The Submission of the Assisted Dying - Coursework Example

ON THE ASSISTED DYING FOR THE TERMINALLY ILL BILL (HL). Introduction The Lawyers Christian Fellowship founded in 1852 has made a submission in response to the publication of the amended Assisted Dying for the Terminally Ill Bill by the Authority of the House of Lords on 9th November 2005, which would legalize medical assistance to be provided for an adult suffering from a terminal illness to commit suicide. The Lawyers Christian Fellowship (the LCF), which has 1700 members strives to uphold the high Christian Principles in the administration of the law in UK. To summarize the submission, the LCF is against the legalisation of euthanasia and physician assisted suicide. The LCF strongly views that the legalisation of euthanasia and physician assisted suicide is against the right of the under Article 2 of the European Convention on Human Rights. The LCF has brought to light that euthanasia or physician assisted suicide cannot be truly autonomous acts which requires consent and the accurate assessment of competence is not adequately guaranteed. Further, the submission also focuses on the fact that it is to too difficult to ensure a truly voluntary decision and it is impossible to regulate euthanasia or physician assisted suicide. The LCF rightly has pointed out that neither the doctors nor patients want euthanasia and the legalization would create a policy drift away from the principle of inviolability of life, thus opening the door to further liberalization of the law. In the submission, ‘ECHR’ denotes the European Convention on Human Rights 1950, ‘ECtHR’ denotes the European Court on Human rights; ‘PAS’ denotes physician assisted suicide, where a doctor helps a patient to take his or her own life; Euthanasia denotes the intentional termination of a patient’s life by a doctor who thinks that death is of benefit to the patient; Involuntary euthanasia denotes euthanasia being carried out against the wishes of a Competent person.; Non-voluntary euthanasia denotes euthanasia being carried out on Non – competent patients; The House of Lords Committee denotes the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill; The Select Committee Report denotes the First Select Committee Report of the House of Lords on the Assisted Dying for the Terminally Ill Bill. The LCF has classified its objections into various categories as The Right to Life, The Right to choose, The Problem of Consent, Depression, The Impossibility of the Regulation, Safeguards, Implication and Conclusion in the submission. The Right of Life : According to the LCF submission, the Right to Life is the corner stone of human rights law, which has the protection under the Article 3 of the Universal Declaration of Human Rights 1948 and Article 6 of the International Covenant on Civil and Political rights 1966, being one of the most fundamental provisions by the Human Rights Act 1998. Article 2 provides protection for everyone’s right to life and under the ECHR, a state cannot set aside this right do life for any reason. Further, Article 2 imposes a positive duty on the state to preserve life within the power of the state to control. The LCF points out that euthanasia is by definition the intentional deprivation of life and hence, a breach of the UK’s obligations under article 2 . The LCF has, in the submission made it clear that there is negligible distinction between euthanasia and PAS due to the fact the PAS also requires a doctor’s decision in the process of ending the life contravening Article 2. The submission also beings to focus the recommendation 1418 (1999) of the Parliamentary Assembly of the Council of Europe which has confirmed that Article 2 prohibits euthanasia and PAS. The recommendation states that (i) recognising that the right to life, especially with regard to a terminally ill or dying person is guaranteed by the member states, in accordance with Article 2 (ii) recognising that a terminally ill or dying person’s wish to die never constitutes any legal claim to die at the hands of any other person (iii) recognising that a terminally ill or dying person’s wish to die cannot of itself constitute a legal justification to carry out actions extended to bring about death. The Right to Choose: The LCF’s submission points out that the Article 2 is non- derogable unlike Article 8 which is argued to be of granting a right to die or self determination under the right to privacy. Further attention is drawn on the pending decision of ECtHR on waiver of Article 2 rights, which would permit a waiver only when it does not run counter to the public interest. Unlike its predecessors the Bill provides only for PAS and not for voluntary euthanasia. The LCF submission addresses a fear that this Bill can be extended when it becomes a law, to anyone who wants euthanasia other than terminally ill, with or without consent. The Consent: The LCF submission addresses a key flaw in the Bill in terms of consent. The submission rightly points out the problems that arise when trying to decide if someone has given free and informed consent for an assisted death. The submission has pointed to the Select Committee Report’s observations that the ‘mental competence’ of the patient is a ‘Crucial factor’ in such decisions. The attention is drawn to the high degree of mental competence required to consent to a procedure that will cause death and the procedural insufficiency to decide on the competence. The submission points out of to a flaw in assessment of competence in the sense that there is no need for a psychiatric assessment of the mental capacity unless recommended by the attending physician. The Select Committee Report at para 126 clearly denotes this flaw. Further the Bill provides for PAS even after the psychiatric assessment of the patients lack of capacity, thus, providing no protection to the attending physicians. The LCF submission has referred to the published reports that 50% of the patients killed under the Dutch euthanasia programme were suffering from depression and has highlighted the need for addressing depression as a crucial