Assisted Suicide bill to be debated in parliament

[jeremyp]

What I am saying is for thousands of years that was the goal of the medical profession and the expectation of the public

Are you seriously trying to pretend that the ongoing research to cure fatal diseases is going to be affected by giving somebody who is definitely going to die in the next six months the option to get it over with?

You must be so desperate to be using crap like that. Give it up.

I’m not asking anyone to carry on living but then again I’m not asking for anyone to assist someone dying.

Where's the extra harm? If a doctor doesn't want to assist somebody to die, there will be no obligation on them to do so.

[jeremyp]

I’m only doing what a devil’s advocate worth their salt would do and if any topic deserved a devil’s advocate, this is it.

A devil's advocate worth their salt would use arguments that aren't crap.

If you are going to argue that assisted dying would be a voluntary matter then everything about it should be voluntary.

I agree. A doctor shouldn't have to assist somebody to die if their conscience does not permit.

[Walt Zingmatilder]

Are you seriously trying to pretend that the ongoing research to cure fatal diseases is going to be affected by giving somebody who is definitely going to die in the next six months the option to get it over with?

One would hope not and there would be less of a risk if assisted dying were to be entirely a matter of choice for patients and practitioners. There is also the question of whether this issue is medicine or whether language has been massaged to include it. Do Doctors and medical practitioners need to be involved at all?

You must be so desperate to be using crap like that. Give it up.Where's the extra harm? If a doctor doesn't want to assist somebody to die, there will be no obligation on them to do so.

But apparently that might not be the case completely.

[ProfessorDavey]

A doctor shouldn't have to assist somebody to die if their conscience does not permit.

And they aren't. The Bill provides a 'conscience' clause which is similar to those for abortion and IVF. Effectively no doctor is required to assist. However, a conscientious objection must not be used to frustrate the right of a patient to access abortion, IVF or, if the law is passed, assisted dying. So if a doctor has a conscientious objection they are required to pass the patient onto another doctor who does not have the same conscientious objection to ensure that the patient is not prevented to accessing the service should they choose to do so. This is exactly the same as the current practice for abortion and IVF, which have worked effectively for decades.

[Walt Zingmatilder]

And there were no vaccinations, which introduce a microscopic risk in order to massively reduce other risks. Medicine has had to develop more nuance as it has developed higher capacity, and as social mores change. This is another example of that - it's an emphasis shift from 'do no harm' to 'reduce harm'. Some will be comfortable with that, and others won't.

I don't propose to justify it on the basis of either of those arguments, Mr Gummidge, maybe go put on your thinking head?

O.

isn’t assuming this is just another medical procedure or a medical procedure at all just begging the question particularly when it emphatically wasn’t part of any code of medical ethics?

[ProfessorDavey]

isn’t assuming this is just another medical procedure or a medical procedure at all just begging the question particularly when it emphatically wasn’t part of any code of medical ethics?

Given that you seem obsessed with a long defunct 'oath' that has no role in modern medical practice, then I will take your claimed reliance on codes of medical ethics with a massive mountain of salt.

I have linked to the code of ethical practice which registered doctors are required to follow - perhaps you should read it. At its heart is the requirement for a doctor to act in the interest of the patient, and for the patient's interest to be best determined by, err, the patient - hence the primacy of patient autonomy and consent in medical ethical practice. There is absolutely nothing in the current code which is in any way inconsistent with assisted dying, where this is lawful and the consensual choice of a dying patient.

[ProfessorDavey]

I’ve only turned out here because there are lawyers who don’t know what to do and the definition of voluntary was apparently not settled by the bill. That’s no fucking game.

What are you on about. The concept of voluntariness will be exactly the same as in all other consent to medical decision making situations (including ones that result in the patient dying, e.g. refusal of life sustaining interventions). There is nothing new in this Bill in those legal terms and the law is pretty settled on these matters from decades of case law on voluntariness and valid consent.

