Assisted dying and coercion

[ArabellaScott]

This is live right now, so I'm not sure how well linking to it will work. Copy-pasting below, aswell.

https://www.bbc.co.uk/news/live/cy5k0qyled2t

'Rachel Clarke, a palliative care doctor, opts to answer a question about coercion and whether some MPs are right to feel concerned about this when considering the bill. (Earlier, MPs heard how medical and clinic staff are trained in safeguarding, though a retired GP acknowledged coercion was hard to spot.)
Clarke says she'd "strongly push back" on the suggestion coercion is something all medical staff are trained in spotting.
"I'm the kind of doctor who believes there is nothing to be gained by sugar-coating reality...about shortcomings, failings, areas where my profession the rest of the NHS are getting things wrong", she tells MPs.
"It is my clinical experience that not only are the majority of doctors not necessarily trained in spotting coercion explicitly, they're often not trained explicitly in having so-called advanced care planning conversations with patients around the topic of death and dying."'

Can we be 100% sure that women aren't being coerced into having abortions? No? Perhaps we should ban abortions then.

Or perhaps it's not a valid reason in either case because it's more important to give people choices even if there is a small risk attached.

Would you rather thousands and thousands of people died drawn out horrible deaths because of that small risk? I guess so.

But please do campaign against abortion on the off chance that they're coerced if you're going to campaign on the same grounds against AD.

PepeParapluie But even with the court safeguard, I can imagine many older people, particularly women but not exclusively who face seeing their life savings eaten up by care fees rather than passed to their children, making a decision to end their life and then insisting it was their free choice. Or not wanting to burden their family, and seeing the toll their illness has on their children or other relatives etc. If someone has capacity and gives evidence that it is their free choice, how hard would it be for a judge to rule that they didn’t actually?

If you only have approximately 6 months to live, as per the proposed legislation, the cost of your care is unlikely to be enough to 'eat up' your savings. They may have been eaten up already by your earlier care, but an extra 6 months is probably not going to make a big difference. And end-of-life care is normally free at the point of delivery in the NHS, isn't it?

Not wanting your loved ones to watch you suffer in the final months of your life, and saying goodbye to them while you still can, is quoted as one of the motivations for choosing to end one's life before your decline is extremely distressing for you, and for your loved ones. That seems like a perfectly valid consideration for a terminally-ill person to take into account, in deciding to choose the timing of the end of their life.

If someone has the capacity to make that decision, and gives evidence that it is their free choice, surely the most reasonable conclusion is that it is their free choice?

I suspect the reverse is probably true, throughout the world thousands upon thousands of women with no or limited access to abortion are faced with their own personal horror of having an unwanted pregnancy.

If as much campaigning, political effort and publicity had been put into improving palliative care I would have inclination to support AD. I speak as someone with a life-limiting illness who may one day need to make a decision about AD as the disease progresses to a not very pleasant end. I for one would prefer vastly improved palliative care in my last months.

It must be possible to make a study of medical coercion, or maybe there already is one.

Surely the families and medical staff who would coerce patients into requesting assisted suicide are already coercing them into refusing treatment and ending their lives prematurely that way.

Staff must have some idea re: patients who have some hope of recovery or delaying progression of their illness but who suddenly request treatment withdrawal or refuse treatment and request palliative measures only?

Presumably there's already some sort of process to ensure that someone hasn't been coerced into making a decision that isn't to their benefit?

I think care costs can depend on the situation, but I’m no expert on that. I’ve certainly been involved in situations where people are paying high care costs and are also at end of life - but granted those may not necessarily be people who would qualify for AD. There are obviously a vast range of different circumstances that affect different people.

I understand what you are saying, I do, but I just really struggle to feel convinced that in our healthcare system, with our standard of palliative care and with all the other factors that may influence someone’s decision, that the choice would reliably or always be a free one. The stakes are too high for us to risk it in my view.

I do understand why people feel it is the compassionate thing, and my heart goes out to families who feel the law and society is too harsh in this regard, but for me we cannot guarantee it can be done properly or safely, and so the best way to safeguard all of us is to keep the line very black and white and not allow AD.

Perhaps a point for a different discussion, but I also don’t trust that the circumstances would remain as limited as the current proposal. I think once we have AD, there will be campaigns to expand it.

Someone I am close to has a life long condition, only 18 months to 2 years ago they were suicidal (we spent a night in A&E at one point). In some jurisdictions they could have accessed AD. But now they have turned their life around and can see a future.

Also in my area the Emergency services have said they may not respond to calls from repeat callers - I find it hard to believe that AD wouldn't be seen as a "solution".

