Assisted Dying Bill [HL]

Viscount Colville of Culross Excerpts

Friday 18th July 2014 Lords Chamber

[Viscount Colville of Culross (CB)]

I, like many noble Lords, have received a lot of letters. One of them in particular struck me. It was written by Professor Alan Thomas, who is a consultant in old age psychiatry at Newcastle University. He works with old people and vulnerable people with mental illness. He is an expert in assessing the capacity of people to make competent decisions about their healthcare. He wrote to me:

“My frequent experience is that many doctors do not know how properly to assess whether somebody is able to make decisions about their healthcare. The poor quality of such assessments is a daily frustration to me and to my colleagues”.

He added his concern about the Bill and said:

“My expert opinion is that large numbers of the vulnerable, especially those with mental illness and/or old people, are not competent but will be deemed to be competent, and killed”.

His comments go to the heart of the matter to me. If we are to give doctors the power to help kill us, we need to be absolutely sure that they and the patient know exactly what they are doing.

I agree with the concerns expressed by my noble and learned friend Lady Butler-Sloss that there are not enough safeguards in the Bill. Clause 3 specifies that the declaration has to be countersigned by two medical practitioners but it leaves who those practitioners are down to the codes of practice in Clause 8. Surely it should be in the Bill. The Mental Capacity Act, as mentioned in Clause 12, specifies that you have to prove that a person lacks mental capacity, the assumption being that everybody has a mental capacity unless proven otherwise. For a decision as serious as assisted dying, doctors need to be certain that the person has mental capacity—a much higher hurdle to jump. At the moment, if there is any doubt about whether a patient has mental capacity, a multidisciplinary team meeting is held which includes a doctor—usually somebody who knows them quite well—a relative and, possibly, a psychiatrist. I fear that even if the codes of practice mentioned in Clause 8 specify that these people should be involved in making the decision, it is going to be hard to get them involved. Many noble Lords have mentioned the concerns of the BMA and the RCP, which say that although they support a good death, they oppose assisted suicide.

Even if you put a psychiatrist into the Bill or into the codes of practice, it could be hard to actually get them involved with the decision. The Oregon Death with Dignity Act 1994 has a clause that refers a patient to a psychiatrist if concern exists that the patient has a psychiatric disorder, including depression, that might impair their judgment. However, according to the Oregon state health department, whereas in 1999 10 patients out of 27 who were given PAS had psychiatric evaluation, in 2013 only two out of 71 were assessed by psychiatrists.

Psychiatrists can be central in coming to a correct decision about a person’s mental capacity. A terminally ill person’s mental health can be altered by the drugs that they are taking, a stay in hospital and, crucially, the onset of depression, as other noble Lords have mentioned. Depression can leave a person with an unchanged mental capacity but, as we all know, it can also radically change a person’s mental state.

In a 2008 article in the BMJ, the authors reported that in Oregon, of the patients who were terminally ill and requested aid in dying, more than 50% met the criteria for depression or met the criteria for anxiety that they were depressed. In an article for the Journal of Clinical Oncology, authors discovered that the risk of requesting euthanasia for patients with a depressed mood was 4.1 times higher than that for patients without a depressed mood.

Patients can also be deceitful about their state of mind so psychiatrists will often need to make another assessment, maybe a month later. I quite see that this sort of period can make the delay too long for many terminally ill patients, but when people are making the most important decision of their life, everyone involved must know exactly what they are doing. I disagree with the Bill and I do not support it, and I am not satisfied that that is what is going to happen.