This is Prospect’s rolling coverage of the assisted dying debate. This page will be updated with the latest from our correspondent, Mark Mardell. Read the rest of our coverage here
28th February
It is little wonder that Kim Leadbeater sounds increasingly exasperated as her bill heads into its third week of line-by-line scrutiny. “This should be a robust process with thorough checks, safeguards and balances throughout, but we are in danger of forgetting the dying person at the heart of this process, and we need to be really careful that we take a patient-centred approach,” she told the committee.
What’s up?
Opponents of the bill on the committee are repeatedly debating at length amendments that are variations on a theme—this week it was mental capacity—knowing full well that in the end they will be defeated. This then gives campaign groups such as the anti-abortion organisation Right To Life the red meat they need to write headlines like “Leadbeater Committee rejects amendments to strengthen safeguards, despite psychiatrists’ warnings”. They can also urge supporters to write to their MPs to vote the bill down at third reading because “The Committee voted down an amendment that would have raised the bar of the Mental Capacity Act to ensure an appropriately high test for mental capacity; rejected an amendment to make it explicitly illegal for someone to ‘encourage’ another person to seek an assisted suicide; and rejected an amendment to protect people from choosing assisted suicide because they feel they are a burden.”
The Christian Institute goes further, arguing that “observers were astonished that pro-bill MPs on the Committee voted down all attempts to introduce safeguards to Clause 1 of the Bill.
“Clause 1 outlines that a person must have ‘a clear, settled and informed wish’ for assisted suicide, and that they are not being ‘coerced or pressured’ into it.
“Amendments to protect people from choosing assisted suicide due to coercion or feeling like a burden were rejected by Kim Leadbeater and her allies, including two supposedly neutral government ministers.”
Gentle reader, this observer wasn’t in the slightest bit astonished at the very predictable outcome of pushing bill-wrecking amendments to a vote.
By highlighting what I believe is their tactic, I don’t intend to imply that the committee’s deliberations were anything other than well-argued, serious and largely good-tempered.
But it is worth looking in detail at what the bill’s opponents were calling for. They wanted to turn the definition of mental capacity on its head. Broadly speaking, mental capacity means whether someone has the ability to make a decision and understand it. At the moment, English law says it is assumed we all have that, unless there are specific arguments that we don’t. The chair explained a key proposed amendment would get rid of “several principles of the Mental Capacity Act: the presumption of capacity, the duty to help someone reach capacity, the irrelevance of an unwise decision, the application of the balance of probabilities, and the diagnostic test”.
The Labour MP Daniel Francis argued: “We should not be afraid to say that a person who is terminally ill is potentially vulnerable. Depression and stress are common and understandable responses to a terminal diagnosis and, whether we like it or not, some people in our society will prey on the fragile for their own gain. Our job is to confront the risk of someone being given access to an assisted death not because that is their considered wish, but because no conclusive evidence is available to the doctors at the time of the assessment, or because someone is controlling or coercing that person and able to persuade them in favour of an assisted death that they do not truly want by hiding any signs of their impaired capacity until it is too late.”
Conservative MP Rebecca Paul said: “A doctor could assess a patient who gives the impression of being confused, illogical, erratic or inconsistent—everything about them could scream that they are not in a good place to make the decision—but they will still be considered to have capacity if there is no identifiable impairment of, or disturbance in, the function of the mind or brain at that point in time. That potentially puts those with depression, anxiety, learning disabilities or eating disorders, or even those in physical pain, in danger of being considered capacitous.”
The indefatigable unofficial leader of the bill’s enemies, Conservative MP Danny Kruger, was characteristically graphic: “If we adopt Clause 3 we are proposing that somebody has capacity if they end their own life. That implies directly that somebody who is standing on a window ledge or a bridge, about to commit suicide, is assumed to have capacity and to be making a rational decision, which other people should support. I say that directly, because there is a direct read-across with the whole topic of suicide prevention, which obviously we all strongly believe in. How can we say that somebody who is about to take their own life, unassisted, does not have capacity and is not making a settled and informed wish? In which case, why should we stop them or try to wrestle them back from the edge?”