factor for assessing competence. The doctors do not seem to be confident that such requests for death could be not due to depression. Given the fact that depression is treatable and the attending doctor’s refusal of such PAS requests may force the patient to a new physician for assisted death increases the risk of medical judgement errors, according to the LCF submission. Voluntary or autonomous nature of the decision of the patient cannot be accepted as truly autonomous or voluntary because of the requirement of two physicians to take the final decision as per the provisions of the Bill. Contrary to the Select Committee Report, the Bill does not guarantee that the PAS decision has been free from external pressure, giving apprehensions about the true reasons for a request for euthanasia. The submission addresses the real danger in some cases when patients are under pressure to request euthanasia or PAS from their relatives. The physicians cannot recognize such external pressures effectively nor there is any psychiatric provision in the Bill to investigate such an influence. The influence may be in such a way that the patient himself may feel himself a burden and go for a request of PAS. Thus, a doctor assisting death will do so with only insufficient information and insufficient time after fulfilling his duty as a doctor to treat. Thus, the concept of autonomy is a myth according to the submission. The clause 2 (2) of the Bill spells out the matters of which patients must be informed in making an ‘informed decision’. This includes medical diagnosis, prognosis and the assisted death process and ‘The alternatives’ of palliative care, pain control and hospice. The clause 2 (2)f requires that a specialist in palliative care who shall be a nurse or physician informs the patients of the benefits of the various forms of palliative care and hospice. The LCF submission reasonably points out that when there is thus, never any need of physician assisted death due to the availability of palliative care, it is difficult to see why a fully informed patient would request euthanasia for reasons other than being dependent on or being a burden to others. The submission beautifully points out that request for deaths are “ a cry for relief or help rather than a wish to die”. Studies have shown that even in Oregon, USA, there has been reports of retraction of request for death after the patients being initiated into palliative care or hospice. Thus, the LCF submission argues that a patients can only be considered fully informed about a decision to request assistance to die where they have experienced good symptom control. The Select Committee Report has also recommended that the state should ensure that all available steps were taken to relieve distress before an application for assisted suicide or voluntary euthanasia could move forward (para 256). The LCF submission further clarifies that the provisions of the Bill fall short of the Select Committee Recommendations and represent euthanasia or physical assisted death as an alternative to palliative care rather than being complementary to it. Regulation : The LCF submission has cautioned that it is not possible to regulate euthanasia in UK. The submission has referred to the House of Lords Select Committee on medical ethics recommendations in 1994 on this issue. The submission has also referred to the euthanasia regulations in Netherlands where there have been three official Select Committee Reports on euthanasia from 1991 through 2001. The LCF submission throws light on the fact that legalisation of voluntary euthanasia has led to non voluntary euthanasia and involuntary euthanasia in Netherlands and thus, would constitute murder as per British law. The submission has pointed out 1,000 lives have been ended in Netherlands in 1991 without request for euthanasia, 950 lives were ended without consent in 1995-96 and 1000 in 2001. Safe guards: The submission argues that the Bill, although provides that the request must be oral and written and there must be two witnesses, with an attention from palliative care specialist , these safeguards are insufficient because there is no provision in the Bill for an adequate system to ensure the practice of these safeguards. Reporting the assisted deaths to a monitoring committee as in Dutch experience will again fail in UK too. The submission effectively has pointed out to a chance of the doctors, not reporting the assisted deaths due to the inconvenience of an investigation and chances of euthanasia deaths being reported as normal death due to natural causes. The LCF submission has also referred to a research study by Professor Clive Seale, whose findings show that just 2.6% of the 857 doctors surveyed felt the Bill to be beneficial; 61% of the doctors surveyed did not want a legal backing for euthanasia for ethical reasons and 80% of geriatricians opposed euthanasia in a legal format. The Royal College of General Practitioners have opposed the Bill. The submission warns of the possible adverse emotional and psychological experience of doctors who participate in euthanasia and any refusal for an assisted death does not protect them from a possible prosecution. The submission has quoted Dr.Nigel Sykes who has revealed that most of the patients do not want euthanasia when he spoke at a briefing in the House of Lords on 7th May 2003. The submission concludes with the observations that the only people who are in favour of the Bill are those who do not have to be involved in the process and those who are not terminally ill. The submission has made it clear that the Bill rejects the principle of inviolability of life and places different values on different lives on a utilitarian principle. The submission goes to highlight the fact that the Bill allows the patient to decide on his worth of life instead of a doctor who has been doing the job till now. The submission places a clear argument that the Bill would be clearly incompatible with Article 2 of the ECHR and the state should never justify putting the lives of a large number of people at risk for the sake of a few. Read More