Assisted Suicide bill to be debated in parliament

[ProfessorDavey]

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.

[Posting here as well as on the 'Abortion' thread as Vlad is making the same (to my mind non-sense) assertion.]

Don't agree.

A consenting person requesting that a life support machine is turned off seems almost entirely analogous to assisted dying. Both involve the consent of an individual who wishes to die but cannot do so without the assistance of others. In both cases the death is as a direct result of the intervention and in both cases the assistance is required as the individual themselves is not in a position to take direct action themselves to allow them to die - they can only do so with assistance.

There are differences, however when we look at the details of the Bill going through parliament and what is already permitted under law.

The turning off of life support machine requires a direct intervention by a third party to ensure that the person dies - in other words someone other than the patient will turn off the machine. For assisted dying, although there is assistance to prescribe the medication, only the patient themselves would be permitted to take them - they cannot be administered by a third party.

The current law allows individuals to make advance directives allowing turning off of a life support machine under circumstances where they can no longer consent. That isn't the case for the proposed assisted dying - where the person must be competent both when they request and when they take the drugs.

The current law allows others to take decisions to turn off life support on behalf of a person who is not competent. The proposed assisted dying does not allow anyone other than a competent patient to take those decisions.

The current law on switching off of life support only requires high court authorisation for 'difficult' cases - where a competent person is consenting for themselves they would not get involved. The proposed assisted dying bill requires high court authorisation in all cases, even when an analogous case (competent person consenting) would not require this for cessation of life support.

So while the fundamentals are pretty well identical - person wishes to die and cannot do so without direct/indirect third party intervention - the proposals are way more strict on assisted dying than cessation of life support.

[ProfessorDavey]

No, one involves the ending of treatment to allow a natural end, the other involves administering a "poison" to kill.
It is important for you then to justify that the means of killing is not a poison or instrument. In withdrawal of treatment, there are no instruments.
Now, in the system of dying proposed, the patient administers the instrument. So the killing is suicide and therefore the practitioner arguably does not kill. Where the line is has been arbitrarily decided by the vote.

This is Vlad's reply to my previous post.

This is the kind of theoretical philosophical sophistry which has no place in the real world. These convoluted 'dancing on head of a pin' arguments are usually concocted by people to justify a conclusion that they have already decided upon rather than being used as logical philosophical instruments to develop a conclusion. They also have a tendency to crumble to dust when challenged under analogous scenarios, such as:

So imaging a person comes across another who is dangling over a precipice clinging onto a rope where a fall would mean certain death. The first man takes out a knife and he:
a). Stabs the second man in the heart which stops beating and the second man dies or
b). Cuts the rope and the second man falls and he dies

Is there a 'moral' distinction between these two acts - I don't think so, and certainly in legal terms both would be clear murder.

And you can make it even closer to the medical scenario:

A nurse enters a side room with a man whose life is being sustained by a life support machine. The man wants to live and there is no medical reason to stop treatment. The nurse:

a). Adds a lethal level of a drug into his drip and the patient dies or
b). Turns off the life support machine and the patient dies

Again is there a moral distinction between those two acts - nope, they are both murder. So it isn't the issue of 'ending treatment' rather than 'administering a lethal dose' which is a relevant moral distinction as in this scenario both are morally indefensible. So Vlad, come back with a valid reason which the turning off of life support is morally distinct from administering a lethal dose - one that will actually not crumble when tested in various scenarios. Here is a clue - it might focus on consent rather than the means by which the person's life ends.

Oh and by the way someone who dies following turning off of life support doesn't die a 'natural death' as they weren't living a 'natural life' as some vital functions were being sustained artificially rather than naturally, so it is the removal of the artificial sustaining elements that results in death, not some natural process.

[jeremyp]

No, one involves the ending of treatment to allow a natural end, the other involves administering a "poison" to kill.

Two problems here.

1: this is the naturalistic fallacy - assuming that what is natural is right (although whether it is really natural is debatable, see PD's answer and below).

2: under the proposed law, the poison must be self-administered. 