After an intervention he continued: “If the right honourable lady thinks that somebody who is terminally ill should be allowed to jump off a bridge or out of a window without anybody saying, ‘Wrestle them back,’ she should say so. We think that whether someone has capacity or is in their right mind or not, they should not end their own life. That is the settled view of this country. That is what the law determines. Currently, it is illegal to help someone to do that. We are proposing to change that, to enable people to help somebody to do that in a medical setting.”
Leadbeater, clearly rather fed up with the same points being made day after day, got straight to the crux of the matter: “Unfortunately I feel that we will probably never get to a point with the bill where he is happy with the level of safeguards, and maybe he is prepared to acknowledge that.”
Kruger, to his credit, did: “It is unlikely that I would ever vote for an assisted dying law but, if we are going to have one, I want to make it as safe as possible.”
However, my strong suspicion is that for Kruger and his colleagues this whole process is designed to create the impression that the committee is recklessly ignoring sensible amendments rather than voting down ones which would make it very difficult for patients to use.
So Leadbeater brings it back to those at the heart of the debate.
She referred to 45-year-old Laura Perkins, who watched the debate from the public gallery on Tuesday. Laura’s mother died last year of ovarian cancer and a separate mouth cancer. The chemotherapy she underwent was brutal. She lost her eyesight and had her tongue removed. She was unable to eat or drink and starved to death. Leadbeater said it had been “a horrible death”. “We have to acknowledge the limitations of palliative care.”
Her remarks are unlikely to have much impact, but we’ll see when the committee returns to its deliberations on Tuesday and Wednesday.
27th February
The Isle of Man parliament, the Tynwald, claims to be the oldest continuous parliament in the world, established by the Vikings in the 10th century—but it still seems a lot more modern in some ways than Westminster. Like the United Kingdom parliament, however, there are two houses, both jealous of each other’s roles. Given that the lower house has rejected an important amendment proposed by the Legislative Council, it will be interesting to see how they react when they meet in mid- March.
The equivalent of a final “third reading” debate opened with the member of the House of Keys who authored the bill, Dr Alex Allinson, tabling the first series of amendments.
“Thank you, Mr Speaker. These amendments strengthen some of the provisions within the bill. The words ‘coercion’ or ‘duress’ are substituted for ‘coercion, duress, or undue influence’. This is a reflection of the concerns raised regarding possible coercion and the need for additional training and analysis to identify it.”
At once it was clear that members of the House of Keys (MHKs) who’d always been opposed weren’t giving up yet. First up was Kate Lord-Brennan, who warned: “Ultimately, from this point forward, I’m not going to be supporting any of the proposed amendments that have come back to further embed some of the issues that we’ve had. I think, actually, this bill should have been bounced back by the Legislative Council. It is not fit for purpose, and I think that it will come with severe and serious consequences.”
Then her colleague Julie Edge made a similar point: “I think this is a very dangerous bill coming to the Isle of Man without the safeguards. We’ve seen what’s happened in Westminster, and certainly, the safeguards there are for the most vulnerable in society, and we do have an awful lot of them. I do not feel they are appropriately covered within this…
“I feel this is a really bad day for the social contract for the Isle of Man and for our people, the most vulnerable in our society.”
The Speaker said he didn’t want a rehash of the main debate where the principle was approved, so opponents did at least try to work by questioning the amendments. But inevitably they made wider points.
Edge suggested that some doctors might see assisted dying as a way of saving the health service money. She quoted Dr Alex Allinson: “The mover of the bill said, ‘there are costs of providing for assisted dying, but at the moment we have costs. I hate to talk about money when we are talking about choice, autonomy and dignity, but we do have costs with people having terminal sedation and being in hospital beds.’ Mr Speaker, that’s what the mover of the bill said—that we’re bed-blocking with some of these patients that the honourable mover of the bill thinks perhaps could have another choice.”
