Assisted Dying (No. 2) Bill

Colleen Fletcher Excerpts

Friday 11th September 2015 Commons Chamber

[Colleen Fletcher (Coventry North East) (Lab)]

The Bill deals with the most profound and emotive issues. It was notable that many of those who wrote urging me to support the Bill acknowledged—presumably because they recognised the legal and ethical significance of what they advocated—that I might have concerns about changing the law in this area. They are absolutely right.

I intend to focus my comments on three specific areas, all relating to the inadequacy of the so-called safeguards in the Bill. First and foremost, I am concerned that irrespective of how robust the safeguards are perceived to be, they can never be completely effective in protecting vulnerable people against undue coercion or duress. Acts of coercion or duress are, by their very nature, exerted opaquely and in a targeted, underhand way, leaving the victim unable or unwilling to speak out for fear of what they perceive the consequences might be, particularly if they are wholly dependent for their care needs on their oppressor. In such circumstances, how are the two registered medical practitioners and the judge able to satisfy themselves that the decision to end life

“has been reached voluntarily, on an informed basis and without coercion or duress”?

Clearly, they cannot. As a result, the Bill does not adequately safeguard against the terminally ill being manipulated by those with an ulterior motive and forced into making a decision that they do not want to take or is not in their best interests.

Secondly, I am concerned that the definition of a terminally ill person for the purposes of the Bill is someone who

“is reasonably expected to die within six months”.

It is of course impossible, as experts in end-of-life care will affirm, to know definitively how long a person will live. We are, after all, dealing with a prognosis, which is by definition surrounded by inaccuracy. This has been proven many times before by those who have outlived their prognosis, sometimes by many years. Under the terms of the Bill, we would be asking doctors to make life or death decisions about matters about which there can be absolutely no clinical certainty.

Thirdly and finally, I am concerned that the Bill does not provide adequate safeguards or an appropriate legal framework to establish whether an individual

“has the capacity to make the decision to end his or her own life”.

There is no stipulation in the Bill for a mandatory psychological assessment of a patient by a medical practitioner who is registered in the specialty of psychiatry. Instead, the Bill puts the onus for establishing psychological wellbeing and capacity on the attending doctor and the independent doctor, both of whom are principally focused on, and trained to deal with, the state of health rather than the state of mind. With those who request assistance to die, there is an association with clinical depression and hopelessness, and a concern that their capacity to make rational decisions is diminished or impaired as a result.

The Bill does not make such provision and in my opinion cannot therefore be said to contain the appropriate, strong safeguards required. People say that we do not do death well in this country. We need to talk about it, but I do not want this Bill to be the start of that conversation.