It is important for you then to justify that the means of killing is not a poison or instrument. In withdrawal of treatment, there are no instruments.
Now, in the system of dying proposed, the patient administers the instrument. So the killing is suicide and therefore the practitioner arguably does not kill. Where the line is has been arbitrarily decided by the vote.

I would argue that, in the case of turning off life support, the doctor is taking an action to end a life. In the second, the patient is taking the action. The fact that the doctor is turning something off makes no difference to the fact that they are ending a life. For example, if you were a deep sea diver and I shot you with one of those James Bond spear guns, it would be murder. However, if I merely turned off your life support, are you claiming that it would be somehow less bad?

[ProfessorDavey]

Two problems here.

1: this is the naturalistic fallacy - assuming that what is natural is right (although whether it is really natural is debatable, see PD's answer and below).

2: under the proposed law, the poison must be self-administered. 

I would argue that, in the case of turning off life support, the doctor is taking an action to end a life. In the second, the patient is taking the action. The fact that the doctor is turning something off makes no difference to the fact that they are ending a life. For example, if you were a deep sea diver and I shot you with one of those James Bond spear guns, it would be murder. However, if I merely turned off your life support, are you claiming that it would be somehow less bad?

Indeed.

Vlad should spend a couple of hours in the company of my delightful old medical ethics tutor, Jonathon Glover, much of whose work has been a systematic demolition of those hoary old philosophical sophistries of double effect, acts vs omissions and the distinction between killing and letting die. He is the most gentle and charming of characters but with the very sharpest intellect that would leave any of those tired, defunct notions that Vlad trots out in pieces within a couple of minutes.

[Walt Zingmatilder]

Indeed.

Vlad should spend a couple of hours in the company of my delightful old medical ethics tutor, Jonathon Glover, much of whose work has been a systematic demolition of those hoary old philosophical sophistries of double effect, acts vs omissions and the distinction between killing and letting die. He is the most gentle and charming of characters but with the very sharpest intellect that would leave any of those tired, defunct notions that Vlad trots out in pieces within a couple of minutes.

Fortunately he has provided a very generous website in which one could spend very many happy hours trawling.It looks like a veritable toyshop...if it's the same Jonathan Glover.

[ProfessorDavey]

Fortunately he has provided a very generous website in which one could spend very many happy hours trawling.It looks like a veritable toyshop...if it's the same Jonathan Glover.

Yup - likely to be the very same.

https://jonathanglover.org

He was the lead tutor when I did my MA in Medical Ethics and Law about 20 years ago. One of his seminal works is 'Causing death and saving lives', which I'd thoroughly recommend you read. Also I'd recommend 'Killing and letting die' by Steinbock and Norcross.

[Walt Zingmatilder]

Yup - likely to be the very same.

https://jonathanglover.org

He was the lead tutor when I did my MA in Medical Ethics and Law about 20 years ago. One of his seminal works is 'Causing death and saving lives', which I'd thoroughly recommend you read. Also I'd recommend 'Killing and letting die' by Steinbock and Norcross.

Thanks.

[Walt Zingmatilder]

BMA campaign for Doctor's right to foist beliefs on to patients?

https://www.theguardian.com/society/2025/jan/15/doctors-to-speak-out-against-changes-to-proposed-assisted-dying-law-in-england-and-wales

[jeremyp]

BMA campaign for Doctor's right to foist beliefs on to patients?

https://www.theguardian.com/society/2025/jan/15/doctors-to-speak-out-against-changes-to-proposed-assisted-dying-law-in-england-and-wales

That's not what the article says at all. The BMA just wants doctors to be allowed to lay out all the options for terminally ill patients. I agree with them.

[ProfessorDavey]

BMA campaign for Doctor's right to foist beliefs on to patients?

https://www.theguardian.com/society/2025/jan/15/doctors-to-speak-out-against-changes-to-proposed-assisted-dying-law-in-england-and-wales

You have it the wrong way around Vlad.

A key element of consent is that patients are informed about all the options that are available to them. That is, of course, the only way in which that person can make an informed consensual choice about which option they wish to choose. If a doctor deliberately refuses to mention one available choice due to their own personal beliefs then they are foisting their belief onto patients as the patient is deliberately not informed about an option that may be the choice they may wish for. Effectively the doctor is saying 'I don't want you to choice option X, because of my personal beliefs, therefore I won't tell you that option X exists'. That is unethical and unprofessional.

