Assisted Suicide bill to be debated in parliament

[Nearly Sane]

True - but surely the people we are talking about are unable (or likely to be unable effectively) to take their own lives, hence the need to be assisted. So this comes back to the question of self-determination. If you are in the late stages of a terminal illness and want to die then you will need some level of assistance to support that choice.

That seems to be just assertion. And is irrelevant to your phrasing ofbthe question being exactly as jeremyp described. 

[ProfessorDavey]

No matter if the medication is provided by the state, the process as described by the bill will involve the approval of the state.

Of course - as are any laws and/or changes to the law.

But that's a different matter to the issue of whether there is provision by the NHS - as far as I understand it that would require completely separate affirmative decision. So a decision to approve the Bill is not a decision to fund this via the NHS.

I think that is a rather important point as there has been a lot of discussion around the impact on the NHS.

[Nearly Sane]

Of course - as are any laws and/or changes to the law.

But that's a different matter to the issue of whether there is provision by the NHS - as far as I understand it that would require completely separate affirmative decision. So a decision to approve the Bill is not a decision to fund this via the NHS.

I think that is a rather important point as there has been a lot of discussion around the impact on the NHS.

The point is still that your phrasing of the question as just about the individuals right to take their life is incorrect.

[ProfessorDavey]

think of the fact that part of the reason I'm opposed to the death penalty is that I think it courses society's attitude to death, and that that may have a detrimental effect overall. How do I balance that here that that could be a similar impact here that may not be changed by the consent of the person?

I had some rather similar thoughts, comparing this debate with the death penalty.

Certainly there are a lot of points raised in relation to the death penalty about process, about whether we can be sure the person actually was guilty, about costs etc.

But for me being against the death penalty is a matter of fundamental principle - so if you said that hypothetically you were 100% sure a person committed a particularly heinous crime would you be in favour. My answer would still be 'no' because it is a matter of principle for me.

That's my point to those that oppose assisted dying. If you were 100% certain that the person was going to die in a few months and 100% certain that their consent was completely valid (were competent, understood the ramifications of their decision, were not pressurised in any way) would you still oppose. Some would still disagree with it, because they oppose on principle. My concern is where people appear to hide behind comments on process, but in reality would still oppose if those issues were completely removed (as I would do for the death penalty).

I do think that it is important that people are clear and honest as to whether they oppose on principle or support in principle but need to be assured that the process etc is robust.

[jeremyp]

No matter if the medication is provided by the state, the process as described by the bill will involve the approval of the state.

Do you mean approval of the bill in parliament, or approval in the sense that a member of the judiciary must sign off each request? Either way, I do not think of this as a major issue.

[ProfessorDavey]

Do you mean approval of the bill in parliament, or approval in the sense that a member of the judiciary must sign off each request? Either way, I do not think of this as a major issue.

I agree - this seems similar to all sorts of other provision that requires some legal involvement and needs to be approved at the outset by parliament.

This doesn't seem to be of the same significant as 'state-funded', ie involving NHS resource, which has been a major point of debate not just here but more generally. Yet I don't think the Bill permits state funding for the provision at all. Were this to be approved it would require an entirely separate process. And this seems consistent with other similar examples (e.g. abortion, IVF etc) where the decision to make it lawful did not also require it to be provided by the NHS. Understanding how approval for provision to be provided on the NHS would make it clear that the Bill was never going to require NHS to fund - nor for that matter to ban its funding via the NHS. As far as I understand it, decisions about NHS provision will be separate from the decisions on the Bill.

[Nearly Sane]

I had some rather similar thoughts, comparing this debate with the death penalty.

Certainly there are a lot of points raised in relation to the death penalty about process, about whether we can be sure the person actually was guilty, about costs etc.

But for me being against the death penalty is a matter of fundamental principle - so if you said that hypothetically you were 100% sure a person committed a particularly heinous crime would you be in favour. My answer would still be 'no' because it is a matter of principle for me.

That's my point to those that oppose assisted dying. If you were 100% certain that the person was going to die in a few months and 100% certain that their consent was completely valid (were competent, understood the ramifications of their decision, were not pressurised in any way) would you still oppose. Some would still disagree with it, because they oppose on principle. My concern is where people appear to hide behind comments on process, but in reality would still oppose if those issues were completely removed (as I would do for the death penalty).

