Assisted Dying Bill

Section 12 deals with the approval of the High Court.
I would expect 12(4) and 12(5) will be the subject of a lot of discussion in Committee, and likely clarifying amendments.

Yes I feel like that. The "oh a judge is involved" gives reassurance until you stop and think about what does involved mean? I think lots of people picture a hearing after the judge has met and talked to the terminally sick person, that was my first thought but then I considered the practicalities and realised that the chances are this would not be the case.

The link you gave is very interesting.

People who are in favour of this law do trust and expect that there will be stringent requirements for how it should be done. As was promised. I assume that most of those supporters wouldn’t support this Bill without that.

But campaigners haven’t specified what they want a judge to actually do, or worked out how practical it would be for them to do it, The parameters are so way off that it feels a bit cynical and PR-y of campaigners to tell us that Judges will be involved as an assurance that patients will be protected properly.

In these blogs that I linked to above Sir James Munby, former President of the Family Division of the High Court of England and Wales argues that there aren’t enough judges to manage this workload around assisted dying even if that was all they did all day, all week, every week. Which would obviously ruin access to justice for other people.

‘The impact of the proposals on the judicial system and the administration of justice
A final matter to consider is the impact the proposed judicial involvement will have on the judicial system and the administration of justice.
Kim Leadbeater MP suggests that as many as 3% of the adult population might eventually choose assisted dying. In 2023 there were 577,620 adult deaths in England and Wales (total deaths 581,363 of which 3,743 were of children under the age of 18): 3% of that is 17,328 – I round it down to 17,000.
Let us assume, in order to illustrate the scale of the problem, that each application takes an average of 2 hours (I make clear that I do not accept that 2 hours would be sufficient).
That would require a total of 34,000 hours of judicial involvement. A High Court judge sits in court for 40 weeks a year, 5 days a week, the court day being 5 hours (to be clear: this is the ‘sitting time’; High Court judges work for much more than 5 hours a day).
So a High Court judge sits for a total of 1,000 hours a year. Including the President of the Family Division there are 19 judges in the Family Division, between them sitting a total of 19,000 hours a year, a figure far short of the 34,000 hours of judicial involvement required on this calculation. The figure speak for themselves.
Where are the judges to be found? And what of the impact on the wider administration of justice which, as is unhappily notorious, is already under enormous strain?’

You're 50 odd years too late for that. Nice try though.

The role of the judges is a massively contested area of this Bill. not least by some of the most senior judges like Sir James Munby, who asked after the publication of the Bill:

‘The issues
It may be helpful at this point to recapitulate the issues, discussed in this and my previous paper, as they arise under the Falconer Bill:

• What level of judge is to exercise this jurisdiction? Is it to be a High Court judge? Or a more junior judge?
• What is the function of the judge? To what extent is the judge expected to exercise a discretion?
• Process and procedures:
• Who can apply to the court and who should be joined as parties?
• Is there to be a hearing or is the application to be dealt with ‘on the papers’ and without a hearing?
• If there is to be a hearing, is this to be in public or in private? Are there to be reporting restrictions? Are the identities of any of the participants, in particular the patient, the witness and the countersigning doctors, to be anonymised?
• What procedures are to be adopted for testing and, if need be, challenging the evidence? Who should exercise that function?
• Is there to be an independent evidential investigation? If so, who is to undertake this and who is to pay for it?
• Should the judge be required to give a judgment in every case and be required to publish the judgment?
• How are appeals to be incorporated in the process?
• What public funding arrangements will there be?
• Even assuming the adoption in every case of the most rigorous procedures, how confident can we be that even the most rigorous procedures will be adequate to identify and prevent possible abuses and in particular be adequate to detect what may be very subtle external pressures?
• Does the conscience clause apply to the judges?
• Is what is proposed a proper role for a judge, given that the judge’s function is not to decide some disputed issue or to resolve some controversy but only to certify that the decision taken by the patient complies with the law?’

https://transparencyproject.org.uk/assisted-dying-what-role-for-the-judge-some-further-thoughts/

Don't you have homework you should be doing?

Do you mean rubber stamping what the doctors have written?

Capacity in the legal system has been raised as a potential issue.
But there is a big difference in the resources that are required for a full court hearing vs. the sort of judicial review process that is required for this.

Victims are waiting between 2 and 5 years for a case to go to court (BBC news, today).

How on earth can they also sign off assisted dying requests? Am I missing something, or is there a specific court set aside?

Given that, even if the bill passes through the parliamentary process without a hitch, it won’t be implemented for at least a couple of years that’s entirely irrelevant. Particularly given the government’s plans to improve those services.

Assisted dying will heap pressure on broken services, ministers warn.

https://www.thetimes.com/article/0e411c79-8091-4c3f-bade-fd8e56807bd5?shareToken=e16be4f301ed2b6b57d397a44cc6d9177_

The undiscovered country, from whose bourn
No traveller returns, puzzles the will,
And makes us rather bear those ills we have,
Than fly to others that we know not of?

Wrote someone once.

We cannot escape the existential question that will enter people's mind when they ask the one of the most famous question a of English literature....to or not to be.

All the medics in the world can't answer this question and yet at the end its a question we have to face. How many last minute reversals will there be? Could someone pause half way when imbibing some pharmaceutical and what would the medical response be....admitted the remainder somehow (??????) or Medicare the patient to combat the effect of the drugs saving their life?

