously not be discussing every single clause of the bill. If I did that, this post would not only be extremely long, it would also potentially be longer than my actual dissertation. Anyway, let’s go through the bill together!
Capacity
The first area of the bill I want to discuss is capacity. The bill states that a person having capacity should be read in accordance with the Mental Capacity Act 2005. So yes, you have to read another act. Thankfully, the explanatory notes of the bill state which sections of that act are relevant, so yippee for us. These are sections 1 and 2 of the act by the way. However, one of the complaints about the Mental Capacity Act is that it’s not capable of responding appropriately to the informational needs and the physical and psychosocial conditions that are there for those that want to die with assistance. Whilst I get this point of view, there are other areas of medical law that could arguably have these same needs and conditions that the act responds just fine to.
The Definition of a Terminal Illness
This is one that gets me in all honesty so I’d love to know your opinions on this. The bill defines a terminal illness as:
A person is terminally ill if – (a) the person has an inevitably progressive illness or disease which cannot be reversed by treatment, and (b) the person’s death in consequence of that illness can reasonably be expected within six months.
The first part of the definition I have no issue with. It’s something we’re all familiar with. To an extent, I don’t particularly have an issue with the second part. A terminal illness is an illness which is going to kill you. However, why six months? As an MP mentioned during one of the debates, what is the importance of six months? Why not go for eight, ten or twelve months?
Of course, there are issues with how a medical professional can be certain that someone is reasonably expected to die within six months. However, reasonably expected is a subjective criteria, so it’s down to the opinion of the medical professionals.
I also should note that this criteria does exist for a reason. There has to be a limit on who can be open to using this bill, otherwise anyone could potentially put in a request. This is one of the safeguards put in place, arguably to protect those that are most vulnerable. Therefore, I do understand the inclusion of this clause.
Voluntary Assisted Dying Commissioner
The next part of the bill I want to discuss is the Voluntary Assisted Dying Commissioner. This is someone that will essentially oversee the practicalities of this bill. The commissioner will be appointed by the Prime Minister which I do see as being somewhat of an issue. There could be potential bias involved but I guess that’s just the way of politics in this country.
However, I do see this inclusion as a positive. This part is in itself a safeguard because if there are any problems, they can act upon it. However, this is definitely an area that needs more detail and clarification. This is because this was not initially included in the original bill. Are you confused? Let me explain.
A Guide to Bills
When a bill is introduced to the House of Commons, it essentially goes on a journey. The first reading is like the formal presentation of the bill. There’s no debate or anything so this is a simple stage. During the second reading, this is where the debate starts, looking at the general principles. MPs will then vote on whether the bill will go to the next stage and that is the committee stage and report stage.
In these stages, amendments are discussed that should be made to the bill. It is at this point that it will go to the third reading. Another debate is held discussing any changes and MPs will then vote on whether to pass the bill to the House of Lords. The bill will then go through the same journey as before, and if any amendments are made in the Lords, the House of Commons will need to agree with them. If an agreement is made, the bill receives Royal Assent and becomes law.
Okay, back to regularly scheduled post
Before the bill had any amendments, the plan was for individuals looking to die to go through the High Court. MPs noted that seeking approval from a high court judge would be expensive and time-consuming. I completely understand why this change was made.
I know that seemed like a detour but I wanted to share why the Voluntary Assisted Dying Commissioner is in its infant stage with regard to the level of detail. However, the Lords are aware of this, with some stating that the role will need to be clarified. This is something to keep an eye on moving forward!
Multidisciplinary Panels
A panel is included as one of the steps the individual must go through if they want assistance to die. This panel includes a legal member, a psychiatrist member and a social worker member. This seems like a positive thing on paper, being one of the important safeguards needed to protect people. However, the House of Lords did note some concerns which I do understand.
One concern was the time it will take for a person to go through each stage, with the Duke of Wellington questioning whether the bill in trying to create sufficient safeguards, has actually exposed the patient to further anxiety, distress and pain. It seems to me that there is a theme of trying to balance the amount of safeguards with the impact that it will have on those that are using the bill.
Another issue I have with the multidisciplinary panel is sort of to do with wider society. Finding the people to work on these panels when there are already issues with staffing in each of the sectors is concerning.
I have barely touched the surface when it comes to this bill and the different areas that bring up concern. This is just a taster of what my dissertation looked at, so if anyone would like to have a read, feel free to let me know in the comments and I will send it over to you!
Thank you so much for taking the time out of your day to read this post and I will see you soon for another one!
Beth
Beth Olivia 