I do think that it is important that people are clear and honest as to whether they oppose on principle or support in principle but need to be assured that the process etc is robust.

Is there anyone on here that you think isn't being honest? If so who, and why?

If someone thinks that it is impossible to avoid the possibility of someone being coerced, then I don't think that it is somehow a less 'principled' decision to oppose assisted dying than how you are portraying your stance on capital punishment. Practicalities matter.

[Nearly Sane]

Do you mean approval of the bill in parliament, or approval in the sense that a member of the judiciary must sign off each request? Either way, I do not think of this as a major issue.

I was thinking of the judiciary but the point specifically there was about the phrasing of Prof D as regards it just being about

'Do you think that people approaching the end of their lives should be able to determine for themselves how and when they die'

And pointing out that it isn't.

[ProfessorDavey]

I was thinking of the judiciary but the point specifically there was about the phrasing of Prof D as regards it just being about

'Do you think that people approaching the end of their lives should be able to determine for themselves how and when they die'

And pointing out that it isn't.

Well we can nit-pick on precise wording till the cows come home, but I do think it applies. For there to be self-determination it requires obstacles to individuals to be able to exercise their choices to be removed. If someone who is terminally ill wishes to die but is unable to do so without assistance then their principle of self determination is thwarted.

[Nearly Sane]

Well we can nit-pick on precise wording till the cows come home, but I do think it applies. For there to be self-determination it requires obstacles to individuals to be able to exercise their choices to be removed. If someone who is terminally ill wishes to die but is unable to do so without assistance then their principle of self determination is thwarted.

  So what, if a terminally ill patient is capable of ending their own life? I've known a number of them. I doubt it's going to make a difference to your position but in the 8nrests of clarity?

[ProfessorDavey]

Is there anyone on here that you think isn't being honest? If so who, and why?

If someone thinks that it is impossible to avoid the possibility of someone being coerced, then I don't think that it is somehow a less 'principled' decision to oppose assisted dying than how you are portraying your stance on capital punishment. Practicalities matter.

But the point is that for the 'on principle' person, no level of safeguards will ever be sufficient for them to support because their objections are ... err ... on principle. And those people, in my experience (and I had an awful lot of experience from one of the last major conscience votes - on embryonic stem cells) often focus their objections on the practicalities (it isn't needed, we can never be sure etc etc) yet will never be in support regardless of the safeguards. And I'm not arguing that principled objection is more or less valid than support in principle but objection due to the practicalities. What I am arguing is that they are different and arguing about the robustness safeguards etc with a principled objector is a waste of time as they will never agree, although they may throw in safeguarding objections to muddy the waters.

So just to check that you aren't one of those people - in a hypothetical situation if you were 100% sure that a person was terminally ill, in the last few weeks of their life and there was no question that their consent was 100% valid (see previous post), would you support that person being assisted to allow them to die when they wanted?

[ProfessorDavey]

  So what, if a terminally ill patient is capable of ending their own life? I've known a number of them. I doubt it's going to make a difference to your position but in the 8nrests of clarity?

What on earth is your point - if someone is able to exercise self determination then there is no fundamental issue - we are discussing those that cannot without assistance.

Although I suspect those that can would feel more comfortable using proven medication rather than trying to overdose, throw themselves in front of a train etc etc.

[Nearly Sane]

What on earth is your point - if someone is able to exercise self determination then there is no fundamental issue - we are discussing those that cannot without assistance.

Although I suspect those that can would feel more comfortable using proven medication rather than trying to overdose, throw themselves in front of a train etc etc.

I don't think we are. I can't see anything in the bill that makes this caveat.

[Nearly Sane]

But the point is that for the 'on principle' person, no level of safeguards will ever be sufficient for them to support because their objections are ... err ... on principle. And those people, in my experience (and I had an awful lot of experience from one of the last major conscience votes - on embryonic stem cells) often focus their objections on the practicalities (it isn't needed, we can never be sure etc etc) yet will never be in support regardless of the safeguards. And I'm not arguing that principled objection is more or less valid than support in principle but objection due to the practicalities. What I am arguing is that they are different and arguing about the robustness safeguards etc with a principled objector is a waste of time as they will never agree, although they may throw in safeguarding objections to muddy the waters.

