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'm concerned it'll go the way of Brexit - PM thought it couldn't happen, but it did.

Exactly.

Relying on 'other people' to ensure that bad law falls, so that you sidestep the responsibility, is a fucking reprehensible deliberate failure.

Thanks Arabella for those excellent links. I too am concerned about this being a private members bill, the closed session of the select committee supposedly to "protect' certain witnesses, the refusal to allow disabled groups to give evidence.

The more I look, the more concerned I am. This should have been a Government led piece of legislation, with an open door for evidence submission from relevant bodies and individuals. Why the sudden rush? (rhetorical question)

https://x.com/nmdacosta/status/1884346664770547929
"Tom Gordon MP (Pro) tries a 'gotcha'. How do you ever define when palliative care sufficient to allow assisted dying? Dr Sarah Cox: "When 70-95% dying that need palliative care, get it. When you don't have to be white, and rich, and have cancer to get good palliative care.."

@ArabellaScott thanks for posting this thread.

I knew AD dying was on the table, but not how strongly it was being pushed and in such a worrying way.

I just don't understand the hurry. Get the evidence. Get the experts. Get it right.

All this shutting down of discussion is.... depressingly familiar.

From Imnobody's link:

'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'

@DrNaomiRichards
, an anthropologist and researcher in 'end of life studies', told the committee: “The numbers are really tiny... you’re talking one or two people in the history of assisted dying… it’s a very minor issue.”

'Our study found at least 60 people w/ eating disorders who were assisted in death — including in Oregon, California, and Colorado. In addition, we identified 25 cases in California and Colorado where severe malnutrition was listed as the qualifying terminal condition.

But the total number of deaths remains unverified. Oversight agencies in California, Colorado, and Oregon confirmed that patients with eating disorders had died by assisted death—but would not disclose how many.

We found eating disorder deaths were categorised in vague classifications like “Other Illnesses” in state reports. If a physician hadn't published case reports about it, no one outside oversight agencies would have even known these deaths occurred.

In short: There is so little oversight in the U.S. that it is not possible to determine how many people with eating disorders have died by assisted death. Yet today, witnesses dismissed the deaths of real human beings as “just one or two cases.” Why was this not factchecked?

The committee cannot make informed decisions based on false information. I respectfully request
@kimleadbeater
and the committee formally correct the record to reflect the facts.'

Chelsea Roff - 'Founding Director of @EBThrive, a nonprofit working to prevent and help people recover from eating disorders. '

https://threadreaderapp.com/thread/1885012599709859986.html

If we're going to talk about compassion then maybe dismissing people's deaths as 'a minor issue' is not the way to go, Dr.

Let’s hope so.

So, we have representatives from psychiatry, an eating disorder charity, disabled groups' advocates, the judiciary, GPs, political experts on drafting, all sounding the alarm, or trying to.

Legally, ethically, practically, I don't see that this momentous Bill has had anything like the scrutiny, research, care and checking that it calls for.

Rushed through in - what, four, five months?!

It's not reassuring.

The thing is though, that many of those raising concerns from the likes of psychiatry, judiciary, palliative care, disability groups, the deaf community etc, have had to shout and campaign to be allowed to speak. They were not allowed to appear as witnesses initially. Leadbeater had already decided on who she wanted to hear and who she wanted to exclude. Wales seems to have been shoved aside very much witness wise and Scotland and the Isle of Man are bringing in their own legislation. It's a total mess. I'm not even sure what is happening around Northern Ireland.

James Munby, former President of the Family Division (England and Wales,) has been refused. Because his views make uncomfortable points for those who want to push the Bill through.

transparencyproject.org.uk/assisted-dying-what-role-for-the-judge-some-further-thoughts/

Thats I really long link I posted above so for those who don't want to wade through existing case law. Here are the questions he asks below.