How do you get into a legal framework someone saying they wish for someone to continue administration of a drug if they themselves feel conscience has made them a coward? Alternatively do you just have medics on standby for resucitation?

I wonder if future votes may look different? Apparently many MPs.we're unsure and there were abstentions. I don't think a private members bill was the way to do this without a full and wide consultation amongst stakeholders e.g. the NHS, hospices, disability and cancer charities, faith leaders etc.

The debate and it is a big one will mature and I wonder if the result will be just that we have sorely neglected palliative care and there should be more state funding for hospices? We also need fewer deaths in hospital of possible.

Not even in yet and already people want it expanded.

I think we also have the moral dilemma of people with condition like MND, full paralysis, dementia etc. being denied this option as they won't die within 6 months and I don't see how you square the moral circle.

Not all in hospital

I think there is a lot to consider with this bill and I do wonder how it will progress.

The immediate reaction as far as I can see is that there have urgent and loud demands for improvement in palliative and hospice care. There is a feeling amongst the palliative care medical community that their voice has not been heard as well as greyhound have liked in this debate. Perhaps some palliative care professionals feel that profession is slighted when anecdotal descriptions of poor painful death dominate the debate as they don't have a high enough profile to promote how a good death looks like when palliative and end of life care works (and it can work).

I heard Esther Rantzen argue passionately for assisted dying but I think a lot of her argument was based on the tacit acceptance that her death was going to be undignified and painful both for her and the her family. There was no evidence presented that this was going to be the case and this may be the situation for a lot of people; you don't know quite how you are ultimately going to die or the physical and emotional plain that comes with it. There is an assumption with assisted dying you are escaping something worse and while in some circumstances this could be true I think palliative care as profession really does need an opportunity to make its case.

The below paper shows that the mean hospital spend is 10K in the late 3 months of life and t with around 700K people dying each year (albeit not in hospital) that could be up to a 7 billion pound per year spend. We really need to look at this spend and ensure it is used effectively; we simply cannot have assisted dying being used as a cost saving.

Ultimately clinicians are going to be very cautious about this for individual patients.

I would expect a conversation with a medic to be like this:

Depressed terminally ill patient 'I want an assisted death's

Medic: 'I am listening but has anyone talked thoroughly to you about palliative options and have you had suitable counselling '

I think this is important as the a patient needs to have informed consent for any procedure and I think part of the informing is a good description of palliative care and an honest appraisal of the options.

One thing that cannot be actually guaranteed is that it may be impossible to give an absolutely pain free death to a cognitively functioning patient. What combination of drugs does give an instant and unambiguously painless passing?

https://spcare.bmj.com/content/14/e1/e885

We elect MPs to exercise their independent judgment when representing us. They are not mandated delegates. Many forward thinking decisions have been taken by MPs over the years which most of us now accept as right. Referendums are a poor alternative.

In fairness, the British public are bloody idiots who jump on any bandwagon for a bit of a laugh regardless of whether they have a clue about what’s going on. That said, our politicians are largely idiots too.

Generally, I’m in favour in principle, but I haven’t read the detail.

I am now wondering what the medics view on this will be and whether the GMC or BMA will put forward statements as at least for some this will alter their practice and lead to a new decision making practice that needs to be focused on. How accurately can you determine date of death for exmaple?.if a patient is depressed how do you decouple suicidal thoughts from a philosophically different desire to end life on a rational basis? As medics are sworn to do no harm would they make judgment about the likelihood of pain towards the end and would this weigh on their decision to get involved? For instance with cancer treatment of you have metastases pressing against the spinal cord the pain is so intense you could imagine that promoting a request but it may be palliative treatment can reduce the rumour mass and allow a different thought process.

Coercion is going to be difficult to prove and indeed most of the coercion may be self coercion as the deceased may want a dignified death to pre went suffering of the family coercion. Are psychiatrists allowed to speak with those considering assisted dying as the discussion could be viewed as weighing in on a patient's decision (Samaritans would be in similar position I guess).

I think there is still a huge amount of debate to be had in parliament and I wonder what the final bill will look like?

The intended aim of assisted dying is death.

The intended aim of driving a car is to get to the shops.

You are naively confident that there won’t be errors and coercion, guilt that leads to people making choices they don’t really want to.

I find it interesting that during the pandemic there was so much complaining about protecting nursing homes where people had dementia and life limiting illnesses and some of those people are now celebrating this bill. My view was that it was best to let those who could carry on as normally as possible and let the nursing homes and others who were vulnerable stay at home. This would in my view have protected the long term health of the young - both mental and physical. I do not support the assisted dying bill.

@IMustDoMoreExercise sorry forgot to tag again

Well, it will be expanded if people want it and the MPs vote for it. What is wrong with giving people what they want if MPs vote for it?

No life is more valuable than another hence terminally ill should not be the only consideration.
If all life is equal then why won't the bill expand?

• What history

Canada, Netherlands etc.

• I don't supprot capital punishment because I don't think juries would ever convict anyone murder if they knew they would be killed in case they made a mistake

Why are mistakes issues in capital murder?

• It will give people like me the choice of when and how I die. For me that is very useful indeed.

So as long as it's useful for you screw the rest?