What you need to know about the Assisted Dying Bill

(Photo: Simon P Caldwell)
Lord Carey

Just in case you've had your head in the sand for the last two weeks, here's our handy guide to the basics of the Assisted Dying Bill.

WHAT'S HAPPENING?

The Assisted Dying Bill will have its second reading in the House of Lords on Friday 18 July when it will be debated for the first time.

The Private Members' Bill was introduced by Lord Falconer, whose first Assisted Dying Bill in 2013 did not proceed past first reading. Assisted dying was first tabled as a Bill by Lord Joffe in 2004.

More than 110 peers have registered to speak during the debate, meaning that they will be allotted about three to four minutes each.

Peers who oppose the Bill have promised not to introduce a wrecking amendment. In this case that means that they won't vote against it so that it can go forward for scrutiny at the committee stage.

WHAT DOES IT MEAN?

We are not talking about euthanasia in its broadest meaning, which is the intentional, painless killing of a patient suffering from an incurable disease or irreversible coma.

The Bill is limited to assisted dying, which means that if the law were to pass through both Houses of Parliament, terminally ill patients over the age of 18, who are mentally competent and have less than six months to live, could choose to end their lives.

The Dignity in Dying campaign makes the distinction between assisted dying and assisted suicide, which allows those who are disabled or chronically ill, but not terminal, to choose to die. However, some campaigners against the Bill say legally assisted suicide is more correct, and the terms are often used interchangeably.

The Bill does not include voluntary euthanasia, when a competent patient consents to a doctor administering life-ending drugs. Nor does it include non-voluntary euthanasia, when a patient lacks sufficient mental competency to make the decision to end their life.

Euthanasia is illegal in the UK under the common law offence of murder. Assisted dying requires a change in the 1961 Suicide Act, which makes it illegal for anyone to "aid, abet or counsel or procure the suicide of another".

For someone to have an assisted death would require the consent of two doctors. The patient would be given a prescription for lethal drugs that they would have to take themselves.

WHAT ARE THE ARGUMENTS IN FAVOUR?

Allowing people to die with dignity. The most vocal lobby in favour of a change in the law is the Dignity in Dying campaign. Their major argument is that allowing people to end their own lives in this way prevents unnecessary suffering, making it the merciful option.

Public opinion. Different polls are cited, some saying that around 70% of the population supports assisted dying, others as high as 80%. If these figures are representative, one argument is that the nation's laws should be changed to reflect public attitudes.

There is also some evidence of support among religious communities. While most faith leaders oppose assisted dying, one study of believers shows support among congregations. In a study of 4,500 people of faith, conducted by Linda Woodhead at Lancaster University, about 70% were found to be in favour of assisted dying. Three quarters of Anglicans and two thirds of Catholics support a change in the law, although this was lower among more devout believers. Support among Jews was around 70% and among Muslims and Baptists it was much lower.

It's a violation of human rights. To prevent people who are in unbearable pain from ending their own lives is a violation of their rights. Jane Nicklinson, the wife of Tony Nicklinson, who suffered from "locked-in syndrome", appealed to the European Court of Human Rights on this basis. Similarly, it is argued that patient choice should cover all aspects of life – and death.

The cost argument. Keeping people alive when they are seriously ill and nearing the end of their lives costs an enormous amount of money. It doesn't make sense to do this if they no longer wish to live.

Preventing people going abroad to die. On average, 18 British people travelled to the Dignitas clinic in Switzerland to end their life between 2002 and 2012. In doing so, some have had to end their life before they would want to, while they were still able to travel. If it were legal in the UK, this would no longer be an issue – people could live as long as they felt able in the knowledge that they could die when life became unbearable.

Brings clarity and protection in the law. When judges ruled against assisted dying in the Tony Nicklinson and Paul Lamb appeal cases last month, they also highlighted the need for Parliament to debate the issue. Dignity in Dying argues that by enshrining this right in law, it offers security for the terminally ill, as well as giving clear parameters for doctors and lawyers.

The slippery slope isn't a thing. Introducing assisted dying doesn't have to precipitate a slippery slope to other forms of euthanasia. An example is the state of Oregon, where assisted dying has been legal since 1997, and only used by 751 people in the last 17 years, without progressing to other forms of euthanasia.

WHAT ARE THE ARGUMENTS AGAINST?

The sanctity of human life. There is intrinsic value in every human life. For Christians who oppose assisted dying, this is because they believe we are created by God and it is up to God to decide when we die. Many faith groups oppose assisted dying on the basis that we should not 'play God'.

