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."'

Having initially refused to allow the RCP to submit evidence, Leadbeater changed her mind after much pressure.
They raise their points of concern here.
https://committees.parliament.uk/writtenevidence/116987/pdf/

Blimey! Hope this link works. 16year olds!
https://www.thetimes.com/uk/scotland/article/assisted-dying-bill-teenagers-scotland-hxbb2zf2m
A bill before Holyrood proposes giving terminally ill adults the right to seek help to die, with the legislation, put forward by the Liberal Democrat Liam McArthur, setting out that an adult is a “person who is aged 16 or over”.
However, Steve Johnson, assistant chief constable of Police Scotland, said that the United Nations Convention on the Rights of the Child was “fairly clear and unambiguous” that childhood ended only once people turned 18.

16!!!! WTAF Scotland?!

Still, this is what happens when you treat young people as adults for some purposes (self ID declaration, voting), it's only a matter of time before it's suggested/ expected/ seen as normal in other areas.

Holyrood is so desperate to be seen as different to Westminster, it's getting embarrassing. It's like a teenager who is desperate to be different to their parents at all costs.

I am very tired so may not make much sense but abortion is not a reasonable parallel. One in five maternal deaths used to be from unsafe illegal abortion. The same factors which make abortion potentially coerced exist regardless of whether it is legal or not; the risk to women’s lives is reduced if abortion is legal. If assisted dying is legal, there is more opportunity for people to be coerced into taking that option, and more people will die sooner than if it is not an option. Legal abortion saves women’s lives.
I do agree however that abortion is a parallel in so far as fewer women might seek an abortion if there was better economic and social support for mothers and larger families and those with disabilities. But this just shows you that people are more likely to go down the assisted dying route for economic and social reasons and these people are more likely to be women, as women are more likely to be in poverty than men and be less assertive.

I am so tired of Scotland being a salutary warning to others.

'A senior police officer has said “clarity” is needed over proposals that could allow terminally ill 16-year-olds in Scotland to get help to end their life – with concerns raised with MSPs it could “make Scotland an attractive place to come” for those considering assisted dying.'

https://www.independent.co.uk/news/uk/steve-johnson-scotland-police-bill-scottish-parliament-b2687685.html

Oh, my days:

'...the Health Secretary made clear to the committee: “We believe the Bill in its current form is outside the legislative competence of the Scottish Parliament.”
He stated that part of the Bill concerning the drugs or substance a person would be given to end their life “appears to relate to the reserved matter of medicines, medical supplies and poisons”.'

What shall they do?

I await a modest proposal.

End of life ‘care’.Ie. Watching an elderly loved one starve (can’t eat), and dehydrate (can’t drink), slowly die.And how long will it take for them to die? 2 days, 3 days, 6 days? 10 days? The fact this is the way some people are left to die is disgusting. Horrific actually. No thank you. If we can help people rather than torture them to death (not exaggerating, slowly starving dehydrating people to death is torture), I don’t see why we wouldn’t.

I understand the complexities of possible coercion. I think this can be addressed satisfactorily.

I understand the complexities of possible coercion. I think this can be addressed satisfactorily.
I'm interested on how you think it can be done if you would care to expand.

Needs to be planned with a medic and a lawyer, and actioned by a medic and a lawyer.

It's more likely to be the young adults with terminal disease that could have capacity to consent. The frail elderly are more likely to have dementia, and from this not have the capacity to consent. So any safeguard would have to ban them from it.

I would argue that capacity would need a medic, but that the killing absolutely must not. I know a lot of doctors who would sooner quit than kill their patients. And the ones who would be happy to kill their patients are probably the ones you really don't want involved...

It is very unlikely that the person you describe would be eligible for AD. They need to have capacity, the process would probably take longer to be approved than the few day window you describe, and they would not be able to take the necessary end of life medication if they are unable to swallow.

Ah the article I wanted didn't post - I'll try again.

I think the fact that this approach was allowed, and was successful, is extremely fishy.

If someone want to die, they should. Doesn't need to be complicated. If someone tries and fails, they are offered a legitimate way to end it.
Sometimes for some people, life is not worth living. Be compassionate

And if someone doesn't want to die but doesn't want to be a burden?

Oh the ‘be kind’ people have arrived!

Seriously this legislation needs to be carefully and logically discussed, compassion has a place but rational non-emotional debate of the serious concerns people have is vital in developing robust controls that enable some protection of vulnerable people making such decisions.

I might seem cold , but if somebody wants to die because they feel all they have to offer is being a "burden" then I'm not sure I could disagree. Im sure forcing people to live that miserably is cruel

Yes, this is callous, but also I feel individualising what is actually a societal question.

The question is whether, if there was adequately funded healthcare and welfare as well as proper palliative care, that person would still feel like a burden. In the absence of adequately funded healthcare and welfare and proper palliative care, we cannot know this.

