Choice & dignity: The Assisted Dying Bill

Karin Smyth MP Health Questions June 2015Karin Smyth is one of the sponsors of a Parliamentary Bill, to be debated by the Commons this week, that would allow some terminally ill people to choose to take their own life.

The Assisted Dying Bill comes before the House of Commons for its second reading on Friday 11 September. It would allow adults of sound mind who have a terminal illness, with a prognosis of six months or less, to voluntarily end their life.

The proposed law would ensure a number of upfront safeguards are in place: for example two doctors and a High Court judge would have to be satisfied of the person’s eligibility, and that he or she had made a fully informed decision, before assisted dying would be allowed.

“The change in the law this Bill seeks will provide choice and dignity, whilst reducing suffering for dying people who want to control how and when they die,” said Karin Smyth.

Outlining the inadequacies of current legislation, she said: “As things stand, lawyers and medical staff are left to navigate the intricacies of existing laws which accepts the principle of compassionate assistance to die, but is unwilling to deal with the reality. People who wish to deal with their inevitable death by choosing to die can do so, but must rely on Switzerland to manage the consequences.

“Moreover, people who can manage and afford to travel abroad have this choice, but others do not. To me, that cannot be right. It is time for Parliament to step up to its responsibility as legislator and clarify the law.”

She explained that her professional background, working in the NHS before being elected in May 2015, helped shape her views.

“This is a hugely emotive and personal issue, and many people hold very strong views either for or against. Like many of them, my own opinions have been shaped by my family and friends’ experiences. They have also been influenced by my professional background in the NHS.

“A few years ago I worked on a project with some excellent doctors and nurses who were trying to build, improve and develop the communication skills of clinicians in order to help patients gain a better understanding of their disease. They were committed to helping patients understand how to live with their illness – and eventually how to die with it.

“As a society we talk a lot about life but not about death, particularly death from long term conditions. Much of the work involved opening conversations, to help enlighten patients about how to cope with the flare-ups that might mean spending time in hospital, their treatment choices, and to empower them to make these choices. I learnt a huge amount, especially from the patients and clinicians. I particularly learnt how poorly equipped they were to talk about how to die with dignity, and how lonely it becomes for the patient when it is nobody’s role to talk about dying.

“This insight into how little choice and control patients have, as well as the ‘minefield’ navigated by doctors and other clinical staff, really opened my eyes to the need for society to acknowledge death as a part of life. It also highlighted to me that we need to be more open about how we respond with compassion to the knowledge of imminent and inevitable death. As I became more aware of the issues, I realised that if we are to see the changes that are needed, then we must change the law.

“Opinion polls suggest public support for a change in the law is strong, but I understand that many people will be worried about this, feeling passionate about the issue and profoundly disagreeing with me.”

Each Private Members’ Bill has a number of sponsors, and their role is to support its passage in the House of Commons, being present when it reaches the various stages. The Assisted Dying Bill’s primary sponsor is Rob Marris MP. Other co-sponsors as well as Karin Smyth are Heidi Alexander, Crispin Blunt, Lucy Allan, Jim Fitzpatrick, Paul Flynn, Norman Lamb and Stephen Twigg,

The Assisted Dying Bill has a clear process, with multiple safeguards.

1. It covers a patient who is “terminally ill”; i.e. life expectancy of less than 6 months. (Hence those with disabilities, however serious, are not covered unless they also have a terminal illness.)
2. The patient must be aged 18 or over.
3. The patient must have been ordinarily resident in England or Wales for at least one year.
4. The patient must be of sound mind. (Hence dementia patients for example are not covered)
5. The patient voluntarily (i.e. not coerced) signs a declaration that they wish to end their own life.
6. The patient’s own doctor counter-signs the declaration that the patient is terminally ill and of sound mind and acting voluntarily.
7. An independent specialist doctor counter-signs the declaration that the patient is terminally ill and of sound mind and acting voluntarily.
8. If a doctor has a conscientious objection to any of this, then he or she does not have to participate in any way.
9. Upon the application of the patient, a High Court judge agrees that the patient is terminally ill and of sound mind and acting voluntarily.
10. After the court order, there is a 14 day cooling off period.
11. After that cooling off period, the doctor takes the medicine to the patient, and waits there.
12. The patient must choose: to take the medicine themselves, or to change their mind and not take it.
13. The medicine is self-administered by the patient, and by no-one else – not by any third party (e.g. not the doctor, not the spouse).
14. If the patient decides not to take the medicine, the doctor leaves and takes the medicine away – i.e. the medicine is not left with the patient.
15. The Chief Medical Officers must monitor the operation of the Act and submit an annual report which must be laid before Parliament.