If you are talking about the voluntariness of doctors - in other words conscientious objection. Again this is the same as in other situations - specifically abortion and IVF where the process has worked well for decades.

[Outrider]

isn’t assuming this is just another medical procedure or a medical procedure at all just begging the question particularly when it emphatically wasn’t part of any code of medical ethics?

We're talking about Doctors being asked to consider it, we're wrapping it up in a presumed medicalisation of end-of-life situations, we're talking about it in the context, specifically, of people who are already in medical care for incurable conditions. No, we're not assuming that, it's the situation it's come to light in. It wouldn't be wrong, perhaps, to suggest that it should be taking out of medicine and undertaken by a different group of people, but Doctors would still need to be cognizant of the fact that it's an option, and to explain it to people in their car when they're offering palliative care and other scenarios.

O.

[Steve H]

It's possible that the requirement for a judge to sign each request off could be dropped. I certainly hope so: the safeguards as they stand are too restrictive. (Apologes for linking to the Hate-Mail.)
https://www.msn.com/en-gb/news/uknews/need-for-high-court-to-sign-off-on-assisted-death-could-be-dropped/ar-AA1vhD7S

[Nearly Sane]

It's possible that the requirement for a judge to sign each request off could be dropped. I certainly hope so: the safeguards as they stand are too restrictive. (Apologes for linking to the Hate-Mil.)
https://www.msn.com/en-gb/news/uknews/need-for-high-court-to-sign-off-on-assisted-death-could-be-dropped/ar-AA1vhD7S

So when the bill was drafted did they put that in with the intention of seeking to have it removed in which case there was already a slippery slope approach? Or didn't they think about the practicalities?

I think that if it were to change it would make less it a lot less likely to pass.

[jeremyp]

So when the bill was drafted did they put that in with the intention of seeking to have it removed in which case there was already a slippery slope approach? Or didn't they think about the practicalities?

I think that if it were to change it would make less it a lot less likely to pass.

The "slippery slope" is a fallacy. Of course people are going to argue about whether the safeguards are too restrictive or not.

For what it's worth, the Dutch version of this law does not require sign off by the courts. Nor does it require that life expectancy must be six months or less. We don't see an epidemic of Dutch people being bumped off by their relatives or doctors because it's inconvenient to keep them alive.

[ProfessorDavey]

So when the bill was drafted did they put that in with the intention of seeking to have it removed in which case there was already a slippery slope approach? Or didn't they think about the practicalities?

I think that if it were to change it would make less it a lot less likely to pass.

As JP pointed out the slippery slope argument is a fallacy and muddled thinking.

But it certainly doesn't apply here. Effectively slippery slope arguments are that we shouldn't allow something that is deemed acceptable (to society/legislators etc) as it will necessarily shift to a new position which was unintended and not accepted by those groups.

But the Bill hasn't passed yet. Were the high court authorisation to be removed at amendment stage and that to become law, this would be precisely what the legislators intended and accepted as they would have voted not only for that amendment, but to approve the amended Bill.

[Nearly Sane]

The "slippery slope" is a fallacy. Of course people are going to argue about whether the safeguards are too restrictive or not.

For what it's worth, the Dutch version of this law does not require sign off by the courts. Nor does it require that life expectancy must be six months or less. We don't see an epidemic of Dutch people being bumped off by their relatives or doctors because it's inconvenient to keep them alive.

As JP pointed out the slippery slope argument is a fallacy and muddled thinking.

But it certainly doesn't apply here. Effectively slippery slope arguments are that we shouldn't allow something that is deemed acceptable (to society/legislators etc) as it will necessarily shift to a new position which was unintended and not accepted by those groups.

But the Bill hasn't passed yet. Were the high court authorisation to be removed at amendment stage and that to become law, this would be precisely what the legislators intended and accepted as they would have voted not only for that amendment, but to approve the amended Bill.