Vulnerable people at risk of harm. It is easy for those who are terminally ill to feel that they are a burden on family members, which would only intensify if the law were changed. If those who are weakest in society are given the option to kill themselves, it could be considered selfish for them to stay alive – using expensive resources to keep them alive.

The draft of the Bill being debated this week has been criticised for its lack of safeguards against the risk to the vulnerable.

Devaluing the weak. The more we purge society of weakness, the more we say that life is not worth living if you are not young, fit and able bodied. All of the major disability rights groups (including Disability Rights UK, SCOPE, UKDPC, and Not Dead Yet UK) oppose a change in the law, believing it will lead to increased discrimination.

The slippery slope argument. Countries that have legalised assisted dying have seen a growth in the number of people choosing to die in this way and some have gone on to legalise other forms of euthanasia, with the fear that non-voluntary euthanasia would be the ultimate consequence.

Assisted suicide was legalised in the Netherlands in 2002, for those whose "suffering is unbearable with no prospect for improvement". In six years the number of people who opted for an assisted death more than doubled, from 1,923 in 2006 to 4,188 in 2012.

In Belgium the law says that a patient wanting to die must be in a "futile medical condition of constant and unbearable physical or mental suffering that cannot be alleviated". Earlier this year this right was extended to children. There was a 25% increase in the number of euthanasia deaths from 2011 to 2012.

It's against the idea of clinical practice. The British Medical Association, the doctors' union, is against the Bill and opposes all forms of assisted dying. The policy, agreed in 2006, says that a change in the law would be "contrary to the ethics of clinical practice, as the principle purpose of medicine is to improve patients' quality of life, not to foreshorten it". The World Medical Association, The Royal Colleges of Physicians and of General Practitioners, the Association for Palliative Medicine and the British Geriatric Society also oppose all forms of euthanasia.

However, it was revealed this week that 27 leading figures in the medical profession, including 11 presidents and former presidents of royal medical colleges, had sent letters to all peers, asking them to support the Bill. It could be that the traditional stance of the medical profession against assisted dying is now changing.

Focus on palliative care. The BMA argues that developments in palliative care allow all terminally ill patients to die with dignity. Religious groups often back this argument as well.

WHAT ARE CHRISTIANS SAYING ABOUT IT?

Although it is thought that the Christian community is largely against all forms of euthanasia, some leading public figures have come out in favour of this particular Bill in recent weeks, including Lord Carey, a former Archbishop of Canterbury.

Lord Carey, who until recently would have opposed the Bill, said in his Daily Mail article on July 11: "The fact is that I have changed my mind. The old philosophical certainties have collapsed in the face of the reality of needless suffering."

Head of the Christian Medical Fellowship Peter Saunders responded to Lord Carey in a blog saying: "Carey's case for legalising assisted suicide is a counsel of despair devoid of Christian faith and hope."

Dr Saunders points out that Lord Carey made little reference to a theological framework for his article, and that in his emotive response to the Bill overlooks the compassionate work involved in palliative care.

The Church of England maintains its opposition to the Bill. Archbishop Justin Welby has been clear in his condemnation and wrote in the Times on July 12: "What sort of society would we be creating if we were to allow this sword of Damocles to hang over the head of every vulnerable, terminally ill person in the country?"

Welby's article received substantial support within the Church, whereas people flocked to vent their frustration with Lord Carey's remarks. Writing for the Telegraph on July 14, Bishop Michael Nazi-Ali said: "The fact that good hospice care is still a postcode lottery is what should shame us, rather than not having an answer to Dignitas in Switzerland, as Dr Carey claims."

However, Lord Carey isn't the only one in the Church of England to have broken rank - the Rt Rev Alan Wilson, shares his view. Although, unlike Carey, Bishop Alan has leaned towards more liberal views on other issues. Archbishop Desmond Tutu also voiced his support for assisted dying in an article for the Observer, emphasising his desire to encourage the idea of a good death.

The Catholic Church in the UK opposes assisted dying. Pope Francis said in a message to Catholics in Irelands, Scotland, England and Wales: "Even the weakest and most vulnerable, the sick, the old, the unborn and the poor, are masterpieces of God's creation, made in his own image, destined to live for ever, and deserving of the utmost reverence and respect".

WHAT ARE CHRISTIANS DOING ABOUT IT?

Several Christian organisations are campaigning against the issue. Care Not Killing is an alliance of organisations and individuals, including Christian groups, alongside human rights groups, healthcare providers and other faith-based groups. They recommend writing to a peer, or to your MP if you wish to campaign on this issue. The Christian political campaign organisation, Care, also launched the Live and Let Live campaign in spring 2014.

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