Thursday, 17 September 2015

Assisted Dying

Parliament can be at its best on a "free vote" where the political parties step aside and where each individual MP tries to reach their own conclusion on difficult and complex issues of conscience.  Last Friday, we all debated one of the most difficult issues of all: the Assisted Dying Bill.

None of us finds it easy to contemplate death. In recent years there have been some heart wrenching cases of individuals who had severe terminal illnesses and who wanted to bring their own life to an end early, on their own terms with medical assistance.  Some of these have ended up in high profile cases before the courts.  In the last few years I have become more sympathetic to some sort of change in the law that would allow professional assistance to be given to those who genuinely want it and had therefore been minded to support the Bill.

However, as always in such areas, the difficulties start once you get into the detail and try to work out how to put such an option into the lawyerly clauses of a written statute.  A week before the debate as part as my preparation, I read the whole Bill from cover to cover and that is when doubt started to set in.  Of particular concern for me were the nature of the "safeguards" and the impacts that creating such an option would have for relationships within families.  It started with the mere description of how a doctor would prepare and then place the drinkable "medicine" beside the patient and then retreat to a neighbouring room to observe from a distance.  There would need to be a signed declaration from two doctors that the persons' condition meant they had less than six months to live. Doctors say it is very difficult on most conditions to make such a judgement on an arbitrary time limit.  It would also not have helped some of the difficult cases which have ended up before the courts and have prompted debate in recent years such as the former rugby player who was severely paralysed.

There would then need to be a High Court Judge to decide whether or not the individual had genuinely wanted to exercise the choice to have assisted dying or whether they had felt under pressure to do it.  But how can a judge really know when you have such complex relationships between an individual and those nearest and dearest to them? Someone might feel very uneasy about ending their own life but could equally feel that they were a burden on their children or feel that they would not want their children to see their condition deteriorate. Their children would most likely feel precisely the opposite and would want their loved ones to know that they would always be there for them. But they would equally fear that they might be being selfish by standing in the way of a loved ones' wishes. The problem is compounded by the fact that people with such terminal illnesses sometimes suffer depression which is understandable. This came up in the debate and the solution put forward by proponents is that, in such cases, doctors would refer the individual for psychiatric assessment before signing off the procedure. But what's that about?  You have to go and pretend to be happy for the psychiatrist before you are allowed to opt to end your own life?

For every case where this gives people the option they want, I feared there would be many, many more where the weight of having to consider whether to actually take such an option would add another intolerable dilemma to people suffering terminal illnesses.  That is why, in the end, I voted against the Bill. However, I remain sympathetic to some other change.  As I listened to the debate I could see an alternative way.  Legal guidance has already been altered in recent years so that there are no prosecutions brought in cases where a family member acted compassionately to assist a loved one in their wishes.  We could, in my view, move that guidance further.  It might also be that people should be able to opt in advance for a palliative care pathway that deliberately seeks to expedite an end rather than try to delay the end.  That would go some way to dealing with these difficult choices without bringing all the new dilemmas inherent in the Assisted Dying Bill.