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

• Amendment Discussions: The session focused on discussing amendments to Clause 4 of the Terminally Ill Adults (End of Life) Bill, which deals with initial discussions between registered medical practitioners and patients about assisted dying.

• Amendment 278: This amendment aimed to prevent doctors from raising the subject of assisted dying if a patient had previously recorded an advanced decision against it. However, it was deemed unnecessary as the Bill already ensures that only patients with current capacity can engage in assisted dying.

• Amendments 8 and 124: Both amendments proposed that doctors could only discuss assisted dying if the patient initiates the conversation. These amendments were rejected, supporting the concept of doctors using professional judgment to decide whether to discuss assisted dying.

• **AmendAcross various clauses, amendments were proposed to enhance protections and ensure discussions are thorough and informed, particularly for vulnerable groups such as those with learning disabilities, autism, and Down syndrome.

• Age Considerations: Amendments 319 and 320 sought to ensure that initial discussions and assistance under the Bill occur only with adults aged 18 and over. These were not adopted, as the Bill already stipulates that eligibility for assisted dying begins at age 18.

• Support for Vulnerable Groups: Amendments like 339 and 368 aimed to provide additional support and time for patients with learning disabilities, autism, and Down syndrome during discussions about assisted dying. These were not supported, but there was a commitment to engage further with relevant communities.

• Timing of Discussions: Amendment 276 proposed delaying initial discussions until 28 days after a terminal diagnosis, which was not adopted to avoid unnecessary delays in patient care.

• Professional Judgment and Conscientious Objection: There was significant debate on whether doctors should be obligated to discuss assisted dying. The Bill maintains that doctors are not required to do so but may if they deem it appropriate, respecting their conscientious objections.

• Role of Specialists: Amendments suggested that initial discussions should involve consultations with specialists in the patient’s illness, treatment options, and palliative care. These were largely rejected, trusting doctors’ professional judgment.

• Information Provided: Amendments aimed to mandate doctors to disclose uncertainties about prognosis, risks of treatments, and available palliative care options during discussions. While some were supported, the overarching view was that existing GMC guidelines already cover these aspects.

• Referrals and Multidisciplinary Teams: There was a consensus on the importance of referring patients to palliative care specialists, and amendments suggested establishing multidisciplinary teams for comprehensive assessments. The Bill’s promoter agreed to support referrals to palliative care specialists.

• Legal and Ethical Concerns: The session highlighted the tension between ensuring patient access to informed decision-making and protecting doctors’ rights to conscientious objection. Discussions also touched on potential conflicts with human rights under the European Convention.

• Outcome of Votes: Most amendments discussed were not passed, indicating a preference for maintaining the Bill as drafted, with reliance on doctors’ professional standards and existing guidelines rather than imposing new legal requirements.

The session exhibits a moderate level of disagreement among the members, hence a rating of 3. Here’s the detailed reasoning behind this assessment:

1. Procedural Disagreements: There are several amendments proposed and debated throughout the session. For instance, amendments such as 278, 8, 124, and others were discussed and voted upon, with some members expressing clear opposition or support for these changes. This suggests a procedural disagreement on how the Bill should be structured and what additional safeguards or revisions should be included.

2. Substantive Disagreements on Policy: Disagreements also surface over key policy issues. For example, the discussion around amendment 342, which would require a doctor to conduct a preliminary discussion upon a patient’s indication of seeking assisted dying, shows a division in views. Danny Kruger argues for the amendment, emphasizing the importance of mandatory preliminary discussions, whereas Kim Leadbeater points out the need to consider doctors’ conscientious objections to such requirements. This indicates a substantive disagreement over how to balance patient autonomy with medical professionals’ rights.

3. Debate on Medical Practitioner Involvement: There are pronounced disagreements on the extent to which medical practitioners should be involved in the assisted dying process. For instance, the discussion on amendments 285 and 286 revolves around requiring consultations with specialists. Naz Shah and others argue for such measures to ensure a higher standard of decision-making, while Dr. Simon Opher raises concerns about legislating medical consultations, suggesting that such requirements could constrain doctors’ professional judgment and increase legal risks.

4. Concerns Over Palliative Care: There is a notable debate on the provision and discussion of palliative care. Sean Woodcock supports amendments that would ensure patients are aware of all appropriate palliative care options, and Dr. Marie Tidball emphasizes the need for transparency. However, Dr. Opher suggests that such requirements might be unnecessary and potentially harmful by overburdening the legislation with details that should be handled under existing medical guidance.

5. Divergence in Views on Guidance and Law: A significant disagreement arises around whether detailed guidance should be enshrined in law. Danny Kruger argues for including all relevant General Medical Council guidance in the Bill to ensure doctors adhere to best practices uniformly. In contrast, Dr. Opher and others suggest that medical practitioners are already guided by existing codes and that legislating such details might hinder medical consultations and lead to legal complications.

6. Voting Outcomes: The voting outcomes, such as those following amendments 8, 124, 319, and others, reflect a consistent division in the Committee, with a majority in the ‘Noes’ consistently negativing the proposed amendments. This indicates a stable disagreement among members on the specific content and direction of the Bill.

These points collectively suggest a moderate level of disagreement rather than an intense conflict, as evidenced by the nature of the debates, the amendments discussed and voted upon, and the concerns raised about the implications of the proposed legislative changes. The session does not showcase extreme opposition but reflects a thoughtful disagreement on crucial aspects of the legislation, leading to amendments being rejected and a need for further adjustments.