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."'

'Between 1998 and 2018 there were 492 DWDA deaths by women age 65 and older, and 578 by men age 65 and older—rates per 100,000 population being 7.8 for women and 11.5 for men in this age group. During the same period there were 441 suicides by women (rate = 7.0) and 2,268 by men (rate = 45.2) age 65 and older. Women represented 46% of DWDA deaths and 16.3% of suicides in this age group'

I have no problem with the concept of assisted dying. However, watching what is happening today in the HoC, I have serious concerns. Kim Leadbetter seems to have no problem using a set of loaded dice and playing with a deck of marked cards. Old people will not live to regret this bill. Many of the rest of us might.

Thank you, it's that an extract from the research you quoted upthread?

Was that from Oregon and Canada?

About 1000 over 20 years, so 50 per year on average.

Not thousands and thousands, thankfully.

It also makes me wonder, if this is thankfully confined to such a small group of the population, why the keen and the pressure to pass the Bill anyway (of course, to each of those 50 individuals the suffering is significant and I don't want to sound callous, but this seems like a small problem in terms of the whole population. Especially given that in the UK it's use is supposed to be restricted to those with less than 6 months to live).

I can't help feeling that the amount of suffering that this Bill is intended to alleviate being over sold. And the potential problems are clearly being minimised.

I thought it was pretty obvious that the government was pushing it as it's cheaper than funding decent access to palliative care. Other bodies may well have different, and hopefully more beneficent, motives.

This Bill leaks like a sieve on a number of safeguarding issues for vulnerable people. Why rush legislation through when these issues have not been properly addressed? Lack of good quality palliative and pain free end of life care, for example, is not a reason to push a poorly drafted Bill through.

Goodness knows we've seen enough badly written legislation discussed on FWR. Why should this particular Bill be nodded through and those raising the red flags be dismissed as scaremongers?

This is a piece of legislation open to abuse in various ways. Superficially it looks acceptable, but on closer reading it is dire in its drafting.

There are genuine concerns around coercion, capacity and it's definition and potential conflicts with Mental Health legislation and case law, the role of doctors in the process, the lack of coherent independent guardians and how such a role would work, for the terminally unwell, amongst other things.

There is a lot of shenanigans around lobby groups with this stuff. I would not assume any of it is primarily grass roots.

In Canada, the organization that pushes MAID, and undoing all the safeguards around it, is Dying With Dignity. They are hugely well funded, much of the money comes from government, but there are lots of other quite interesting donors.

This article is well worth reading, and I will mention The Walrus is a very well thought of, left wing publication - I'm actually surprised to see this article there.

Personally, I think even more worrysom than coercion is the likely change in people's sense of what is morally right for them to do with regards to end of life care. People will start to think in terms of minimizing the impact of their own vulnerable years on their family and the medical system.

The comparison with abortion isn't unreasonable there - look at any thread where someone talks about a youngish daughter or person in difficult circumstances who finds herself pregnant. There will be a contingent of people saying how irresponsible it is not to have an abortion, that the mother needs to be pushing for an abortion even if the daughter doesn't want it, that the child will end up a burden of society. I've actually seen people say that a mother should "March her daughter" to the doctor to get an abortion referral.

an increase in older women of 190.2%.

^ This. That statistic means the number of older women has nearly trebled while in older men it's gone up less than a quarter.

When they look at the data of who is 'choosing' assisted dying in places it's been made legal like Oregon and Canada, it's not rich white men opting to end their lives in large numbers. It's women. It's minorities. It's people with disabilities, addictions. It's the poor.

Assisted Dying has so many potentially catastrophic impacts that in its present state it should not pass. Until checks and balances are locked in securely, it's unsafe legislation and will cause the needless deaths of many vulnerable people.

Do you know what reduces a patients request to end his or her life in a large number of cases? Sufficient pain relief and a decent standard of care. Fix that part first.

Sorry, that was from SugarandSpice's link - i should have said.

It will be abortion all over again. Nearly every day on MN we see posts from women being coerced by their partner into having an abortion they don't really want.

I understand the wish to alleviate suffering and agree that in some cases it would be the right thing to do to allow assisted dying.

My concern is how it is determined which cases. The potential for abuse and error seems very high. And the debate is being framed in sentimental ways rather than being rigorously and carefully tested.

And the debate is being framed in sentimental ways rather than being rigorously and carefully tested.

I agree @ArabellaScott, I think this is one of the most concerning things for me actually in some ways. I understand why there are emotional pleas (on both sides) but it really needs to be looked at from quite an objective and logical standpoint rather than starting with the emotion of it. I’m sure we have all come across or heard about instances when it would have been kinder if someone had gone sooner, but that doesn’t help us come up with a safe and effective system to make sure if we have AD it always works how it should and is never abused.

The emotional framing is one of the main reasons I don’t think the limits on who can access it will stay in place very long. Wherever the line is drawn, there will always be an edge case of someone who doesn’t quite qualify but who people are generally sympathetic to and think should. Some of the major campaigners, for whom there was/ is a great deal of public sympathy, are people who wouldn’t qualify under this proposal - e.g Tony Nicklinson and Paul Lamb.

I'm very wary of only one scenario being put forward, when the rules have room for other scenarios that aren't being considered.