The issues

• What level of judge is to exercise this jurisdiction? Is it to be a High Court judge? Or a more junior judge?
• What is the function of the judge? To what extent is the judge expected to exercise a discretion?
• Process and procedures:
• Who can apply to the court and who should be joined as parties?
• Is there to be a hearing or is the application to be dealt with ‘on the papers’ and without a hearing?
• If there is to be a hearing, is this to be in public or in private? Are there to be reporting restrictions? Are the identities of any of the participants, in particular the patient, the witness and the countersigning doctors, to be anonymised?
• What procedures are to be adopted for testing and, if need be, challenging the evidence? Who should exercise that function?
• Is there to be an independent evidential investigation? If so, who is to undertake this and who is to pay for it?
• Should the judge be required to give a judgment in every case and be required to publish the judgment?
• How are appeals to be incorporated in the process?
• What public funding arrangements will there be?
• Even assuming the adoption in every case of the most rigorous procedures, how confident can we be that even the most rigorous procedures will be adequate to identify and prevent possible abuses and in particular be adequate to detect what may be very subtle external pressures?
• Does the conscience clause apply to the judges?
• Is what is proposed a proper role for a judge, given that the judge’s function is not to decide some disputed issue or to resolve some controversy but only to certify that the decision taken by the patient complies with the law?

Leadbeater had already decided on who she wanted to hear and who she wanted to exclude.

She's not fit for the job. They should remove her if they want this process to have any credibility at all.

Stephen Kinnock too imo Eresh.

This is from Dr Naomi Richards, again.

Worth reading the arguments in favour of AD. (Although she's written this in response to Scottish legislation, which tbh I'm a bit scared to even look at).

http://endoflifestudies.academicblogs.co.uk/assisted-dying-in-scotland-as-a-new-parliamentary-bill-is-launched-time-to-bust-5-myths/

'*MYTH 3 – People with dementia will get access to assisted dying

Earlier this year (2024) I facilitated a series of workshops for Hospice UK, and in each workshop the issue of assisted dying for people with dementia came up. This didn’t surprise me as I hear this a lot in the many conversations I have with members of the public about assisted dying. Dementia is one of the leading causes of death in economically advanced countries and will continue to be so in the future. Survey evidence also suggests it is also more feared by people over 65 years old than cancer.
However, assisted dying is not currently an answer to the question of how to die well with dementia and nor is it likely to be an answer in the future. Currently, in the small number of jurisdictions where assisted dying is legalised for reasons of ‘unbearable suffering’ rather than terminal illness, and where people with dementia could officially (as per the legislation) be eligible, tiny numbers of those people access the law. In the Netherlands in 2022 for example, just 3.3% (n=288) of assisted deaths were for people with dementia.'

(bold in the last para mine).

How can you write a paragraph with that title, and MYTH in all caps, and then go on to say 288 people 'tiny numbers' of people with dementia have been assisted deaths?

It's not a myth if its happening. And I'm shocked at the repeated use (as in when discussing EDs) of 'tiny numbers' as if it doesn't matter if the law leads to deaths that shouldn't happen if it's only 'tiny numbers'.

I do completely agree with her last para:

'MYTH 5 – Assisted dying is the panacea for all the problems of dying in the 21st Century
The number of people dying in the UK and in other economically advanced countries is on the rise. The question of how, as a society, we are caring for all of these people in a way which prevents them and their loved one’s distress and supports their wellbeing until death is one which needs societal-wide consideration.
Many of those who are dying now, and who will be dying in the future, will be dying with complex symptoms of frailty, multi-morbidity and cognitive decline. As already discussed, assisted dying is not an answer to dying with dementia and cognitive impairment. Moreover, and to point out the obvious, most people will not choose to make use of any assisted death legislation, preferring to live on until natural death. In both cases, assisted dying is not going to provide an answer.
In short, assisted dying will simply never be the answer to all of the distressing situations which present themselves at end of life. Political, media and public pre-occupation with the issue somewhat belies this fact. The assisted dying debate takes up a lot of the discourse around dying, giving the impression that it is a more significant end of life intervention than others which don’t accrue such attention but which actually might benefit more people e.g. community initiatives and funding to support and enable dying at home.
UK palliative care charities are using the assisted dying debate and the media coverage generated as a way of smuggling stories about palliative care provision or funding challenges into the press. In other words, they are piggy backing conversations about palliative and end of life care which are not as headline grabbing onto conversations about assisted dying which are. This is one way to broaden out the debate, albeit with an agenda to fund more palliative care.
But more reckoning with the reality of contemporary dying is needed across the board and we need to question the sheer volume of rhetoric and expanding discourse which surrounds assisted dying. Assisted dying is not the panacea for all the problems of dying and will only ever be just one end of life intervention among many. '