By legislating for assisted dying, the government removes the incentive to provide these things and opens up an alterative pathway which is that people who are terminally ill and require resources to support their end of life care should in fact not take these resources but remove themselves from the world, thus freeing up resources for other people. The additional problem, as has been expressed by people more learned than me, is that assisted dying will further take resources out of already stretched systems, making it even harder to properly resource care.

And as already said, it is a societal issue that will fall across classed, gendered and possibly racialised lines. It is very unlikely to be your white middle-class male who feels a burden because your white middle class male will have the resources and social capital to ensure more comfort in his last days.

And my final point is a general one, which is whether we live in a society which responds to someone who feels a burden by going tough shit, kill your self then, or by asking how we make that better.

Have you read the discussion upthread about the myriad problems with the legislation as drafted, the lack of safeguards and the fact that it will disproportionately affect women?

Do you have any thoughts on how these issues could be addressed?

Or do you think that even discussing the issues is not compassionate and should be prevented?

I really object to your ‘be compassionate’ line in your previous post. It’s not fair to make out that only one side of this debate is the compassionate one. There are people who have reasons for thinking it’s compassionate to allow assisted dying but there are also compassionate people and positions on the other side.

In relation to the above quoted post, it does seem cold. And to me it actually seems to lack compassion, but there we are. This is a debate driven by high emotions but we are talking about fundamentally changing the fabric of society here, it needs to be a debate that gets out of individual cases and out of emotion. Until now (particularly since the abolition of the death penalty) citizens’ relationship with healthcare and the state has been governed by the basic premise that the state won’t kill us, and that our healthcare system will try and treat us, but if that’s not possible, it will try and make our last days as comfortable as they can be (I understand that it doesn’t necessarily do this effectively but this is the aim).

Changing our society so that the state has a mechanism to kill us, and that the line of ‘do not harm’ in medical care is crossed, is an enormous and fundamental change. We must be exceedingly careful with making that change.

If you believe that AD can be achieved compassionately, safely, free from coercion and abuse, then I’d be really grateful to hear what safeguards you think would enable that to happen. How do you address or respond to the Oregon statistics above about the massively disproportionate effect on women? Or if your position is that some risk is acceptable - what level do you think is acceptable?

Finally, plenty of people have moments or periods in their life where they feel they are a burden, they feel their life is not worth living, or they feel they would be better off ending their lives. Your statement that if people want to die they should is quite chilling to me. Often people can surmount issues they thought would be insurmountable, they emerge from the period of their lives that caused those feelings for whatever reason. I really strongly disagree that we should help people to die because they’ve attempted suicide or because they state they want it for reasons such as ‘feeling a burden’.

Yes I agree with this. I think it’s probably going to be a very limited group of people who will qualify for this as an option. The diagnosis has to be terminal with less than 6 months but the person has to have capacity to consent to it, which I think may make it of limited application. Disability and mental health conditions are specifically excluded.

I think there is general support for the concept of assisted dying in the UK, so politically it probably seems like a good move from a popularity perspective. However, I think many of the conditions people may have in mind as conditions they themselves would want to avoid by ending their life early are conditions which aren’t covered, e.g. dementia and degenerative conditions. It feels to me like this is the (intentional) thin end of the wedge - get this passed so we have a mechanism, and then you can increase the scope from there.

Yes. I think there's lot of misunderstanding around who will qualify and how.

It has to be loaded with safeguards, and the more safeguards you put in, the fewer instances it will be usable.

Seems you either accept that murders and mistakes will happen to possibly a fairly large number of people, or that you accept that we can't have AD.

A third path may be massively improving palliative care. As many have suggested.

Havent bothered to read all the usual scaremongering but I'm rather tired of the "internal coercion" line when it's applied to people not wanting their children to suffer their extended dying. Or the line that it's somehow dreadful to prefer passing on money to your children rather than having in go on payments to carers to wipe your bottom for you.

I'm an adult - if I want to make those choices while I'm fit enough to do so it's my choice. But if I need a bit of help there is forced pain and indignity because other people want to make a different choice. And I cant end my life when I choose painlessly because someone else doesnt want that choice for themselves.

IME doctors fight to preserve life past the point at which it really benefits their patients. My concern is perpetuating the current coercion to stay alive.

But the point is how do we, as a society, ensure that the things you want actually happen, without all the problems discussed upthread (that you can't be bothered to read)?

When changing the law, we need to figure out specific mechanisms for ensuring the intended outcomes and minimising unintended / unwanted ones (a bit like writing computer code).

There isn't any scare mongering here, there's been a discussion of the text of the drafting and discussion of stats from Canada and Oregon where they already have laws like this.

No one has mentioned inheritance apart from you 🤷‍♀️

It's a bit childish to say I want blah but I can't be bothered to figure out how that should happen, it just should, because I want it.