🤝 Terminally Ill Adults (End of Life) Bill (Second sitting)

• The Public Bill Committee heard evidence from key medical professionals including Professor Sir Chris Whitty, Duncan Burton, Mark Swindells, Dr Andrew Green, Glyn Berry, and Professor Nicola Ranger on the Terminally Ill Adults (End of Life) Bill.

• The Bill aims to legalize assisted dying for terminally ill adults, a sensitive topic with various perspectives across the medical profession and society.

• Chris Whitty emphasized the need for a careful, non-rushed implementation of the Bill if passed, highlighting the importance of training and preparation for healthcare professionals involved.

• Concerns were raised about the potential inequalities in healthcare access and how they could affect the implementation of the Bill, especially given the disparities observed during the Covid-19 pandemic.

• The accuracy and definition of a “terminal illness” were discussed, noting the difficulties in creating a precise list of qualifying conditions due to the variability in disease progression.

• Discussions included the need for robust safeguards to assess mental capacity and prevent coercion, with suggestions to incorporate multidisciplinary approaches involving social workers and nurses alongside doctors.

• There was a consensus on the importance of a patient’s autonomy and informed choice, with professionals from various backgrounds advocating for safeguards that respect this while ensuring ethical and safe practice.

• The role of the NHS in providing assisted dying services was a topic of debate, with opinions split on whether it should be a separate service or integrated into existing care frameworks.

• The need for clear guidance and training for healthcare professionals was emphasized, including how to handle complications and the legalities surrounding the process of assisted dying.

• Concerns about the current state of palliative care and its potential impact on the decision for assisted dying were raised, with calls for equitable and sustainable palliative care funding.

• The emotional and psychological support for healthcare professionals, including nurses, was discussed, with suggestions for clinical supervision and the need to protect the rights of those who object to being involved in assisted dying.

• The practicalities of implementing the Bill within care homes were also considered, raising questions about how to balance residents’ autonomy with the operational and ethical concerns of care providers.

The session displayed moderate levels of disagreement among the participants, primarily centered on the operational and ethical aspects of the proposed Terminally Ill Adults (End of Life) Bill. There were notable differences in perspectives on issues such as the involvement of medical professionals, the necessity of specialized training, the role of non-medical professionals, and the potential implications for existing palliative care services.

• Medical Professional Involvement: There was a notable disagreement on the role of doctors and nurses in initiating discussions about assisted dying. Dr. Andrew Green suggested that doctors should be able to raise the subject in certain circumstances to guide patients properly, whereas other participants, such as Professor Nicola Ranger and Glyn Berry, emphasized patient autonomy and argued that the initiative should come from the patient themselves. This difference in approach to patient interaction reflects a significant area of contention.

• Training and Specialization: The session also highlighted disagreements on the training necessary for professionals involved in assessing eligibility for assisted dying. Professor Chris Whitty emphasized the need for some level of specialization, particularly for doctors who might be involved in the final stages of the process. In contrast, Dr. Green stated that general expertise rather than specialist status should be sufficient, as long as doctors have the ability to seek further advice if necessary. This discrepancy in views on professional qualifications and training remains unresolved.

• Multidisciplinary Approach: There was a clear divergence of views on the involvement of multidisciplinary teams, particularly regarding social workers and nurses. Glyn Berry advocated strongly for a more inclusive approach, suggesting the introduction of an ‘approved palliative care professional’ role to supplement the current two-doctor system. This proposal aimed to balance clinical and social assessments, but it differed from other participants who seemed to focus more narrowly on the medical aspects of the Bill.

• Impact on Palliative Care: Concerns were raised about the potential impact of the Bill on existing palliative care services. Glyn Berry expressed worries that inadequate funding for palliative care might drive patients towards assisted dying out of desperation. This concern was not unanimously shared among all witnesses, as some focused more on the autonomy and choice aspects of the Bill.

• Timing and Implementation: The timeline for implementation and readiness of the NHS to provide an assisted dying service was another area of disagreement. Professor Chris Whitty suggested that two years might be a reasonable timeframe for the Bill to come into initial force, yet cautioned against a fixed deadline for full service implementation. Rebecca Paul and other members questioned the practicality of this timeframe, indicating a divergence in opinion on how quickly the service could be equitably and safely integrated into the healthcare system.

Given these points of contention, the session exhibits a moderate level of disagreement, warranting a rating of 3. The disagreements are not pervasive enough to classify the session as highly contentious (rating of 4 or 5), nor are they minimal or absent enough to be considered low (rating of 1 or 2). The disagreements are balanced and significant enough to impact the discussion and potential amendments to the Bill, but there is also a notable degree of cooperation and shared concerns among the participants.