Stop the Joffe Bill now


Universe Column for April 30th 2006

by David Alton

If you want to make representations against Lord Joffe’s Bill to legalise assisted killing of patients you have just 12 days left in which to do it.

People have asked me what they can do and who they should write to. Others have asked what arguments are the Bill’s supporters putting forward in its favour.

On Friday May 12th the Bill will be debated in the Lords and so the best people to contact are any Peers you know  – maybe your former MP is now in the Lords, or your local Anglican Bishop, or someone you have dealt with professionally in the past, or maybe someone whose name is known to you through the media. If you are a member of a political party you can write to the Peers who are members of your party. The House of Lords web site lists all the names.

Peers may all be written to at The House of Lords, London SW1A OPW. When writing it’s always best to be clear, concise and courteous. If you have a brief personal example of why you  oppose euthanasia or assisted suicide so much the better.

You can also write to your MP (at the House of Commons)  because this Bill – or one like it – will eventually end up there. You can ask MPs to contact colleagues in the Lords asking them to establish whether they  intend to support or oppose the Bill.

And what of the arguments being put forward in favour of the Bill?

I have written previously (see last week’s column) about the ethical and social dangers posed by  what Lord (Robert) Winston has described as a “Mad” Bill.

Its supporters regularly say that a similar law has been working in the American State of Oregon. It’s worth remembering that having seen it in operation, first-hand, no other American State has followed suit. It’s also worth pointing out that even the limited “safeguards” which were introduced in the State of Oregon have not been included in Lord Joffe’s Bill. It has even  been stated that the Bill contains more safeguards than any other of its kind.  This is not the case.

Moreover, the Bill has ignored most of the recommendations of the 2004-05 Select Committee under Lord Mackay’s chairmanship which were designed ensure more robust safeguards in any future ‘assisted dying’ Bill.  Indeed, not only have most of the recommended tightening-up measures been ignored but some of those which appeared in Lord Joffe’s last Bill, and about which the Select Committee had reservations, have actually been weakened. Baroness (Illora) Finlay of Llandaff – who is a professor of palliative care and who travelled to Oregon and saw the situation first hand  – has trenchantly listed set out the arguments against this ill-conceived legislation.

These are some of the facts:

1. Assisted Suicide Only

Oregon: Yes               Joffe: No

Oregon allows doctors simply to prescribe lethal drugs.  Joffe allows them also, where “appropriate”, to supply the means for the drugs to be ingested e.g. an intravenous line.  This goes well beyond Oregon, which is based on the principle that, once lethal drugs have been prescribed by a doctor, any action required to take them is for the patient.  Joffe takes doctors to the brink of euthanasia and thereby opens up opportunities for abuse – for example, for a doctor or someone else to cross the line and administer lethal drugs to the patient.

2. Protection for Patients with Impaired Judgement

Oregon: Yes               Joffe: No

Oregon requires the doctor, if they believe that an applicant for assisted suicide “may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment”, to refer him or her for “counselling” (i.e. psychiatric assessment).  The previous Joffe Bill contained a similar safeguard, but this has now been removed  -despite a recommendation by a recent House of Lords Select Committee that it needed to bestrengthened. The present Joffe Bill prescribes referral to a psychiatrist only if the doctor believes that the applicant “may lack capacity”: it makes no reference to impaired judgment – for example, as a result of depression.

3. The Patient Must Be Suffering Unbearably

Oregon: No                Joffe Yes

This is a cosmetic safeguard, as neither the doctor nor anyone else can say whether or not an applicant is “suffering unbearably”.  Only the patient can answer this question, as is freely admitted by Lord Joffe.   A requirement whose fulfilment is not objectively verifiable cannot be regarded as a safeguard.  Moreover, it is not clear how a doctor could assess a patient’s suffering as being “unbearable” if the patient receives the prescribed lethal drugs but stores them away for possible future use.  Though this practice is said to be common in Oregon, there is no requirement on doctors there to diagnose “unbearable suffering” before prescribing lethal drugs.  The Select Committee report recommended “unrelievable” suffering as a way of resolving this problem, but this too has been ignored.

4. The Patient’s Decision is Fully Informed

Oregon: Yes               Joffe: Yes

However, the Select Committee observed in its report that an applicant who has simply had been told, as is provided for in Joffe, what palliative care can do to relieve his or her suffering but who has not experienced proper symptom control cannot be deemed to be making a fully informed decision .The Bill ignores this.  The evidence from hospices is strong that some patients resist referral, not believing how much their suffering can be relieved until they actually experience the improvement.

5. The Patient Must Be Assessed by Two Doctors

Oregon: Yes               Joffe: Yes

If the experience of the 1967 Abortion Act is anything to go by this provision will be next to useless. Have you ever heard of anyone unable to obtain the necessary “two doctors” to secure an abortion? That’s all that some doctors end up doing.

6. All Relevant Facts Must Be Explained

Oregon: Yes               Joffe: No

The Joffe Bill requires the doctor to explain “the process of being assisted to die” but not specifically, as is provided for in Oregon, to explain to the patient the potential risks and complications of taking lethal drugs.  Experience in Oregon and Holland shows that complications sometimes arise, and it is important therefore that doctors should be required to be explicit with applicants as to the possible consequences of their actions.

7. The Doctor’s Actions Are Clearly Set Out

Oregon: Yes               Joffe: No

Oregon sets out clearly what a doctor may and may not do in order to implement a patient’s approved application for assisted suicide.  Joffe does not do so – despite a clear recommendation from the Select Committee that there is a need for an explicit statement of a doctor’s permitted actions.  Instead Joffe talks simply of the doctor “assisting the patient to die”.

8. There are Two Witnesses to an Application

Oregon:                      Joffe: Yes

However, there has been a weakening of this safeguard in the latest Joffe Bill.  The previous Bill required both witnesses to be personally known to the applicant for assisted suicide and to be of the view that he or she was of sound mind and acting voluntarily.  The latest Joffe Bill requires only one of the witnesses to fulfil these requirements.

9. Safeguards against Coercion

Oregon:                      Joffe: No

Oregon states that “a person who coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient’s life or to destroy a rescission of such a request shall be guilty of a Class A felony”.  No such sanction appears in Joffe.

10. Explicit Prohibition of Euthanasia

Oregon:                      Joffe: No

Oregon states that “nothing [in the Act] shall be construed to authorize a physician or any other person to end a patient’s life by lethal injection, mercy killing or active euthanasia”.  Joffe contains no such explicit prohibition.

So, these are the facts – of life and death.. Before legislating on such a crucial matter these are facts that need to be widely known and understood – not least by our legislators. And there are just twelve days left in which to make representations.

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