So just to check that you aren't one of those people - in a hypothetical situation if you were 100% sure that a person was terminally ill, in the last few weeks of their life and there was no question that their consent was 100% valid (see previous post), would you support that person being assisted to allow them to die when they wanted?

Again you seem to work in abstracts. This is about law, and if your principle is that you fear the death of the one person who is coerced or might be coerced outweighs the right of people who wing to, that is a matter of practicality.

As to your question, in principle yes, but again this is about practice and practicalities, and if I think the involvement of the state in that is problematic then I'm left with realising ghat principles are fine, in principle.

[ProfessorDavey]

I don't think we are. I can't see anything in the bill that makes this caveat.

The Bill will permit terminally ill people who that cannot exercise self determination without assistance to do so. Of course it isn't going to be restricted only to those that would not be able die without assistance. That would be bizarre.

[Nearly Sane]

The Bill will permit terminally ill people who that cannot exercise self determination without assistance to do so. Of course it isn't going to be restricted only to those that would not be able die without assistance. That would be bizarre.

So we are talking about people who could commit suicide and when you wrote  'but surely the people we are talking about are unable (or likely to be unable effectively) to take their own lives, hence the need to be assisted' you were wrong.


By the way I asked this about you thinking people were not being honest about their reasons, you appear not to have answered it.


Is there anyone on here that you think isn't being honest? If so who, and why?

[ProfessorDavey]

As to your question, in principle yes ...

Good - glad we've cleared that up. But there are others who will never accept assisted dying on principle who will still attempt to muddy the waters in terms of safeguards, slippery slopes etc etc, which are necessarily irrelevant to them as their objection is on principle.

, but again this is about practice and practicalities, and if I think the involvement of the state in that is problematic then I'm left with realising ghat principles are fine, in principle.

Sure - but when we get into the world of process, practicalities and safeguards etc we aren't in a position now where people are adequately safeguarded. Far from it - those who do not wish to die in the only way legally available to them are clearly not safeguarded whatsoever. So, to my mind, we are in a situation where we are looking to balance safeguarding those who through their own choice wish to die using the routes that are currently available and do not want assisted dying with safeguarding those that do not want to die in the only way currently legally available to them but through their own choice wish to use assisted dying.

And while we may want to get it 100% right, if we are honest we won't, but surely we should be aiming at a situation where as many terminally people as possible die in the way that they would choose and as few in a way that they desperately don't want. And we won't get that 100% right but it seems to me that we currently don't even try as we prioritise totally those that do not want to use assisted dying over those that do as it is currently unlawful. To my mind safeguarding the person does not want to end their days in the only manner currently available to them is just as important as safeguarding those who do not want to use assisted dying.

[ProfessorDavey]

So we are talking about people who could commit suicide and when you wrote  'but surely the people we are talking about are unable (or likely to be unable effectively) to take their own lives, hence the need to be assisted' you were wrong.


By the way I asked this about you thinking people were not being honest about their reasons, you appear not to have answered it.


Is there anyone on here that you think isn't being honest? If so who, and why?

We are trying to have a serious and important discussion NS - don't go down a rather tedious 'gotcha' route. But I'm sure you understand what I am saying - those who cannot end their lives without assistance are, of course, those that would benefit most from the Bill if it passes as they currently cannot exercise self determination without assistance (which is illegal).

Those who could, potentially, end their lives but in a manner which is likely to be less certain and potentially much more traumatic and distressing will also benefit, but to a lesser extent. Taking an overdose (which may or may not work) or jumping in front of a train (which may or may not work) isn't really consistent with dying with dignity.

[Nearly Sane]

Good - glad we've cleared that up. But there are others who will never accept assisted dying on principle who will still attempt to muddy the waters in terms of safeguards, slippery slopes etc etc, which are necessarily irrelevant to them as their objection is on principle.
Sure - but when we get into the world of process, practicalities and safeguards etc we aren't in a position now where people are adequately safeguarded. Far from it - those who do not wish to die in the only way legally available to them are clearly not safeguarded whatsoever. So, to my mind, we are in a situation where we are looking to balance safeguarding those who through their own choice wish to die using the routes that are currently available and do not want assisted dying with safeguarding those that do not want to die in the only way currently legally available to them but through their own choice wish to use assisted dying.

