Expert panel proposes framework to underpin any future change in law on assisted dying for terminally ill people

Thursday 5th January 2012

The Commission on Assisted Dying will today (Thursday) publish a 400 page report into the safeguards that would need to be in place for a safe assisted dying law to operate in England and Wales.

The expert panel Chaired by Lord Falconer QC includes members of the House of Lords and House of Commons, a former president of the General Medical Council, a former Police Commissioner, a leading consultant in disability equality, an Anglican priest and medical, mental health, palliative care and social care specialists.

Over the last twelve months the Commission has held extensive public evidence hearings and consultations, conducted international research visits and commissioned expert briefing papers to produce the most comprehensive study to date of how a change in the law on assisted dying might affect English and Welsh citizens.

The Commission finds that the choice of assisted dying could safely be offered to people who are suffering at the end of life and likely to die within twelve months, provided that they satisfy the eligibility criteria. People who might not have the mental capacity to make such a choice, who might be clinically depressed or experiencing pressure from friends or relatives, would be protected by a comprehensive set of safeguards.

The Commission also finds that the provision of high quality end of life care must be a priority for Government, independent of the issue of assisted dying. It recommends that in parallel with any change in the law, the Government should also take action to tackle inequalities in end of life care and ensure that good quality end of life care is available to every person approaching the end of their life.

Under the proposed framework, a dying person who met the legal criteria would be able to ask their doctor to prescribe them a dose of medication that would end their life. The person would need to be able to take the medication themselves, as a clear expression of the voluntariness of their choice. Appropriate practical support to take the medication should be provided if it is required by a terminally ill person with physically impairments but this could not take the form of another person administering the medication on their behalf (euthanasia). The Commission does not propose that any form of euthanasia might be allowed if the law were to be changed.

The Commission recommends that if Parliament were to decide to adopt assisted dying legislation in the future, this should include the following eligibility criteria:

1. The person concerned is aged 18 or over and has a diagnosis of terminal illness

2. The person is making a voluntary choice that is an expression of his or her own wishes and is not unduly influenced by others

3. The person has the mental capacity to make a voluntary and informed choice, and the person's decision-making is not significantly impaired as a result of mental health problems such as depression

The Commission recommends that any future legislation should also include the following safeguards to ensure that potentially vulnerable people were protected:

1. A decision-making model involving the assessment, advice, support and independent judgements of two independent doctors, with support from other health and social care professionals where necessary.

2. A safeguard to ensure the person has been fully informed of all other treatment and end of life care options that are available and still wishes to proceed;

3. Safeguards to ensure that the eligibility criteria are met

4. Safeguards to ensure that the person has a settled intention to die

5. Safeguards to ensure the safe storage and transportation of lethal medication

6. Safeguards to ensure the person has a reliable and supported assisted death

7. Safeguards to ensure that assisted deaths are reported correctly

8. Monitoring and regulatory oversight by a national monitoring commission with powers to investigate suspected non-compliance.

The full report from Commission on Assisted Dying proposes an approach that could be taken to assure these issues were addressed in assisted dying legislation in an appendix to the report, a copy of which can be obtained on request from Demos.

The Commission stresses that the issue of assisted dying cannot be viewed in isolation from the need for adequate health and social care, and emphasises the urgent need to improve discussions with patients about the care they wish to receive at the end of life. The Commission recommends that if assisted dying were to be legalised in the future, we would need to make improvements in end of life care in parallel, to ensure that all people dying in the UK could expect to receive an adequate level of care, regardless of where they lived. The Commission puts forward a series of core principles that frame and run throughout their recommendations on assisted dying. These are:

• Open discussion about death and dying

• Each person should be entitled to core rights in end of life care

• Good quality end of life care should be available in all settings

• An end to all forms of discrimination in end of life care, whether these are based on geographical location, physical condition, ethnicity or wealth

• More choice in how people die and clear and accessible information

• Effective support and protection for more vulnerable people