It's all about choice, isn't it? Choice to have a child, choice to end a pregnancy, choice to have palliative care, choice to have assisted dying.
Each option deserves support, and the amount of campaigning does not determine the validity of the option - many very unpopular causes receive little or no publicity, but that doesn't mean they are wrong.
The decades-long campaign for assisted dying is an example - it is only recently that it has gained significant public attention.

I respect your choice, and hope you get the quality palliative care which is your preference.

Where are you getting the 'thousands and thousands' figure from?

I thought one of the arguments in favour of this legislation was that the numbers of people expected to use it are relatively small?

Are you really comparing the legal abortion of a foetus to the coerced assisted dying of an adult human, and finding them the same? That sounds rabidly pro life.

Yes, PP including myself have acknowledged that there are winners and loser in all social policies. However, in other cases the losers aren't losing their lives though. The stakes here are really high.

Thank you for starting this thread OP. I agree the likelihood for coercion is a glaring weakness in the AD bill. It doesn’t have “the strongest protections in the world”. It is written very similar to the Oregon AD laws. Studies done on who has used AD do show disproportionate rate of deaths among the socially disadvantaged- so female, not white, poor, disabled, addiction are more likely to be processed for AD. The same pattern is repeated in Canada- although it is even worse. This isn’t a hypothetical risk, people, mostly women, will be coerced into death. How many are too many? I think any number is too many when you balance the life of a person being taken from them against the desire of another person to exert control over the time and place of imminent death.

The comparisons to coercion into an abortion upthread are insulting. Being coerced into having an abortion isn’t even remotely like being coerced into death. One is literally healthcare that benefits you, and the other is death, ending your life.

Finally, we abolished the death penalty because the benefit to society by killing serial murderers and rapists was not enough when balanced against just executing one wrongly convicted innocent person. Trials for murder are 99% of a man. Let’s not kid ourselves. We stopped the death penalty to protect the lives of some of the most inhuman violent men in existence just in case we got it wrong in a handful of cases. We are happy to house, feed, entertain and care for them for life just to make sure one innocent man doesn’t end up dead.

So why then are the lives of these women who most certainly will be coerced and end up dead, whose only crime is to be female, poor, non-white, disabled and/or an addict worth less than the life of the very few innocent men wrongly convicted of murder?

And why are women arguing so strongly that the lives of vulnerable women are an acceptable sacrifice so that terminally ill men and women who want a more convenient death can have it? That’s not feminism, that’s submission.

@SugarandSpiceandAllThingsNaice the contrast with the death penalty is a striking one, I haven’t considered that before but it’s very interesting and you make the point well.

That is a spurious and insensitive comparison. They are not equal.

In any case, women being coerced into abortion IS a problem. All abuse and coercion is wrong and should be thoughtfully countered, not dismissed.

Im also curious where you get the 'thousands and thousands' from? What leads you to think the numbers of murdered, coerced women will even be less than the numbers of terminally ill people who wish to choose AD?

Coercion and abuse is all too common, unfortunately.

Good question. There should be research done. Substantial, considerate research.

That will need to encompass doctors, as well as familial abuse, and societal coercion. It's a massive subject, or set of subjects.

SomethingUniqueThisTime that sounds a difficult path to navigate. I wish you all the best, and hope that you find the care and support you hope for.

“The change in rate of self-initiated death in Oregon between 1998 and 2018 for those aged over 65 years can be derived from the figures provided by Canetto and McIntosh.Reference Canetto and McIntosh26 Over this period, self-initiated death among those aged over 65 years increased by 59.6%m with an increase in older men of 23.3% and an increase in older women of 190.2%.”

”Canetto and McIntosh and both studies by Steck et al show that the change in self-initiated death after the introduction of EAS may be far greater in older women than in older men.Reference Steck, Zwahlen and Egger23,Reference Steck, Egger and Zwahlen24,Reference Canetto and McIntosh26 This is an omission in the studies by Jones and Paton, and Nanner.Reference Jones and Paton22,Reference Nanner25 The reasons why women may be more likely to die by EAS have been outlined variously as empowerment and disempowerment, depending on the perspective of the commentators. Data from suggests that women are more likely to seek EAS, with fears of being a burden: this consideration may be a factor in the gender disparity.Reference Canetto and McIntosh26,Reference Girma and Paton29 These disparities may be associated with lifelong disadvantages in social, occupational and economic areas in the context of women perceiving they are not as highly valued as men, and may have internalised a view that their value is relative to their service to others. Women also have higher incidences of depressive illnesses, which may indicate an unmet mental health need.”