Her voice breaking with emotion, she continued: “They might be coerced at that point, Mr Speaker, in a hospital bed. I’ve seen this live in action, Mr Speaker. I’ve seen an aged person asked, do they want to die? Mr Speaker, it’s really, really important that we have ethical people that will protect our most vulnerable.”
But one important amendment was actually opposed by the bill’s mover: the Legislative Council had suggested cutting the five-year residency criteria to just 12 months.
MHK David Ashford welcomed Allinson’s opposition: “I think this amendment moves things backwards. For me, [the five-year criteria] was one of the fundamental safeguards,” he said. “Certainly for me, it was an absolutely essential part of the bill.”
And with 23 members of the House of Keys pressing their green buttons, the proposal was unanimously rejected.
So what happens now? The bill goes back to the Legislative Council. Dr Allinson was asked by Manx radio if ping pong would ensue.
“I hope not. I think the House of Keys has been quite clear on the amendments they did not accept, and they explained their reasoning in a coherent way. So I hope the Legislative Council will take that on board and agree with the House of Keys.
“Should they disagree, then I’d be keen on holding a bit of a conference, which is part of our parliamentary process—to sit around the table and try to work out how we can achieve consensus on this. This is important. I think the bill has been under discussion for a considerable amount of time, and it should go forward.”
26th February
Not so fast. I rather jumped the gun yesterday suggesting the Isle of Man would be the first place in the British Isles to vote to legalise assisted dying. They probably will be, eventually, but there’s a way to go yet. The House of Keys voted to reject several important amendments suggested by the Legislative Council—a sort of cross between the bill committee and the House of Lords. So now they will meet to decide whether to accept this or fight back. This could end up in parliamentary ping pong, Manx style. More detail soon.
25th February
The House of Keys has voted to throw out lowering the residency requirement from five years to one.
24th February
6pm
History will (probably) be made tomorrow when the Isle of Man becomes the first place in the British Isles to legalise assisted dying. The quaintly named House of Keys will vote on the remaining amendments suggested by the Legislative Council, which undertook the committee stage. Given these were all relatively minor tweaks unlikely to sway hearts or minds it is likely to pass without much fuss. This would mean the assisted dying bill would be sent for royal assent and the option would be available from 2027 for residents who have lived on the island for at least 12 months. They would need to have a terminal illness expected to kill them within a year.
Sarah Wootton, chief executive of Dignity in Dying, said: “We pay special tribute to the Manx families who intimately understand the dangers of banning assisted dying, and who have fought for so long for a safer, fairer future. That future is now within touching distance.
“There is growing recognition across our Isles that banning assisted dying causes harm and fails to protect people. Dr Alex Allinson MHK’s Bill represents a thoughtful and balanced response to this problem, and Members of the House of Keys and Legislative Council should be commended for their leadership.” More tomorrow.
3pm
Victoria was the first state in Australia to introduce assisted dying in 2017—20 years after the practice was briefly legalised and then banned again in the Northern Territory. Now Victoria is signalling that its ban on doctors discussing assisted dying with patients may soon be lifted.
This change is one of those proposed in an important review which has just been published as the law becomes four years old. The review body found the law “has been safe for patients, families and the community at large.” The government has accepted all their recommendations, including increasing the time limit from predicted death from six months to 12.
It is little wonder that groups campaigning for a more liberal bill in Britain point to this as a success story with lessons for Kim Leadbeater. Humanists UK writes: “The Victorian law requires that the patient accessing assisted dying must have six months left to live or less, or 12 months left to live if they have a neuro-degenerative condition. The proposed law in England and Wales is six months for everyone, although an amendment has been put forward to change that to the same system as Victoria.
“In New Zealand (a six-month limit), many people lost their decision-making capacity before they could proceed. In contrast, in Victoria, only 7 per cent lost competence during the process.
‘However, as the 12-month limit has proven more compassionate for people with neuro-degenerative conditions, the Victorian government is now proposing extending it to all conditions. They argue this will also help doctors who have difficulty determining how long a patient has left to live.”
So far I haven’t seen any reaction to the news from opposition groups, but when it comes we’ll bring it to you.
