Assisted Suicide bill to be debated in parliament

[Nearly Sane]

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.

Which Alan's already said he would disagree with. That people might use the most effective arguments even if they don't believe in them doesn't affect the arguments.

I don't see why the motivations of some may not be completely honest is useful in deciding what to do.

[Gordon]

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.

Then perhaps it should be an option - I can't imagine a greater example of love than for her to let me go when the time is right for my family. I doubt anyone can legislate precisely for that, given individual circumstances, but to think this is about process and procedure is to entirely miss the personal perspective.

[ProfessorDavey]

Then perhaps it should be an option - I can't imagine a greater example of love than for her to let me go when the time is right for my family. I doubt anyone can legislate precisely for that, given individual circumstances, but to think this is about process and procedure is to entirely miss the personal perspective.

I think that's right and I'm certain that Ann will be allowed to make all sorts of other decisions on your behalf and in your best interests if you no longer have the capacity to make them yourself. But not this one, I'm afraid.

And I think this gets to the heart of the matter - loved ones typically want to do nothing other than to act in the best interests of their loved ones. And where they don't during end of life I think it is far more likely to be on the basis of hanging onto hope and trying to do everything possible to extend the life of their loved one just a little bit longer. Completely understandable but sometimes not in the best interest of the dying person themselves.

Yet all the talk is about greedy relatives coercing their relatives into dying, rather than well meaning but perhaps misguided relatives trying to persuade their loved one to try just one last round of therapy rather than move from active, but intolerably burdensome, treatment to palliative care. Or not to stop continuing life sustaining medical treatment or to agree to be rescusitated rather than sign a DNR.

[jeremyp]

Yet all the talk is about greedy relatives coercing their relatives into dying, rather than well meaning but perhaps misguided relatives trying to persuade their loved one to try just one last round of therapy rather than move from active, but intolerably burdensome, treatment to palliative care. Or not to stop continuing life sustaining medical treatment or to agree to be rescusitated rather than sign a DNR.

It muddies the water and is irrelevant as far as I am concerned. If we disallowed everything where an unscrupulous person could game the system to take advantage, we wouldn't be allowed to do anything. For example, Enduring Power of Attorney would be out for sure.

[Gordon]

I can't see why, at a point when I had competence and wasn't yet medicated to the extent that I wasn't fully alert, when I was advised that I was unlikely to survive for more than 'x' weeks or months, that I couldn't designate someone to, with their agreement, administer the fatal dose if they judged it appropriate and in accordance with my wishes.

I know that Ann would do that for me, and if I couldn't do it myself then I'd rather it was her.

[ProfessorDavey]

It muddies the water and is irrelevant as far as I am concerned. If we disallowed everything where an unscrupulous person could game the system to take advantage, we wouldn't be allowed to do anything. For example, Enduring Power of Attorney would be out for sure.

I agree.

And in a much closer sense to assisted dying, right now there will be patients deciding to come off active treatment and move to palliative care, even though that may reduce their lifespan by months or even longer. Others will be deciding that they do not want to be resuscitated if they have a cardiac arrest. Others still that they will refuse active treatment that is offered to them.

In every case the result is likely that the person in question will die much earlier than they otherwise might have done. So where are the campaigners up in arms at all these decisions (that are happening right now) as they may be being coerced by relatives who want their inheritance money early. Of course in all these cases highly trained medical staff will be on alert for signs that consent is not valid due to pressure or coercion. But the safeguard in all these cases are way less than what is proposed for assisted dying, where there needs to be the involvement of two independent doctors in the consent process (in the current cases that would be just one) and separate legal approval (a judicial decision would never come close to the decisions currently happening in hospitals, hospices, clinics etc as we speak).

And a final point - given the length of time the process is likely to take, at best a greedy relative might get their inheritance perhaps five months earlier than they otherwise might. I imagine in most cases assisted dying would be within a few days or weeks of death otherwise. Pressuring someone to agree to assisted dying will still be a criminal offence - who on earth would risk that to get their money perhaps a month or two early?

[ProfessorDavey]

I can't see why, at a point when I had competence and wasn't yet medicated to the extent that I wasn't fully alert, when I was advised that I was unlikely to survive for more than 'x' weeks or months, that I couldn't designate someone to, with their agreement, administer the fatal dose if they judged it appropriate and in accordance with my wishes.

I know that Ann would do that for me, and if I couldn't do it myself then I'd rather it was her.