”The studies based in Switzerland and Oregon suggest that older women might be disproportionately vulnerable to EAS where this is legislated for, and when the higher rates of depressive illnesses among women are considered, this may indicate a need to address suicide prevention more assertively in this population.”

Dennis Noel Kavanagh, friend of FWR, and lawyer, ( a proper one) has written an article on this regarding the so called safeguards. Here's a link if anyone is interested.
https://substack.com/home/post/p-155684047

Of course some people will be coerced, that goes without saying. But it is not a reason to delay assisted dying. It's absolutely inevitable there will be some coercion, but it's the lesser of two evils.

This makes no sense at all.
Some people will be coerced/bullied into dying before they want to, so that some other people can die when they want to.
I'm pretty fucking sure staying alive when you want to is way better than being killed. And it is murder.

I said this right back when this started, coercion will be used to prevent people paying for care, so the family can inherit more. Also the very real possibility of mission creep, be careful what you wish for, in 40 years will it be you with an expensive condition that the NHS dont want to pay for, so they ask you if you're ok with permanent pain or would you like assisted dying.

SugarandSpiceandAllThingsNaice So why then are the lives of these women who most certainly will be coerced and end up dead, whose only crime is to be female, poor, non-white, disabled and/or an addict worth less than the life of the very few innocent men wrongly convicted of murder?

I think we all agree that coercion is wrong. We probably all agree that humans being what humans, unfortunately are, there will be some cases of attempted coercion. A proportion of cases of attempted coercion will be detected in advance by the safeguards built into the legislation. A proportion will succeed, and indefensibly, some terminally-ill people with a short period left to live will be coerced into shortening the few months left to them still further.

At the same time, female, poor, non-white, disabled and/or an addict people, along with a whole range of other people, will be given the right to make, without coercion, their own decision about how to live the last few months of their lives, and how and at what point to choose their inevitable death.

I don't accept that former should override the latter; the rights of the non-coerced have as much validity as the rights of the coerced, and both should be defended with equal vigour.

A proportion of cases of attempted coercion will be detected in advance by the safeguards built into the legislation.
You obviously haven’t read the AD bill. There are no safeguards. That is why the HoLs has proposed writing an amendment to try and tackle coercion and all these HCPs and Justices are coming out and saying don’t ask me to be the one responsible for spotting and stopping coercion, I can’t do it.

will be given the right to make, without coercion, their own decision about how to live the last few months of their lives, and how and at what point to choose their inevitable death

We already have this right? You can live your life how you want, you can end your life how you want, at any time you want.

There is absolutely no right to state funded assistance to help you die faster because that is all AD is.

The only human right in this equation is the right to life, and guess what the desire to have state funded help to die faster is not only not a right, it is outweighed by the right to life of other human beings.

I fully agree @SugarandSpiceandAllThingsNaice

That's very helpful and thorough, thank you.

566 men prosecuted for coercive control in year ending 2023.

How many didn't go to court?

www.womensaid.org.uk/information-support/what-is-domestic-abuse/coercive-control/

An estimated 5% of adults in E&W experienced abuse/coercive control in 2022.

'The Crime Survey for England and Wales (CSEW) estimated that 5.0% of adults (6.9% women and 3.0% men) aged 16 years and over experienced domestic abuse in the year ending March 2022; this equates to an estimated 2.4 million adults (1.7 million women and 699,000 men).'

https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/domesticabuseinenglandandwalesoverview/november2022

Just to give an idea of the scale of domestic abuse and coercion.

SugarandSpiceandAllThingsNaice
you can end your life how you want, at any time you want.

If you're so ill that you only have 6 months to live, you may end your life how you want, but you may not be able to do so without assistance.
The difference between 'you can end your life' and 'you may end your life' is not just grammar, it's a horrible reality for some terminally ill people.

I realise that your opinion is that the unbearable suffering of terminally ill people weighs less than the possibility of coercion, and I respect your opinion. But as someone who not only agrees with AD in principle, but wishes it to be an option for myself, I hope your opinion doesn't prevail.

Meanwhile I'll do what I can with Advanced Healthcare directives and making sure my doctors and family know my wishes, and hope I'll be surrounded by respect and mercy if I have to say 'Enough'.

That's interesting. And stark:
Male self initiated death up by 23%
Female self initiated death up by 190%

That is a whopping difference that deserves further consideration.

I wonder what the actual numbers using this are expected to be in the UK (I doubt 'thousands and thousands').

I also wonder how the actual figures from Oregon and Canada compare to the expected figures - more, fewer or about the same as expected using AD?