🤔 Terminally Ill Adults (End of Life) Bill (Twelfth sitting)

• The parliamentary session focused on discussing amendments to the Terminally Ill Adults (End of Life) Bill, specifically regarding the requirement for consultations with palliative care specialists.

• Naz Shah proposed amendment 281, which would mandate that individuals seeking assisted dying must consult with a palliative care specialist to ensure they are fully informed about available care options. This amendment aimed to strengthen the safeguards within the Bill.

• Debate arose around whether mandating consultations with palliative care specialists would infringe on patient autonomy, as some patients might not wish to see such specialists. Opponents argued that the Bill already requires doctors to discuss palliative care options during initial consultations.

• Concerns were raised about the potential bureaucratic burden that mandatory consultations could impose, possibly complicating the process for terminally ill patients.

• Danny Kruger supported the amendment, emphasizing the importance of palliative care as a genuine alternative to assisted dying, arguing that without it, the Bill leans more towards autonomy than safeguarding vulnerable individuals.

• Dr. Simon Opher and others expressed concerns that requiring a consultation might exclude patients who refuse to meet with a palliative care doctor, suggesting that while palliative care should be offered, it should not be mandatory.

• The session also delved into the definition of “terminal illness” within the Bill, with amendments proposing to narrow it to only include illnesses and diseases, excluding broader “medical conditions” to safeguard against extending eligibility to frail or disabled individuals.

• Concerns were voiced about the potential for people with mental disorders, like anorexia, to qualify for assisted dying if their physical conditions resulting from their mental health were deemed terminal.

• The Committee highlighted the need for clarity and safeguards in the Bill to protect vulnerable groups, including those with mental health issues and disabilities, while also ensuring that those eligible for assisted dying are fully informed of their options.

• The proposed amendments were ultimately rejected, with the Committee deciding that the Bill’s existing provisions for discussing palliative care were sufficient, and that further requirements could complicate the process for patients.

The parliamentary session on the Terminally Ill Adults (End of Life) Bill displayed a moderate level of disagreement among the members. The rating of 3 reflects several instances of contention, primarily centered around the amendments concerning palliative care and the definition of terminal illness, especially related to mental disorders and disabilities. However, the discussions remained generally respectful and focused on the substantive issues at hand, with members articulating their positions clearly and often engaging in constructive dialogue.

1. Disagreement on Palliative Care Amendments: The session saw significant contention regarding amendments that aimed to require consultations with a palliative care specialist before proceeding with assisted dying. The amendments (e.g., amendment 281) proposed by Naz Shah were debated at length, with some members arguing for the necessity of such consultations to ensure patients are fully informed about all their options, while others, including Dr. Simon Opher and Dr. Neil Shastri-Hurst, expressed concerns that mandatory consultations could infringe on patient autonomy and potentially complicate the process unnecessarily. These contrasting viewpoints highlight the disagreement over the balance between patient autonomy and ensuring informed consent.

2. Definition of Terminal Illness and Protection of Vulnerable Groups: Another major area of disagreement was the definition of ‘terminal illness’, particularly with regards to the inclusion of ‘medical condition’ and its implications for disabled individuals and those with mental disorders. Amendments 399, 400, and 401 sought to exclude ‘medical condition’ from the definition, arguing it could potentially include conditions like frailty, which might be used as grounds for assisted dying. This sparked a debate on the adequacy of the Bill’s safeguards for vulnerable groups. Danny Kruger’s concerns about the inclusion of ‘medical condition’ broadening the scope to include people who might not traditionally be considered terminally ill faced opposition from others, including Lewis Atkinson, who argued for a broader interpretation to account for multiple illnesses leading to death. This shows a significant disagreement on the scope and eligibility criteria of the Bill.

3. Mental Health and Eating Disorders: Specific amendments addressing the eligibility of those with mental disorders, such as anorexia, further fueled the disagreement. Amendment 11’s proposal to disallow assisted dying for those with mental disorders or disabilities caused by physical conditions was debated. The disagreement centered on how to protect individuals with conditions like anorexia from using the Bill’s provisions. Rebecca Paul and Naz Shah emphasized the need for stronger safeguards, while Kim Leadbeater argued that existing provisions and capacity assessments were sufficient.

Despite the disagreements, the session was marked by thoughtful interventions and a clear intent among members to refine the legislation in a way that balances patient autonomy with ethical safety and protection of vulnerable groups. The level of disagreement is moderate because while there were clear differences in opinion and voting outcomes, the core debates remained civil and centered on policy improvement.