And while we may want to get it 100% right, if we are honest we won't, but surely we should be aiming at a situation where as many terminally people as possible die in the way that they would choose and as few in a way that they desperately don't want. And we won't get that 100% right but it seems to me that we currently don't even try as we prioritise totally those that do not want to use assisted dying over those that do as it is currently unlawful. To my mind safeguarding the person does not want to end their days in the only manner currently available to them is just as important as safeguarding those who do not want to use assisted dying.

And you are entitled to that opinion, as are others who disagree. I'm not sure what your point about principle helps at all here.

[Nearly Sane]

We are trying to have a serious and important discussion NS - don't go down a rather tedious 'gotcha' route. But I'm sure you understand what I am saying - those who cannot end their lives without assistance are, of course, those that would benefit most from the Bill if it passes as they currently cannot exercise self determination without assistance (which is illegal).

Those who could, potentially, end their lives but in a manner which is likely to be less certain and potentially much more traumatic and distressing will also benefit, but to a lesser extent. Taking an overdose (which may or may not work) or jumping in front of a train (which may or may not work) isn't really consistent with dying with dignity.

I agree but it was you who were saying that it was only those who couldn't take their own life that we were talking about. It isn't and looking for clarity isn't a gotcha.

By the way, I see you haven't answered the question, again
 

[ProfessorDavey]

And you are entitled to that opinion, as are others who disagree.

True - but I might also argue that if you prioritise one group to the complete exclusion of the other in terms of safeguards then perhaps you are really someone who opposes on principle - specifically that no matter how many people die in a manner they desperately do not wish this will never be sufficient to elicit support for assistance to allow them to die as they wish.

I'm not sure what your point about principle helps at all here.

See above - but I do think the distinction between those who object on a fundamental matter or principle and those that are supportive on principle but are opposed on practicalities is important in framing the discussion and I been here before.

A little over 20 years ago I was very actively involved in the debate over embryonic stem cells (also a conscience vote). I was formally involved in one of the earlier 'on-line discussion forums' which was set up by the House of Lords as part of the consultation. A couple of points from that experience. The issue raised previously about people claiming to be there as just Joe Public, but actually there as part of an organised group was there in spades (and on both sides of the debate). But also there were people who would claim everything could be done with adult stem cells (not true) but also completely dismissed any progress with embryonic stem cells - realistically even were there to be a dead cert cure for all cancers from embryonic stem cells they'd still oppose, because their opposition was on principle. Of and in the interests of balance I was equally irritate with people who were in support who also cherry picked just the studies they wanted to focus on - which were always embryonic stem cell studies.

I got so irritated that I asked everyone to reveal who they actually were - and most crept out of the shadows and admitted they weren't just ordinary members of the public but activists involved in pro-life groups or representing patient advocacy groups. I also posted a whole bunch of recent studies - including those from both adult and embryonic stem cells.

[Nearly Sane]

True - but I might also argue that if you prioritise one group to the complete exclusion of the other in terms of safeguards then perhaps you are really someone who opposes on principle - specifically that no matter how many people die in a manner they desperately do not wish this will never be sufficient to elicit support for assistance to allow them to die as they wish.
See above - but I do think the distinction between those who object on a fundamental matter or principle and those that are supportive on principle but are opposed on practicalities is important in framing the discussion and I been here before.
...

I'd suggest that both your opinion, and the opposite opinion are perhaps further principles that people may have but it wouldn't mean that the person who holds the opposite view isn't being influenced by the practicality of ensuring something they want to avoid. Again I think that looking at this in abstracts is fairly useless. People may say they have principles,, but those principles may be in conflict, or that may think of practicalities and not see things in absolute rules, or a mixture of the two. You still seem to me to be looking on your approach as the correct one, and not accepting that people are messy in their thinking.