That would be an advanced directive - and these are permitted in all sorts of cases, for example DNR (where almost by definition the individual is unlikely to be in a position to make the decision when they need CPR), refusal for blood transfusions etc. Yet I don't think they are permitted in the proposed assisted dying legislation, which I think requires a competent person not only to request the drugs, but also to take the drugs themselves while they remain competent.

It is another example where the so-called 'safeguards' are much more stringent in this case than in other cases which similarly will result in someone dying earlier than they otherwise might have done.

[ProfessorDavey]

Which Alan's already said he would disagree with. That people might use the most effective arguments even if they don't believe in them doesn't affect the arguments.

But it is deeply disingenuous if you campaign on aspects of the argument that are frankly irrelevant to your actual position. And it tell us loads about the strength of their actual position if people who disagree on principle based on religious dogma fail to mention their actual reason for disagreeing but focus on 'too rushed', 'too few safeguards', 'NHS over-stretched'. Why don't they just be honest and argue on - because the bible says it is wrong ... erm rhetorical question, I think we all no the answer to this.

And of course the repost to:

'Too rushed' is 'so how long is reasonable for this debate?'
'Too few safeguards' is 'what level of safeguards are sufficient?' etc

But you'll never get an answer to those questions as the reality is that those people and campaigning groups will never accept there has been sufficient time, nor sufficient safeguards as their opposition is actually on principle and time for debate and safeguards are irrelevant, albeit used as a convenient harbour of convenience to muddy the waters.

I don't see why the motivations of some may not be completely honest is useful in deciding what to do.

So you don't want an honest debate? Astonishing, given this is a really, really important issue and surely they very least we should expect is an honest debate.

[Nearly Sane]

But it is deeply disingenuous if you campaign on aspects of the argument that are frankly irrelevant to your actual position. And it tell us loads about the strength of their actual position if people who disagree on principle based on religious dogma fail to mention their actual reason for disagreeing but focus on 'too rushed', 'too few safeguards', 'NHS over-stretched'. Why don't they just be honest and argue on - because the bible says it is wrong ... erm rhetorical question, I think we all no the answer to this.

And of course the repost to:

'Too rushed' is 'so how long is reasonable for this debate?'
'Too few safeguards' is 'what level of safeguards are sufficient?' etc

But you'll never get an answer to those questions as the reality is that those people and campaigning groups will never accept there has been sufficient time, nor sufficient safeguards as their opposition is actually on principle and time for debate and safeguards are irrelevant, albeit used as a convenient harbour of convenience to muddy the waters.
So you don't want an honest debate? Astonishing, given this is a really, really important issue and surely they very least we should expect is an honest debate.

That's not what I said. I said it's not useful in deciding what to do. That is not the equivalent of not wanting an honest debate.

[ProfessorDavey]

That's not what I said. I said it's not useful in deciding what to do. That is not the equivalent of not wanting an honest debate.

So if you want an honest debate presumably you think individuals and groups should focus on the issues that they consider are determinative in decision making, which for those who disagree on principle will not be the time permitted in parliament, the level of safeguards etc as for them no amount of time, nor level of safeguards will be sufficient.

I think an honest debate is key, but that requires honesty from those engaging in the debate.

[Nearly Sane]

So if you want an honest debate presumably you think individuals and groups should focus on the issues that they consider are determinative in decision making, which for those who disagree on principle will not be the time permitted in parliament, the level of safeguards etc as for them no amount of time, nor level of safeguards will be sufficient.

I think an honest debate is key, but that requires honesty from those engaging in the debate.

I don't think the motivations of the people affect the arguments which is what matters. If someone is lying about their motivation, it does not mean that the arguments they're are bad.

[ProfessorDavey]

I don't think the motivations of the people affect the arguments which is what matters. If someone is lying about their motivation, it does not mean that the arguments they're are bad.

But in many cases they are using those 'arguments' that are irrelevant to them as cover to prevent them actually debating the real reason for their opposition. Why are these folk so unwilling to have the argument about their principled opposition to assisted dying?

And if an individual or an organisation's argument is 'too little time', 'too few safeguards' etc it is a reasonable expectation that they need to be clear about how much time would be sufficient and what levels of safeguards would be sufficient. Otherwise they are not actually engaging in the debate are they, merely muddying the waters.

This is an incredibly important decision and we should expect honesty in the debate.

[Nearly Sane]

Then perhaps it should be an option - I can't imagine a greater example of love than for her to let me go when the time is right for my family. I doubt anyone can legislate precisely for that, given individual circumstances, but to think this is about process and procedure is to entirely miss the personal perspective.

