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."'

What a lot of men who are frustrated by society’s infringement on their wish to do whatever they want.

I don’t understand why we aren’t looking at end of life care. I’m just a punter, no medical knowledge, however-

Bad deaths appear to be the result of a fear of administering harmful levels of pain relief, and the desire to treat everything come what may.
When DF was dying, there was no one present to increase the dose on his driver. He was given antibiotics to deal with a chest infection.
I would have thought the antibiotics were pointless, and the higher morphine dose not an issue for a man in his last days.
I wasn’t necessarily able to pay close attention to details, but that’s what I remember. Along with the instruction about needing to file a DNR as paramedics would aggressively resuscitate whether we wanted it or not, unless a dnr was in place.

Why aren’t we just managing it better? Being a bit less aggressive with treatment and a bit more generous with pain relief?

Is it about denying Shipman types with cover for their murders?

Exactly.

Shipman certainly made things a lot harder for palliative care, from what I understand.

But then, there may have been other Shipmans we don't know about.

Predators and abusers seek out positions of power and opportunity, and also, sometimes, power corrupts.

Voting now.

'MPs have voted to support a safeguard which prevents a person meeting the requirement for assisted dying "solely as a result of voluntarily stopping eating or drinking".
New Clause 14 is one of several amendments aimed at closing the so-called "anorexia loophole", with the aim of ruling out people with anorexia. The amendment was tabled by Labour MP Naz Shah.
Labour MP Kim Leadbeater, the sponsor of the bill, has previously signalled her support for the amendment.
The amendment was passed on the nod, meaning it was accepted without a vote.'

'MPs have agreed that ministers should get powers to update the National Health Service Act 2006, as part of the Terminally Ill Adults (End of Life) Bill.
This would include voluntary assisted dying services as part of the NHS's purposes.'

Fuck.

23 votes.

Well this is going to be interesting in a few years....

Perhaps people work in in the field will see the coercion and the unintended consequences, and whistleblow.

Even if they do, it'll take 20 years to work out. And there will be a big scandal.

We know the drill. There will need to be a 'this will never happen' thread on it.

One of the problems is that the victims will not, of course, be able to whistleblow or tell their stories.

I really dislike the way that people frame everything around the concept of 'Individual choice' these days. It totally undermines our moral foundations, as well as safeguarding.

Unfettered individual choice is an impossibility, really.

I needed the sad button. 😒

They are talking on R4 about dignity. Do you think that’s a bigger deal for women or for men? Whose expected standards of dignity are higher, I wonder?
Men who expect to be in charge and in authority, or women who are expected to be ladylike at all times?

Three quarters of Britons still think assisted dying should be legal in principle,
https://yougov.co.uk/health/articles/52413-support-for-assisted-dying-unmoved-by-the-debate

I didn't think it was that high. But I think the way the media has reported it, plus tv personalities have had an impact.

I wonder what would happen if there was a bill to improve funding for palliative care. And in fact how many people in the UK know what that is.

Or if it isn't, then it certainly gratifies itself by ignoring the reality of responsibility towards the collective.

In fact I think people who work in palliative care find it extremely satisfying. I've known a number of people who've worked in hospices, and every single one has said what a privilege it is to care for people in their last weeks and days.

How is this fundamentally differernt than the argument that we should also not deny people the right to death when they don't have capacity, if it is determined by those responsible for them that they are likely to have made that decision because they don't have the capacity?

A person with an intellectual disability, for example - do they not deserve assistance to end their life, just because that assistance meas the consent of their responsible caretakers?

There is no intrinsic reason that "help" needs to be only the physical act. The same way that there isn't any clear reason that mental illness should preclude assistance to die while those with physical ailments can demand it?

The fact is that if you want to kill yourself, and you take action to that end, you can. You won't go to jail, though that is not because it's a human right, it's because it is not useful to prosecute people who want to kill themselves.

But no one has any right to demand society provides an administrative or legal set of institutions in order to facilitate people who want to kill themselves, because creating those things implicates society directly in the deaths of citizens, is dangerous to many people in society, and undermines the basis of much of our human rights traditions.

It's worth saying that this isn't a done deal yet. The Bill still needs to pass the Lords. By all accounts the Lords is sounding hostile to the Bill and will try and put a whole pile of safeguards/blocks to the bill in.

What makes this particularly interesting is because it's a backbench vote which is free of the whip.

You need to understand the significance of this little issue.

It means the following. The Lords are in a position where if there is enough people who want to block the bill they may be able to do so for some time possibly indefinitely.

Protocols unofficially allow all manifesto pledges bills to ultimately be passed by the Lords.

Bills which are not manifesto pledges face ping pong between the Lords and the Commons, but ultimately the various parties will invoke the whip to help enable a bill to pass.

What makes this one unique is that it's a free vote. The parties will not be getting involved in this vote.

So there is no protocol to force it's passage and there's no political backing to force it's passage. It comes down to whether enough individuals in the Lords think the bill is robust enough and good enough to pass the Lords and into law.

Now there is a law which allows the Commons to force a bill through without the Lords support. This is the 1911 Parliamentary Act. This allows the Commons to pass something without the approval of the Lord's after it's got stuck for two parliamentary sessions (basically two years).

There's two problems with this:

There are ramifications for the Lords to do this - it might make them look undemocratic and encourage reform of the Lords and a weakening of their influence. But the Lords really could work on concerns about lack of safeguarding in the bill with the public to gain support for its position and to persuade more MPs to drop support for the Bill.

And the other problem is who needs to enforce the 1911 Parliamentary Act. Typically it's the government that holds the power to do this. But this is a private members bill and a free vote. Technically it could be done but there's no guarantees and it is more difficult.

Given how close votes already are, its probably going to be a while before this becomes law. And it could see a lot more amendments yet.

It's not about the people who already work in palliative care. It's about recruiting in the numbers in which you would need to do. I don't doubt it could be a satisfying job but it would take a high emotional toll on a person and that kind of job would only be attractive to a small number of people imo.

Honestly, I just think you are wrong about this. Hospices don't have trouble reruiting staff -- they have trouble paying for them because they are so underfunded. Palliative medicine is a specialism that is particularly attractive to women, because it's one of the very best specialisms to combine with having a family, and because (unlike in most other specialisms) you get to do holistic care for people with a team.

I'm a vicar, and people often think that doing funerals must be the worst part of my job. It isn't: it's one of the most satisfying. And every deathbed I've attended has felt like sacred ground, and I've felt it a huge privilege to be with people in their dying. I've never met a vicar who hasn't felt that way.

I think it's a reflection of society's fear of and lack of experience of death that makes people think that these things are unpleasant. They're sometimes hard, but what thing in life that is truly worth it isn't?

Good post! It encapsulates a sense that I have that the motivations of those who seem over-joyed at the passing of this bill are something to do with a difficulty in accepting or not wanting to face up to life's more painful episodes. And perhaps also the idea that one needs to be in 'control' at every stage of one's life.

i can't quite articulate it fully yet...but that is the feeling.