On Friday 18 July the Assisted Dying Bill passed its second reading in the House of Lords without a vote. The proposed legislation, which is unlikely to become law without government support, would allow doctors to prescribe a lethal dose to terminally ill patients who request assistance to end their lives and have less than 6 months to live. The bill would allow patients to self-administer the dose but would not enable doctors to administer the dose to the patient themselves.
What is the current law?
Currently, the Suicide Act 1961 makes it a criminal offence for anyone to assist another person to commit suicide and this carries a maximum sentence of 14 years. However, there are three situations in which doctors are not compelled to provide life-supporting treatment to patients. Firstly, where a capacitated adult makes an informed decision to refuse treatment, doctors must accept that decision; to continue to treat in the face of the refusal is unlawful.
Secondly doctors are able to withdraw life sustaining treatment. The decision to withdraw treatment will be based on the best interests of the patient, which can put pressure on both doctors and relatives involved in the decision making process. The recent Court of Appeal decision discussed here has now imposed a duty on doctors to consult with patients or their family before putting a DNR order in place and this should enhance transparency and cooperation. Thirdly, a patient can make an advance decision, or appoint a donee of a lasting power of attorney with authority to make such a decision. However, an advance decision can be withdrawn at any time by the patient should they change their mind.
What does the bill propose?
The bill is still being debated. However, as currently drafted the bill proposes certain restrictions on the proposed right to assisted dying. To obtain assistance a capacitated adult would need to have a clear or settled intention to end their life and must have made a declaration to that effect in writing, signed in the presence of a witness who is not a relative or directly involved in that person’s care. This declaration would be countersigned by the medical practitioner providing the assistance as well as an independent doctor. A patient would be able to revoke this declaration at any time verbally and there would be a 14 day “cooling off” period after the declaration is signed during which assistance cannot be given (unless a patient has less than one month to live, in which case the cooling off period is 6 days). Only once this period has passed and the patient has confirmed they do not wish to revoke their declaration can assistance be given. Crucially, the bill would not grant medical professionals the authority to administer medication to patients themselves, but only to prescribe it for patients to self-administer.
What will it mean for patients and practitioners?
Although the bill is perceived as unlikely to pass, it does reopen the debate on assisted dying and the ethical questions this raises for medical practitioners, patients and their relatives. For practitioners, the bill would allow conscientious objection which negates any duty to participate. For terminally ill patients, the bill could be a step towards empowerment. However, any legislation would need to incorporate appropriate safeguards and clear guidelines to ensure both patients and practitioners are adequately protected.