Two doctors would need to assess terminally ill adults who wish to end their lives under proposed assisted dying legislation for England and Wales.
The bill, which will be subject to a ‘free vote’ among MPs on 29 November, states that doctors are not under ‘any duty’ to raise assisted dying with patients or to ‘participate in the provision of assistance’ if they do not wish to.
Published yesterday, the bill sets out the eligibility criteria for adults wishing to end their lives as well as requirements for doctors involved in the process.
The proposed legislation stipulates the involvement of both a ‘coordinating doctor’ and an ‘independent doctor’ who can attest to the person’s eligibility.
After confirmation from both doctors, as well as a ‘declaration’ from the person themselves, the High Court must then make a decision, and must ‘hear from’ at least one of the doctors.
Only adults whose death from terminal illness ‘can reasonably be expected’ within six months would be eligible to receive assistance to end their life.
But the definition for terminal illness does not include ‘mental disorders’ or ‘disabilities’, under the proposed legislation.
The process must also take at least three weeks, with ‘reflection’ periods built in for the person between clinical assessments and after the High Court’s decision (see box).
Doctors must ensure that persons wishing to end their own life:
- Are aged 18 or over;
- Are terminally ill;
- Have ‘capacity’ to make the decision;
- Have been resident in England and Wales and registered at a GP practice for at least 12 months beforehand;
- Have a ‘clear, settled and informed wish to end their own life’;
- Have made the decision ‘voluntarily’ and have ‘not been coerced or pressured by any other person into making it’.
The draft legislation makes clear that a doctor providing assistance ‘in accordance’ with the requirements is not guilty of any criminal offence, nor do their actions ‘give rise to civil liability’.
However, if a doctor ‘induces another person’ by ‘dishonesty, coercion or pressure’ to make declarations or to self-administer a substance, this would be an offence punishable by a prison term of up to 14 years.
The bill also stipulates that employers ‘must not subject an employee to any detriment for exercising their right’ not to participate in assisted dying processes.
Process set out in the Terminally Ill Adults (End of Life) Bill
- If a person indicates to a doctor their desire to seek assistance to end their own life, the doctor may ‘conduct a preliminary discussion’ about the requirements.
- The person must make a ‘first declaration’ stating their intention, with witnesses.
- The ‘coordinating doctor’ must soon after conduct a first assessment to confirm the person’s eligibility.
- There is then a seven-day period of ‘reflection’ beginning once the coordinating doctor has made a statement attesting to the person’s eligibility.
- The ‘independent doctor’ must then carry out a second assessment as soon as possible after the reflection period, to confirm the findings of the first assessment.
- If there’s doubt about the terminal illness, either assessing doctor can refer for assessment by a specialist.
- Assessing doctors should advise the person to inform their GP about the request to end their own life.
- Once the person’s first declaration has been made and the the doctors’ assessments done, the person can apply to the High Court for a ‘declaration that the requirements of this Act have been met’.
- If the High Court refuses, the person can appeal this decision.
- If the High Court approves, a 14-day period of reflection then begins.
- After this, the person must make a ‘second declaration’, and the coordinating doctor makes another statement.
- The coordinating doctor can then provide assistance to end their life by preparing an ‘approved substance’ and providing it ‘directly and in person’.
- The substance must be self-administered, but the coordinating doctor can prepare a medical device to help do so.
- The coordinating doctor then makes a ‘final statement’ and this must be recorded ‘as soon as practicable’ in the person’s GP record.
Source: UK Parliament
Following the introduction of this bill to Parliament last month, the UK’s most senior medical leaders advised that it is ‘entirely reasonable’ for doctors to take part in the public debate around assisted dying.
However, the UK’s chief medical officers also warned doctors against ‘implying’ that they speak for the entire medical profession rather then ‘expressing their personal views’.
The new bill, put forward as a private members bill by Labour MP Kim Leadbeater, follows a Health and Social Care Select Committee inquiry looking into the current law and at international examples of assisted dying becoming legal.
