Care Not Killing (CNK) has warned that the resurrected bill to legalise assisted suicide lacks institutional conscience protections and could put pressure on care providers and hospices that are unwilling to participate in the controversial procedure.
CNK pointed to an analysis by medical ethics and human rights law expert Professor David Albert Jones who argues that although some protections would allow individuals not to participate in assisted suicide, there is no equivalent institutional right of conscientious objection for organisations such as hospices and nursing homes.
In his report, Prof Jones warned that some institutions could face pressure to participate or risk their continued operation.
Essentially, this raises the possibility that an institution like a hospice could find itself under pressure to provide or facilitate assisted suicide despite its ethical or religious objections.
This tension in the legislation has been acknowledged during parliamentary scrutiny. Lord Falconer, the bill's sponsor in the House of Lords, referenced concerns from Hospice UK that an institution refusing assisted suicide could potentially have its state funding affected, and said that the issue needed to be addressed in the bill. He said the concern had validity in relation to hospices, although he distinguished these from care homes.
There is precedent for the broader principle that religious organisations can be forced to choose between complying with a legal requirement and abandoning a service they believe conflicts with their religious ethos.
The Equality Act (Sexual Orientation) Regulations 2007 made it unlawful for adoption agencies to discriminate on grounds of sexual orientation. The Government explicitly rejected an exemption for faith-based adoption agencies and gave Catholic agencies a transitional period to comply. Catholic adoption agencies that wished to maintain a policy excluding same-sex couples therefore had to change their approach or cease providing adoption services in that form. Some did indeed close their adoption operations, while others changed their organisational structure or secularised their services.
The most prominent legal battle involved Catholic Care, a Leeds-based Catholic adoption agency, which had argued that it should be allowed to maintain a policy of placing children only with married heterosexual couples. After a lengthy legal dispute, it was ultimately faced with the choice of changing its policy or ending its adoption service.
Prof Jones has also highlighted what he sees as an imbalance in the bill's conscience protections. Individuals can decline to participate in assisted suicide, but there is no equivalent statutory right allowing a hospice or other organisation to refuse to participate on grounds of institutional conscience. The issue extends beyond the doctor who actually provides the lethal substance: parliamentary debates have raised questions about the position of other healthcare and care staff, including those involved in ancillary or administrative functions.
The concern is therefore not simply that individual doctors could be forced to carry out assisted suicide. The wider question is whether organisations with a clear ethical or religious ethos against assisted suicide will be able to maintain that ethos while continuing to provide publicly supported palliative or end-of-life care.
Without institutional conscience protections, critics argue, patients who want to spend their final days in an environment where assisted suicide is not practised could have fewer opportunities to choose a hospice or other care setting that shares those convictions.
CNK CEO, Dr Gordon Macdonald, said, “This report demonstrates yet again that the current Terminally Ill Adults (End of Life) Bill is an unsafe piece of legislation.
"It fails to protect the vulnerable, and as Professor Jones highlights, fails to protect medics or institutions that are philosophically or ethically opposed to killing their patients or those they care for via assisted suicide or euthanasia.
"In this unsafe form, the legislation and crisis engulfing palliative and social risks creating a perfect storm that pushes the elderly, sick and disabled people into ending their lives early.”
He added, “This is why the new Prime Minister is right. The focus of the Government and every Parliamentarian should be to fix palliative and social care first, ensuring universal provision to all those who need it, before changing the law to legalise assisted suicide, or euthanasia."
