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."'

I accept that there are avenues for abuse and it’s right to challenge the safeguarding protocols and training of professionals to ensure we minimise risk.

However, I have watched three beloved members of my family die agonisingly slow deaths. They were “coerced” by their religious believes and a false hope that they might live to see better days.

There’s a point in time when there are no more “better days”, but often that point in time is still far from the date of death. And these are patients who could not stand up and obtain a packet or two of paracetomol and end their life by choice, even if their morality allowed them to think about it.

And not everyone slips away quietly and peacefully.

Some people think that they should try to remain alive, whatever the price in terms of pain and suffering. Would it be coercion for me to beg a relative to take the easy way out? Emotional blackmail, for sure.

While the law denies the right to die, people will feel that it is wrong.

Like abortion - I would definitely not run to a country where it was legal, if it became illegal in the Uk. Because I am law-abiding. So I’d end up having an unwanted child.

I do not think AD should be undertaken lightly, but I do think it should be a possibility for the most sincere and inevitable cases.

This is a piece of legislation that potentially affects everyone. It's important that it is right. Why do deaf people have to beg to submit relevant evidence?
The Committee overseeing evidence gathering on the Terminally Ill Adults (End of Life) Bill has given in to pressure to include a Deaf and Disabled People’s Organisation (DDPO) on their list of witnesses giving oral evidence this week.
www.disabilityrightsuk.org/news/assisted-dying-bill-ddpos-welcome-last-minute-u-turn-criticise-inadequate-scrutiny-process#:~:text=The%20process%20and%20progression%20of,it%20as%20non%2Ddisabled%20people.

It should not come down to a medic saying: you have two choices: crap care and pain and a distressed family OR you can be helped to pop your clogs now.

No one is saying it should. In addition this isn’t (or shouldn’t be) just about end of life care. It is also about people who might not be near end of life, or people who have incurable health conditions. Probably more.

For example people who go to Dignitas in Zurich, are rarely (if ever) that.

They are also people who can afford the cost of choice. Unlike many others. Another societal divide based on wealth.

The issue is the way it's spoken about across the board focuses on people on end of life care/older patients. So that's what people jump to rightly or wrongly.

But do i trust Overworked HCPs in the NHS to currently be able to make safe, conscious decisions regarding patients being given access to AD? No. Too many things already fall through the cracks and vulnerable peoples lives aren't acceptable collateral.

I say that as someone who watched 2 loved ones deteriorate slowly and painfully before dying in the last 5 years. It shouldn't be seen as you either die now and don't burden your family with your care OR substandard care from others.

I don't have any answers to it at all but that's just my 2p.

So coercion of the few is ok. They are collateral damage, I suppose. Be clear, any coercion is wrong. If Assisted Dying is enabled without sufficient safeguards then some people - many of them elderly women - will be murdered. That is under no circumstances acceptable, ever.
If there is any suggestion that coercion might happen then Assisted Dying cannot be enabled. And there is evidence of both coercion and of people feeling pressurised to die for the convenience of others - again, this massively impacts on women who are brought up to put others first. Not only this, but in countries that have enabled Assisted Dying the categories allowed to commit suicide in this way has widened to cover those who are mentally ill, those who are homeless (Canada), those who feel that they have no purpose left in life - so not only the terminally ill.
Having some people murdered by friends, family, society is not the lesser of two evils.

Thank you for that viewpoint. This is what some people understand as palliative care. I am dying of cancer and am spending days in pain. There are two ways to stop this pain. One sees me lying in bed all day drugged up unable to go anywhere, do anything or have an intelligent conversation. The other sees me put out of my discomfort with my lived ones around me. Coercion will happen and will be happening already but that shouldn’t be a reason to make so many of us live and die and pain.

larklane, I'm so sorry. That sounds gruelling and traumatic.

It's not the right to die, being discussed ffs. it's the poor quality of the proposed legislation many are concerned about.

Exactly.

People can throw around insults and fury as much as they want, it isn't going to help address the flaws in the proposed legislation nor the apparently increasing tendency for law to be flung together on the basis that if the intention of the people making it is self righteous enough any problems will magically evaporate.

Whatevershallidowithmylife I'm very sorry to hear you are ill and in pain. I hope you get the very best care and support possible.

I'd roughly agree with all of your points re AD in theory. I'm just not sure how it will work in principle, without the risk, if not an inevitability, that it will cause as much or more harm than it helps alleviate.

A big old red flag is the apparent failure to listen to dissent or questions or criticism.

@Wemaybebetterstrangers The proposed Bill only applies to people with a maximum of six months to live. So while I do take your points and concerns, the Bill in it's present form does not cover people outside of that six months.