[ProfessorDavey]

I'd suggest that both your opinion, and the opposite opinion are perhaps further principles that people may have but it wouldn't mean that the person who holds the opposite view isn't being influenced by the practicality of ensuring something they want to avoid. Again I think that looking at this in abstracts is fairly useless. People may say they have principles,, but those principles may be in conflict, or that may think of practicalities and not see things in absolute rules, or a mixture of the two. You still seem to me to be looking on your approach as the correct one, and not accepting that people are messy in their thinking.

Of course I understand that people can be messy in their thinking, but that doesn't really affect the reality that some people will have objections on principle that will not be shifted regardless of the carefulness of the process or the robustness of safeguards in place. I'm not saying that is wrong (and indeed I'm of that persuasion on the death penalty) but it is important to recognise that.

But there is another issue - as with the embryonic stem cell debate, most of this isn't being played out amongst ordinary Joe Public, but largely amongst pro and anti-activists. And those people will use arguments to their advantage even if they might be irrelevant to their actual thinking. So what I am thinking is anti-activist groups that may be driven by people who strongly oppose on principle who realise that shifting ground to arguments (that they aren't really concerned with as their opposition is on fundamental principles) about the practicalities, or the safeguards, or the length of time for debate, or the claimed slippery-slope etc etc, which act to chip away at the other side. Yet no amount of reassurance on these matters will ever be enough for the 'against-on-principle' person.

And there is a further point, specifically the general credibility of the argument - I suspect many who object on principle, particularly if that is based on religious dogma, may feel that were they to be overt about the reason for their opposition that there would be a general dismissal of that argument as the basis for a universal policy which affects those who do no hold to those religious dogmas. As an example AB is against on principle and while we might respect his individual right to hold those principles and to personally act in accordance, I suspect many of us feel that he has no right to try to impose his religious view on others when is curtails their freedoms and beliefs, which may be just as fervently held as his.

And therefore to campaign on 'practicalities' is likely to gain more traction and therefore be adopted by the principle-objecting person but one who is a smart campaigner.

[Gordon]

Ann and I were talking through this last night: since it can be assumed the option of AD will become relevant for me at some point.

We came to the view that the only circumstance for this to be an option for me would be; 1) I was in severe and intractable pain, 2) it was distressing the younger members of our family to see me like that, and 3) that the time I had left was judged to be short. Of course were I in such severe pain then I would be medicated accordingly, and therefore my awareness might be compromised. As NS says - it can get messy.

So, I would like an option whereby Ann could take the view that I'd suffered enough and agree to AD when I was ready and able to comply - I'd be comfortable if that could happen since, after over 50 years, I know that she has my best interests at heart and, and more importantly, the interests of those I will leave behind.

[ProfessorDavey]

Ann and I were talking through this last night: since it can be assumed the option of AD will become relevant for me at some point.

We came to the view that the only circumstance for this to be an option for me would be; 1) I was in severe and intractable pain, 2) it was distressing the younger members of our family to see me like that, and 3) that the time I had left was judged to be short. Of course were I in such severe pain then I would be medicated accordingly, and therefore my awareness might be compromised. As NS says - it can get messy.

So, I would like an option whereby Ann could take the view that I'd suffered enough and agree to AD when I was ready and able to comply - I'd be comfortable if that could happen since, after over 50 years, I know that she has my best interests at heart and, and more importantly, the interests of those I will leave behind.

Thank you again for your very personal insight and I think you are absolutely right to discuss this. I also think the scenarios you talk about are likely to be very common for those considering assisted dying.

But how the Bill is framed you may face a couple of challenges. First, as was mentioned earlier it may take several weeks for the process to move to the point where the drugs are available. So I suspect were you to want this as an option it may be wise to start the process relatively early as a few weeks during the period towards the end of life can result in massive change in circumstance, both in terms of pain and in terms of competence to consent. And I think the Oregon experience suggests that many patients get the prescription but will not use it for a considerable time, until they feel the time is right. And of course plenty (I think about 20%) get the prescription and never use it.

The other point is that, as far as I'm aware, the patient themselves must take the drugs and therefore must be competent not just at the point when they request, but also at the point when they take them. So while I have no doubt at all that you have complete confidence that Ann has your best interests at heart if you have gone beyond the point where you are competent to take your own decisions, she nor anyone else will be able to administer them.