Now in the real professional world there are a small number of areas of medical practice (abortion, IVF and likely assisted dying) where a legal conscientious clause is available to doctors and other healthcare professionals. However, this does not allow the doctor actually to attempt to ensure that a patient is not informed of the choice their personally oppose. Rather it requires a doctor (or other professional) who has that objection to pass their patient onto another doctor who is able to discuss all options with the patient. So while the conscience of the professional is protected, this is not allowed to prevent the freedom of the patient to choose from all options.

[Walt Zingmatilder]

You have it the wrong way around Vlad.

A key element of consent is that patients are informed about all the options that are available to them. That is, of course, the only way in which that person can make an informed consensual choice about which option they wish to choose. If a doctor deliberately refuses to mention one available choice due to their own personal beliefs then they are foisting their belief onto patients as the patient is deliberately not informed about an option that may be the choice they may wish for. Effectively the doctor is saying 'I don't want you to choice option X, because of my personal beliefs, therefore I won't tell you that option X exists'. That is unethical and unprofessional.

Now in the real professional world there are a small number of areas of medical practice (abortion, IVF and likely assisted dying) where a legal conscientious clause is available to doctors and other healthcare professionals. However, this does not allow the doctor actually to attempt to ensure that a patient is not informed of the choice their personally oppose. Rather it requires a doctor (or other professional) who has that objection to pass their patient onto another doctor who is able to discuss all options with the patient. So while the conscience of the professional is protected, this is not allowed to prevent the freedom of the patient to choose from all options.

But I'm not talking about the right of the patient to assisted dying, they will presumably have that right.

I'm talking about providing, albeit accidently the practitioner space to inflict their beliefs on the issue.

[Steve H]

But I'm not talking about the right of the patient to assisted dying, they will presumably have that right.

I'm talking about providing, albeit accidently the practitioner space to inflict their beliefs on the issue.

You don't half spout some prize bollocks.

[Walt Zingmatilder]

You don't half spout some prize bollocks.

Talking shite again,Steve?

[ProfessorDavey]

But I'm not talking about the right of the patient to assisted dying, they will presumably have that right.

But they won't be able to make a consensual decision on the matter unless they are informed about it along with the other options.

I'm talking about providing, albeit accidently the practitioner space to inflict their beliefs on the issue.

Which is exactly what will happen, completely intentionally, if a doctor (or other medical professional) refuses to inform the patient that assisted dying is an option available to them due to their own personal beliefs.

So if you are concerned about doctors foisting their personal opinions on patients I think the place to look is doctors who dogmatically oppose assisted dying failing to inform patients of their rights to access this option, or to actively push patients to choose other options.

[Walt Zingmatilder]

But they won't be able to make a consensual decision on the matter unless they are informed about it along with the other options.

Consensual makes it sound like there’s more than one person making the decision to die. One person is making that decision and that’s the person dying. The independence of that should be paramount and it is the government’s place to inform everyone of their right.

So if you are concerned about doctors foisting their personal opinions on patients I think the place to look is doctors who dogmatically oppose assisted dying failing to inform patients of their rights to access this option, or to actively push patients to choose other options.

So there is a potential problem then with influence. Whether it’s from people wanting patients backing down or pressuring people not to change their minds.

[ProfessorDavey]

Consensual makes it sound like there’s more than one person making the decision to die.

No it doesn't - it means that a decision is made through the consent of the individual making that decision, which is pretty clearly defined legally and ethically for medical decision-making (which is clear that the decision is the indidivual's and the individual's alone). 

One person is making that decision and that’s the person dying. The independence of that should be paramount and it is the government’s place to inform everyone of their right.

Of course as it would be in this case and in other medical decision making where the individual has the capacity to consent. But consent also requires there to be sufficient and adequate information to allow that decision to be made. And that must involve the individual being informed about the various options available to them, including assisted dying.

So there is a potential problem then with influence. Whether it’s from people wanting patients backing down or pressuring people not to change their minds.