I'll take both comments - I'd point out that they post doesn't make the 'slippery slope' argument, as it's not about whether the bill should be passed, but rather that the comment that the requiremen could just be dropped plays into the idea that when those proposing it say they have built in the safeguards based on the need for this to be the strongest safeguards and that being why the bill.should be passed that they are lying in order to get it through.

Given that some support was according to speeches in the debate, and comments after, from those who thought there should be more safeguards, dropping one would seem to me to make it less likely to pass as it jeopardises some of the support. That could be in theory offset by support from anyone who had voted against it because there were too many safeguards but I am not aware that that was anyone's position.

[Walt Zingmatilder]

It's possible that the requirement for a judge to sign each request off could be dropped. I certainly hope so: the safeguards as they stand are too restrictive. (Apologes for linking to the Hate-Mail.)
https://www.msn.com/en-gb/news/uknews/need-for-high-court-to-sign-off-on-assisted-death-could-be-dropped/ar-AA1vhD7S

Already he's talking about dropping safe guards.

[ProfessorDavey]

I'll take both comments - I'd point out that the post doesn't make the 'slippery slope' argument,

Well I, and perhaps JP too, would disagree. The post read to me very clearly as alluding to the slippery slope argument.

... as it's not about whether the bill should be passed, but rather that the comment that the requiremen could just be dropped plays into the idea that when those proposing it say they have built in the safeguards based on the need for this to be the strongest safeguards and that being why the bill.should be passed that they are lying in order to get it through.

Given that some support was according to speeches in the debate, and comments after, from those who thought there should be more safeguards, dropping one would seem to me to make it less likely to pass as it jeopardises some of the support. That could be in theory offset by support from anyone who had voted against it because there were too many safeguards but I am not aware that that was anyone's position.

It is nothing like as simple as you imply.

Firstly there are MPs who think that the levels of safeguards go over the top and the overlay of a requirement in all cases for high court judicial approval is unnecessary, not consistent with other critical end of life decisions and problematic as it would act to delay the process. So those people may be more likely to vote in favour.

But there has been another criticism - specifically that the system isn't equipped to cope with the extra workload, and that has been levelled at both the NHS and the courts. So removing an automatic layer of court oversight, again, make make some MPs more likely to support as assisted dying would have less impact on an already stretched judicial system.

And the final point is that removing automatic oversight of the courts would require an amendment of its own, which would require a vote. So presumably only those who would be comfortable with the amended Bill would vote for the amendment and would presumable be OK with the amended bill being passed. So there is a kind of self levelling approach here - should the amendment pass, then we can presume there is majority support for the amended bill. If there isn't majority support for the amended bill then presumably the amendment won't pass. The only spanner in the works would be MPs playing silly 'wrecking' games - in other words those who oppose voting in favour of amendments that make the bill less likely to be supported.

But, of course, none of this has any relevance to your claimed slippery slope as whatever amendments are passes and whatever amended bill gets passed (should it pass) will be what was intended and accepted by parliament.

[ProfessorDavey]

Already he's talking about dropping safe guards.

Who is he?

And as discussed with NS, the bill hasn't passed yet, so you cannot talk about dropping anything yet as the bill is still processing through parliament and I imagine a whole range of amendments, some that appear to tighten safeguards, some that appear to relax safeguards and some that have nothing to do with safeguards will be debated and voted on.

[Walt Zingmatilder]

Given that you seem obsessed with a long defunct 'oath' that has no role in modern medical practice, then I will take your claimed reliance on codes of medical ethics with a massive mountain of salt.

This suffers from being a fallacy of modernity and the fallacy of saying that because one part should be rejected the whole can be rejected.