It doesn't cover anyone who has a long term chronic condition who could live many years with poor quality of life. And it's really unclear about the situation regarding people who have poor mental health and suffer from, say, suicidal ideation.

So as I say, it's about a person's genuine choice for me, not their illness speaking nor undue pressure nor influence. When someone I love leaves me, I want it to because it's on their terms and no one elses, including my own emotional wish for it to be over for them.

sorry, I mean in practise*, not in principle.

Yes I know. I agree with everything you said.

@Whatevershallidowithmylife I'm so very sorry and words are not enough and sound hollow on a typed page. Here if you ever want some company or a rant just pm.. So sorry that little is all I can offer. Thanks for taking the time to post here..

I'm really sorry to hear this. Thank you for sharing here.

Hello 👋

I'm not sure why you think it's smug to discuss details of shoddy, rushed legislation (incidentally I wouldn't piss on the guardian if it was on fire). Maybe you could explain, rather than just telling me to fuck off?

When joiming a discussion, people usually a) rtft and b) give reasons for the position that they have put forward. that's sort of how it works. Its not 'carping' to want to discuss details.

I'm not sure why you're so cross.

https://www.hospiceuk.org/assisted-dying Extract below.
As well as making sure that properly funded, high-quality palliative and end of life care is available to all who need it, a number of other key areas of concern will be important in ongoing debates.

These include questions around eligibility; the effects on colleagues who work in hospice, palliative and end of life care (in clinical and non clinical roles); conscientious objection or refusal to participate; the potential financial impacts on hospices; and the broad lack of public awareness that already exists around end of life care and choices.

Doctors get it wrong. My aunt was given 2 days to live and lived another 10 years. She spentv3 months in hospital before the doctors decided she might as well go home.

The thing is, it took ages for them to realise she wasn't dying. Once you are on the dying pathway, it is really difficult to get off it.

This is where we are my dad atm. Doctors in hospital thought he had days left. He wasn't expected to see Christmas. My brother had contacted all the family.

And yet I had an hour long visit with him earlier where he was sitting up, chatting, drinking tea....

It is these cases that worry us. Not the people in terrible pain who have chosen to die, but the ones who were wrongly diagnosed, who aren't as close to death as they thought.

Thread from Nikki Da Costa on the last day of evidence.

https://threadreaderapp.com/thread/1885104671401951259.html

A big part of the problem seems to be that this is a Private Members' Bill.

'This is far more complex than bill backers (and frankly No 10) anticipated and want to admit. There are huge problems with writing a bill, and then asking the policy questions.'

And Prof Louis Appleby:

https://x.com/ProfLAppleby/status/1885235080370573445

'Astonishing claim. “Voluntary assisted dying is a form of suicide prevention.” Statistically false. Confusing to families. Sophistry. Word play.'

More from Nikki Da Costa:

https://x.com/nmdacosta/status/1885227090867261642

'The conduct of the majority of the Committee is a microcosm for what society we may create. For them protecting the Bill justified silencing or diminishing the voice of those made vulnerable. The Committee REFUSED repeatedly to hear from disabled person's groups.'

'The Committee REFUSED three times to hear from those working to protect the elderly vulnerable to abuse and coercion Richard Robinson, CEO, Hourglass was only invited at the last minute, because someone dropped out'

'The Committee VOTED to exclude psychiatrists from the process. They didn't want to hear why mental state might matter and what a profound change this is for society's approach to suicide'

'The Bill sponsor tried to speak over the concerns of palliative care workers Dr Sarah Cox, President at Association of Palliative Medicine'

'And use Points of Order to silence a witness'

'For Parliament to make law in this way is to shake the foundations of society. Our MPs are there to scrutinise and confront the reality of the choices they make for us. For Govt to tacitly condone - delaying assessment of the Bill's impact - is horrendous'

A big part of the problem seems to be that this is a Private Members' Bill.

'This is far more complex than bill backers (and frankly No 10) anticipated and want to admit. There are huge problems with writing a bill, and then asking the policy questions.'

Exactly, why is Leadbetter fully in charge of this? Conflict of interest.

Suicide prevention.

Where have we heard that false claim before? 🙄

This woman typifies everything that's wrong about this bill.

https://x.com/ChelseaRoff/status/1885012599709859986?t=YpiZqn33qCXjsD8VFUgSrQ&s=19

1/ In today’s committee, witnesses with no expertise in eating disorders made inaccurate statements that went unchecked & unchallenged.

MPs and the public were misled about the risks this bill poses to people with eating disorders.

Let’s look at the facts. 🧵👇

A new mode of dying

Fits perfectly with widening the bandwidth of woman.

There are murmurs on X that Starmer knew it would be a mess and was doomed to fail.

I'm concerned that the expectation that bad law will fail in drafting is too optimistic.