Mental health is one glaring problem area.

Doctors who are murderous.
Doctors who are negligent.

The additional pressures on doctors and HCPs.
The responsibility placed on judges.

Coercion.
Misdiagnosis.

And raising any of these issues risks accusations of being callous, or some assumption about being anti-abortion, as evidenced on this thread. Which is illogical and a result of tribalism, which leads to absolutist thinking, black-and-white thinking, and risks the dismissal of serious concerns.

And raising any of these issues risks accusations of being callous, or some assumption about being anti-abortion, as evidenced on this thread. Which is illogical and a result of tribalism, which leads to absolutist thinking, black-and-white thinking, and risks the dismissal of serious concerns.

Fully agree. It completely reminds me of the trans debate in that aspect.

.Some of the major campaigners, for whom there was/ is a great deal of public sympathy, are people who wouldn’t qualify under this proposal - e.g Tony Nicklinson and Paul Lamb

This is another concern for me. There are already indications that once/if this becomes law in the form this Bill takes, there will be demands to widen the parameters of the legislation by using the Human Rights Act. Everyone's right to choose the time of their death. Not really what that piece of legislation was intended for. That's not something that sits comfortably with me.

This article was brought to my attention via Black Triangle.
https://www.thecanary.co/uk/analysis/2024/12/12/assisted-dying-bill-committee/?

Leadbeater has appointed no disabled MPs who opposed the bill to the committee – despite being the majority position of disabled parliamentarians. So, it means the committee has no disabled representation for disabled people who’ve overwhelmingly come out against the bill. Specifically, of 350 Deaf and Disabled People’s Organisations (DDPOs), not a single one backed Leadbeater’s bill.
The Canary shouldn’t have to explain why excluding disabled MPs against assisted dying is enormously problematic. Since Leadbeater seems to have missed the memo, we’ll spell it out.
Crucially, it’s chronically ill and disabled people that the bill poses the biggest risks to. Most significantly then, Leadbeater’s selection means that disabled voices in parliament won’t have a seat at the table on decisions that could genuinely threaten the very lives of the disabled community.

That's really badly set out above -sorry all -but I'm sure you will get the gist. It's one of those wonky days at Lark Lane.

I agree, it will stop being an option and become an obligation.

My dad is 91 and believes everything anyone in authority tells him. My brother is the same. So they both completely trust the doctors. I am much more questioning, which neither of them likes, so I am having to tread carefully. But anyway, when my dad was told he had run out of options and had to go to a hospice, they both just accepted it. The cancer nurse was incredibly blunt about his prognosis. They were all wrong as it turned out - he was supposed to have days left, but 6 weeks later he is still with us. But for sure if they had made taking AD a good option, they would have listened to that. And from what I saw of them, I have no doubt they would have pitched it if it was available. They withdrew treatment from him no problem.

And then where would we be? My brother and I both have power of attorney. Would we be fighting in court?

Really sorry to hear about your situation 💐

One of the points Dennis Kavanagh makes in the article linked above is that, in the current drafting, there is no provision to appeal a decision to allow AD.

IANAL but that sounds like in your situation you would have no possibility to appeal if your fathers application for AD was granted.

The Bill doesn't consider a situation where AD is granted and the person makes a seeming miraculous recovery. Can the Order then be annulled? If not, does it just sit in their medical records? Because that seems like a loophole that could be abused by someone with malicious intent, or just open to accident - because there seems to be no official way to record that they have changed their mind.

At the moment I don't think someone with LPA can apply on someone else's behalf, the applicant must have capacity themselves. But once it becomes law, that could potentially be changed.

I was having similar thoughts re the lack of logical debate and the reliance on over blown emotional pleas .

It's exactly why I started to have concerns. It's the censoriousness, the assertion that there is only one righteous and Good position, and the refusal to allow for questions or dissent.

I'm really not saying that anyone who supports this bill or AD is in that position, btw, but the tone set by Leadbetter and the government on it has exactly the quality I recognised from supporters of the GRA etc.

There is a debate to be had, it needs to be lengthy enough to cover all of the very very pertinent and serious points, and it needs to be exhaustive.

Because even supporters of the bill acknowledge that it will lead to state sanctioned murders, and we all know how very difficult it is to fix bad law once its in place.

We're in the Supreme court arguing whether humans can change sex!

What the fuck would it take for anyone to roll back on this law?

Another concern - if we would have a situation where effectively state sanctioned executions are permitted, we are in very very dangerous territory.

Do feel free to tell me I'm being hyperbolic or misunderstanding, btw.

My feeling is that every potential risk and disaster has to be at least considered before being dismissed.

https://www.thetimes.com/article/9c707f98-9ea1-40b6-af76-22dca655e94b?shareToken=36bbc24f06d2b5cb7780119293fed724

https://archive.ph/mEsku

'The technicalities might be tedious but — whatever one’s view on assisted dying — this is a mess. The reason it’s never happened before is because legislation this potentially enormous has always been introduced by governments not backbenchers. That a change in the way we live of this significance may be passed into law without the government of the day expressing a view is abnormal in the extreme. A more experienced government, frankly, would have contrived a way for this not to be happening, but it is, and it’s wildly controversial.'