I have linked to the code of ethical practice which registered doctors are required to follow - perhaps you should read it. At its heart is the requirement for a doctor to act in the interest of the patient, and for the patient's interest to be best determined by, err, the patient - hence the primacy of patient autonomy and consent in medical ethical practice.,

But Professor that is at the heart of any professional code. It is the bare and vague minimum. The only thing like assisted dying at the end of the day is assisted dying. Your analogous situations are not as analogous as you believe

There is absolutely nothing in the current code which is in any way inconsistent with assisted dying, where this is lawful and the consensual choice of a dying patient.

I think you rather have this arse about face.

[Steve H]

On a side issue, I get fed up of people suggesting that their knowledge or experience means that their opinion carries more weight, eg "I'm a palliative care doctor and I favour assisted dying", or "I'm disabled and I oppose assisted dying" (like that tiresome Carr woman). By all means express your opinion, but don't assume we've got to agree with you. It's like saying "There must be a God, because the Archbishop of Canterbury says so, and he's an expert".

[jeremyp]

Already he's talking about dropping safe guards.

And that will be argued. If it is successfully argued that the judge safeguard is not needed, then it will be dropped. If it is successfully argued that the judge is needed but that it will be impossible to find a judge due to workload, it is likely that the bill will fail.

You and NS don't need to get hysterical about this.

[jeremyp]

Well I, and perhaps JP too, would disagree. The post read to me very clearly as alluding to the slippery slope argument.

The clue was in NS's post explicitly mentioning a "slippery slope approach".

[SqueakyVoice]

(Caption top of the article)

Labour MP Marie Tidball voted in favour of the bill but wants the law amended to ensure doctors present all options to patients

Not sure how (or if) that's a snag?

[ProfessorDavey]

(Caption top of the article)
Not sure how (or if) that's a snag?

I don't think it is a snag as doctors are already required to present all options to patients as part of consent. Rather than being an issue for those in favour it may actually act to rebut those who are opposed who have suggested that doctors should only discuss assisted dying if a patient brings it up first. That would run completely counter to the basis tenet of 'adequate and sufficient' information that requires patients to be informed of alternatives.

By contrast with those opposed who seem to want to restrict information I'm unaware of those in favour suggesting anything other than all options should be presented. Certainly I'd expect all options to be presented and discussed as part of the process.

Point being - that I don't think there is any need to amend the bill as the requirement to present all options is implicit in the consent. However I've no issue with this amendment being inserted but it will make no difference in practice (unless opponents attempt to stifle the requirement for all options to be presented).

[ProfessorDavey]

The clue was in NS's post explicitly mentioning a "slippery slope approach".

It was indeed.

[ProfessorDavey]

This suffers from being a fallacy of modernity and the fallacy of saying that because one part should be rejected the whole can be rejected.

It is nothing of the sort. I was merely pointing out that the hippocratic oath is no longer the ethical code of practice that doctors are required to adhere to, so is of no relevant.

As mentioned previously the professional ethical code of practice that doctors are required to adhere to is the GMC's Good Medical Practice:

https://www.gmc-uk.org/-/media/documents/good-medical-practice-2024---english-102607294.pdf

I presume you've read this, and it's relevant further guidance, e.g. on consent which is linked to in the main document.

So more than happy to discuss the ethical code of practice that doctors in the UK are required to adhere to with you. But discussing an ethical code that is not in actual use in medical practice in the UK is rather pointless I would have thought.

[ProfessorDavey]

But Professor that is at the heart of any professional code. It is the bare and vague minimum.

Actually it isn't - the notion of patient autonomy/consent and the patient themselves being the best person to determine what is in their best interests is rather radically modern. Really only becoming the prime concern in the past 50-100 years or so. Prior to this medicine was not about patient's making choices for themselves (autonomy), but paternalism where the doctor was the 'expert' and therefore decided what was best for the patient (regardless of whether they would choose it themselves).

Oh - and the hippocratic oath is completely silent on patient autonomy and consent - indeed it actually advocates concealing information from patients. Not surprising then that the hippocratic oath is no longer used as a code of ethical conduct.