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

I fully agree, and IMO that sophistry is due to using "assisted dying" as a term when we already have the term for ending your own life. Suicide. "Assisted suicide is a form of suicide prevention". Doesn't sound so compelling, does it.

So, not all that many people will seek this or be suitable candidates. It's a small number who will be in receipt of AD. But it's desperately important that it passes. This argument is represented by presenting the very real suffering of people with illnesses and calling for death as a compassionate solution.

But the cases that are going to lead to miscarriages or mistakes or coercion or even murder are even smaller numbers, so it doesn't matter. This argument dismisses the unnecessary deaths or murders as apparently compassion isn't necessary in these cases, for some reason.

Some people's lives apparently matter more than others.

From the data upthread, the lives that don't matter so much are highly likely to be women's lives.

Sorry if that is a bit garbled, I'm trying to work it out.

So, not all that many people will seek this or be suitable candidates. It's a small number who will be in receipt of AD. But it's desperately important that it passes.

Reminiscent of the GRA. "The unintended consequences won't be a problem because it's only a tiny number affected".

Exactly, Eresh. And again, it's apparently imperative that this 'tiny minority' get what they want, but inconsequential that others will be harmed as a result.

So many parallels.

I also have been wondering why the compassion is imperative for one group, but irrelevant for those that will suffer (and actually die, fgs) unnecessarily due to this legislation.

Caroline Criado Perez has also written on this:

https://newsletter.carolinecriadoperez.com/p/they-just-dont-want-me-over-christmas

'We know that in Canada, women “seem 2 times more likely to seek MAID track 2—which allows for those with non ‘reasonably foreseeable’ deaths to die” — that is, women who are not terminally ill. We know in Belgium that women dominate the figures of those given “psychiatric euthanasia.” Why are these psychologically troubled women so much more likely to seek death than their male counterparts? The data is silent on this issue, and the states in question seem in no hurry to uncover the reason behind the sex discrepancy. '
...
'The Other Half’s research revealed that “at least 5 UK men per year violently kill women who are disabled, elderly or infirm, under the guise of mercy killings.” Eighty-eight per cent of the killers were male, overwhelmingly husbands and sons, and the killings were extremely violent, involving “cutting women’s throats, bludgeoning them, shooting them, or using stabbing, suffocation and strangulation.” One woman was thrown off a balcony by her son. Another was strangled with her dressing-gown cord by her husband. Many women had their throat slit. “Overkill,” the authors found, was frequent. Meanwhile, men are “overwhelmingly the survivors of ‘failed suicide pacts’.” '

(CCP's blog is paywalled, and although there is an archive link out there
archive.ph/yAp21 her work deserves support, so please sub if you can)

(my bolding)

One more quote from that:

'A <a class="break-all" href="https://archive.ph/o/yAp21/www.bma.org.uk/media/3367/bma-physician-assisted-dying-survey-report-oct-2020.pdf" rel="nofollow" target="_blank">recent survey by the British Medical Association found that 50% of doctors were in favour of the legalisation of assisted dying, which is already a substantial drop from the position of the general public. The difference was even more pronounced when considering only palliative care doctors, that is, the doctors who are most likely to have direct experience of the realities for the patients involved (how good care can change their attitude to life; how vulnerable to coercion patients might be). Among these doctors, 76% were against a change in the law — almost the exact inverse of the opinion of the general public. '

I wonder what will be in the Stephen Kinnock Impact Statement in April?
And what will be left out?
https://x.com/HansardSociety/status/1882070409215934876

And I really ought to have added the Bill itself:

https://commonslibrary.parliament.uk/research-briefings/cbp-10123/