The All Party Parliamentary Group (APPG) on Choice at the End of Life, in partnership with the interest group, Dignity in Dying, has published a draft Bill aimed at modifying the statutory law for assisted dying.
The Bill follows on from the Assisted Dying Commission’s report of earlier this year.
Readers will be aware that this issue remains very topical and some of you will have read our recent briefing on the Nicklinson/AM case, in which Mills & Reeve acted on behalf of the interested NHS party in relation to AM.
Responses are invited by all who may have an interest in the consultation. The closing date is 20 November 2012 and responses can be made at www.appg-endoflifechoice.org.uk.
In summary, the Bill seeks to safeguard assisted dying for patients in a terminal phase of their life (ie, one year or less to live) who have capacity and a settled intention to die.
Only the patient themselves will be able to raise the issue of assisted dying with their doctor and two doctors must assess whether the patient meets the eligibility criteria. It would not be for a doctor or any other third party to raise the issue with the patient and in fact this would be a breach of the Act, if passed. One of the assessing doctors would be the “attending” doctor which would usually be the patient's GP or a specialist in charge of an aspect of their care. The other would be an independent doctor, who would not know the patient or be connected to the attending doctor. On this basis the Bill, if passed, would have an impact for independent clinicians together with provider and commissioning services.
The two doctors would independently check, evidence and record that the patient:
- Has a terminal illness with a prognosis of twelve months or less to live
- Has mental capacity to make the decision
- Has made a clear and settled decision, voluntarily and without coercion
- Is aware of palliative, hospice and other supportive care available to them
If either doctor had any concerns that the patient did not meet the four criteria above, they can refer the patient to another health or social care professional for a second opinion.
The patient must be able to prove that:
- They are an adult (aged 18 and over)
- They have been a resident of England and Wales for at least the previous year
The patient would make a formal written request to be witnessed by an independent person. The patient could revoke their request at any time.
If both doctors agree that the patient is eligible, a formal declaration, signed by both doctors, is made. A copy would then be sent to the monitoring inspectorate, which would specifically be created to monitor compliance with the Act and which would have a complement of staff attached to it.
The attending doctor would then write a prescription of life-ending medication for the patient and the medication would be stored securely with an assigned pharmacy.
The patient would be required to wait for a period of at least 14 days after the declaration takes effect before they can ask the attending doctor (or another registered doctor or nurse who has been authorised to do so by the attending doctor) to pick up the medication and deliver it to their home. In cases where the patient was expected to die within one month, the waiting period could be reduced to six days.
The medication would be delivered to the patient by an assigned doctor or nurse, who would again check the patient’s capacity and ask the patient if they still want to die. If the patient does, the medication will be given to them and the patient will then take the medication themselves (this is a specific requirement of the Bill). The doctor or nurse would remain on the premises while the patient took the medication.
The death of the patient would then be reported by the doctor or nurse to the monitoring inspectorate. The doctor would certify the death. The Bill specifically allows for a conscientious objection for professionals.