I doubt many people, and very few MPs do think it is just about process, and procedure but law makes that what it needs to be. I suspect that the debate will concentrate on personal perspectives, and personal stories from the MPs lives, and constituents. I think it will be one of the better debates that we will see in parliament because it won't just be about the party political divisions, and is something that is not hugely technical.

It's one of the benefits of it being a Private Members Bill that frees ot up to be more personal. I'm ambivalent about the use govts make of Private Members Bill's in such situations, as it feels in part like passing the buck, but it doesn't affect the arguments.

[Nearly Sane]

But in many cases they are using those 'arguments' that are irrelevant to them as cover to prevent them actually debating the real reason for their opposition. Why are these folk so unwilling to have the argument about their principled opposition to assisted dying?

And if an individual or an organisation's argument is 'too little time', 'too few safeguards' etc it is a reasonable expectation that they need to be clear about how much time would be sufficient and what levels of safeguards would be sufficient. Otherwise they are not actually engaging in the debate are they, merely muddying the waters.

This is an incredibly important decision and we should expect honesty in the debate.

If the arguments are good arguments, then they aren't 'muddying the waters', and all the arguments that will be made in this will be ones that some people honestly agree with.

[ProfessorDavey]

If the arguments are good arguments, then they aren't 'muddying the waters', and all the arguments that will be made in this will be ones that some people honestly agree with.

If their principled arguments were good ones then why are these individuals and organisations so unwilling to debate on the basis of those.

But the argument 'too rushed', 'too few safeguard' is actually only an argument if you are able to articulate what constitutes 'not rushed' and 'enough safeguards' - otherwise even the framing of the argument is dishonest.

[Nearly Sane]

If their principled arguments were good ones then why are these individuals and organisations so unwilling to debate on the basis of those.

But the argument 'too rushed', 'too few safeguard' is actually only an argument if you are able to articulate what constitutes 'not rushed' and 'enough safeguards' - otherwise even the framing of the argument is dishonest.

And perhaps there are some who make those arguments honestly, who make statements about what they think is required, and they may be joined in some of those statements by those who make them from dishonest motivations but you seem to just be throwing out the arguments because of the motivations of that second group, which s already covered doesn't affect whether the arguments themselves are bad.

Just as that some on the pro assisted dying side will laud the safeguards as excellent when they will be looking to get them removed in the future because they see the bill as a necessary first step. Note, there are of course MPs, groups, and individuals who will be honest about that, just as Alan us honest about his motivation, but some won't, and that doesn't affect whether those are good arguments either.

[ProfessorDavey]

Just as that some on the pro assisted dying side will laud the safeguards as excellent when they will be looking to get them removed in the future because they see the bill as a necessary first step.

Really!?! Do you really think that there are people on the pro assisted dying side who want to remove all safeguards. If so I don't think there are any here and I don't believe I've ever encountered anyone who wants to remove all safeguards.

But even if they did want to get rid of all safeguards (they don't by the way) any removal or alterations in safeguards around the process would require a change in the law and would therefore require that argument to be won at a point in the future when it was proposed and debated.

[Nearly Sane]

Really!?! Do you really think that there are people on the pro assisted dying side who want to remove all safeguards. If so I don't think there are any here and I don't believe I've ever encountered anyone who wants to remove all safeguards.

But even if they did (they don't by the way) any removal or alterations in safeguards around the process would require a change in the law and would therefore require that argument to be won at a point in the future when it was proposed and debated.

I think there are lots of people whobthink the safeguards in the bill are excessive, some have said it openly, and some have not. I think those people are lying about their motivations and stating the bll will be the end of it, and they don't intend it to be. In terms of motivations, that's lying about it.

But as I said, that I think that doesn't make any difference to whether the arguments are good or not.

[ProfessorDavey]

I think there are lots of people whobthink the safeguards in the bill are excessive, some have said it openly, and some have not. I think those people are lying about their motivations and stating the bll will be the end of it, and they don't intend it to be. In terms of motivations, that's lying about it.

Not what you said NS - you said they were looking to get safeguards removed in the future - not just to amend them. To quote:

'Just as that some on the pro assisted dying side will laud the safeguards as excellent when they will be looking to get them removed in the future because they see the bill as a necessary first step.'

Do you really think that there are people who want to remove all safeguards NS? I've never met someone who thinks like that.

[Nearly Sane]

Not what you said NS - you said they were looking to get safeguards removed in the future - not just to amend them. To quote:

'Just as that some on the pro assisted dying side will laud the safeguards as excellent when they will be looking to get them removed in the future because they see the bill as a necessary first step.'