Theoretically, but the medical profession are extremely well trained and experienced (and professional) and there are highly relevant exemplars (where there hare conscientious objection clauses) that having worked well for decades (e.g. abortion and IVF). And as with abortion and IVF an objecting doctor will be legally required to ensure that the individual will be able to access all options available to them by passing them onto to another professional who has not exercised a conscientious objection.

[Walt Zingmatilder]

No it doesn't - it means that a decision is made through the consent of the individual making that decision, which is pretty clearly defined legally and ethically for medical decision-making (which is clear that the decision is the indidivual's and the individual's alone). 
Of course as it would be in this case and in other medical decision making where the individual has the capacity to consent. But consent also requires there to be sufficient and adequate information to allow that decision to be made. And that must involve the individual being informed about the various options available to them, including assisted dying.
Theoretically, but the medical profession are extremely well trained and experienced (and professional) and there are highly relevant exemplars (where there hare conscientious objection clauses) that having worked well for decades (e.g. abortion and IVF). And as with abortion and IVF an objecting doctor will be legally required to ensure that the individual will be able to access all options available to them by passing them onto to another professional who has not exercised a conscientious objection.

I couldn't go without questioning the notion of Death as
just another "Treatment option" a term close to that other piece of officialese "solution",  term not used in connection with Death for about 8 decades.

It is up to the government to inform the population that this is a society where this is an option, not foist it onto doctors pretending it's a treatment option no matter how much people with interests in medical ethics might want ownership of this.

[Gordon]

I couldn't go without questioning the notion of Death as
just another "Treatment option" a term close to that other piece of officialese "solution",  term not used in connection with Death for about 8 decades.

It is up to the government to inform the population that this is a society where this is an option, not foist it onto doctors pretending it's a treatment option no matter how much people with interests in medical ethics might want ownership of this.

Who exactly is presenting Assisted Death as being a 'treatment' option?

Surely the point is for the affected person to consciously and permanently choose to end their pain and suffering, and not to 'treat'.

[jeremyp]

I'm talking about providing, albeit accidently the practitioner space to inflict their beliefs on the issue.

But you are trying to inflict your beliefs on the issue on all the patients.

[ProfessorDavey]

It is up to the government to inform the population that this is a society where this is an option, not foist it onto doctors pretending it's a treatment option no matter how much people with interests in medical ethics might want ownership of this.

No it isn't.

It is for the government to determine whether or not assisted dying should be an option and if so what criteria apply in terms of who is able to access assisted dying (in the Bill this is terminal illness diagnosis, considered to have less than 6 months to live, have capacity to give consent etc).

Once the government has made that decision (should it chose to do so) then it will be for medical practitioners to put the provisions of the law into practice. And that will include the provision of information about choices available to a terminally ill person. It is very important that information about all options is provided as this is the only way in which consent to one of those choices would be valid (legally and ethically).

[Walt Zingmatilder]

No it isn't.

It is for the government to determine whether or not assisted dying should be an option and if so what criteria apply in terms of who is able to access assisted dying (in the Bill this is terminal illness diagnosis, considered to have less than 6 months to live, have capacity to give consent etc).

Once the government has made that decision (should it chose to do so) then it will be for medical practitioners to put the provisions of the law into practice. And that will include the provision of information about choices available to a terminally ill person. It is very important that information about all options is provided as this is the only way in which consent to one of those choices would be valid (legally and ethically).

I'm sure what you describe is the way things will, wrongly go, so I can't fault you on your administrative acumen.
The medical profession has no role in persuading or dissuading
People from this decision since this is not treatment as such and  it is the Government who have sanctioned this.

Once it is passed it is unlikely that anyone will not have heard of the availability of assisted dying and those who avail themselves of it will merely experience a freedom from any constraint they would now come across.
Information on whether assisted dying is legal or not is not a medical matter.

[ProfessorDavey]

The medical profession has no role in persuading or dissuading
People from this decision since this is not treatment as such and  it is the Government who have sanctioned this.

But it does have a key role in informing people of their choices and options. Not to do so would be deeply unethical as it would mean that people were making choices without sufficient information about the options available to them. That would render their consent invalid.