Do you really think that there are people who want to remove all safeguards NS?

Apologies for not being clear, my previous post clarified that.

[ProfessorDavey]

I think there are lots of people whobthink the safeguards in the bill are excessive, some have said it openly, and some have not. I think those people are lying about their motivations and stating the bll will be the end of it, and they don't intend it to be. In terms of motivations, that's lying about it.

It is perfectly reasonable to consider that the current Bill is a reasonable first step, but to think that it could be improved at some point in the future. And that could be via amendments during the current process or through change in the law in the future. And those people will fall in both directions - those that may wish to see the criteria extended and/or safeguards loosened (although I've never met someone who would want them removed) and those who may wish to see the criteria tightened and/or safeguards loosened.

But we are debating the currently proposals - not some hypothetical proposals that may or may not be brought forward at some point in the future. And the law always has an element of compromise and there will always be people who think that it could be better, yet they may be content not to allow the good to be the enemy of the excellent. In other words to support even though they might ideally wish for something different and may even campaign for something different in the future.

You seem to be engaging in the classic deceit that is the slippery slope argument - effectively that we should reject something that is broadly accepted by society because it will inevitably and without intention lead to something unacceptable. It won't unless the government of the day chooses to refine the law further and they'd presumably only do that if they deemed that the revised position was broadly accepted at the time in the future when they are making that decision.

Use homosexuality as an argument - no doubt back in 1967 when homosexuality became lawful I'm sure there were some who used slippery slop arguments that if you made it legal, next gay people would be saying their 'pretend' relationships should be accepted, and that they might want to adopt children and ... heaven help us, get married. And guess what, all those things have come to pass - not through some unintended slippery slope shift to a place which society deems unacceptable. Nope it shifted because the attitudes of society have moved on and society broadly is now comfortable that not only should homosexuality be legal, but that gay people should be able to marry and adopt children etc. But each of these steps required a distinct new decision by lawmakers.

[ProfessorDavey]

Apologies for not being clear, my previous post clarified that.

Apologies accepted - I'm glad we've clearer that up.

But my point remains - we can only really debate what is proposed. If something else is proposed at some point in the future, that is the time to debate that. See my gay rights argument. Probably back in 1967 there were gay people who really would have loved to be able to get married - but that isn't what the 1967 debate was about, so it isn't dishonest of those people to clearly indicate that they supported the 1967 changes to the law even if ultimately they wished for the extension of rights to go further.

[Gordon]

Just wondering if some of the 'demand' for AD could be met by allowing a service along the likes of Dignitas to operate here for those whose life expectancy qualified them, who we able to access it and who might otherwise have travelled to Europe - would also make dealing with post-death arrangements more practical for relatives.

[ProfessorDavey]

Just wondering if some of the 'demand' for AD could be met by allowing a service along the likes of Dignitas to operate here for those whose life expectancy qualified them, who we able to access it and who might otherwise have travelled to Europe - would also make dealing with post-death arrangements more practical for relatives.

I think that is quite possible, particularly as far as I understand it the Bill, if passed, will not result in provision via the NHS.

I suspect it is quite possible that if legalised assisted dying may well remain only available under private provision. And while that might seem inequitable on the basis of ability to pay, it is also quite possible that the charitable sector will fill the gaps, effectively delivering provision and covering costs. Remember, of course, that currently a lot of palliative care is provided, not by the NHS but by private charitable organisations.

Now in an ideal world we'd want properly integrated provision where patients may use palliative care and some may at a later stage choose to use assisted dying. I think that is actually the case in Oregon where about 90% of people using assisted dying were also using hospice provision at the time. However I am worried that some hospice organisations will refuse to engage with assisted dying on idealogical grounds, which would be a shame as the care and provision (whether palliative or assisted dying) should alway be focussed on the needs and choices of the patient - any ideology should, surely be secondary to the best interests of the individual patient.

[Nearly Sane]

Apologies accepted - I'm glad we've clearer that up.

But my point remains - we can only really debate what is proposed. If something else is proposed at some point in the future, that is the time to debate that. See my gay rights argument. Probably back in 1967 there were gay people who really would have loved to be able to get married - but that isn't what the 1967 debate was about, so it isn't dishonest of those people to clearly indicate that they supported the 1967 changes to the law even if ultimately they wished for the extension of rights to go further.

It is dishonest if they represent their intentions as this and no further when they aren't.