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

• The Public Bill Committee continued its session on the Terminally Ill Adults (End of Life) Bill, focusing on amendments related to the reflection periods and the assessments required for an assisted death.

• Proposals were discussed to extend reflection periods, with suggestions to increase them from 7 to 14 days and from 14 to 28 days. Additional amendments aimed to adjust the reflection period for patients expected to die within a month from 48 hours to 7 days.

• Evidence was presented highlighting the need for longer reflection periods to allow patients time to adjust to their diagnosis, and concerns were raised about the influence of alcohol misuse on decision-making within short reflection periods.

• The Minister clarified the impact of proposed amendments on the reflection periods, noting that some amendments could influence the urgency of palliative care referrals.

• Discussions focused on ensuring adequate time for reflection without rushing such a significant decision, particularly emphasizing the challenges posed by NHS waiting times for medical appointments.

• Amendments aimed at preventing “doctor-shopping” were debated, with proposals to ensure that patients could not seek multiple assessments from different doctors.

• Concerns were raised about the potential for coercion if patients could repeatedly seek different doctors until they received approval for an assisted death.

• Evidence from other jurisdictions was cited, showing instances of patients seeking multiple opinions until they received a favorable outcome, prompting discussions on safeguards.

• The role of the independent doctor was discussed, emphasizing the need for transparency and accountability in their assessments and the importance of preventing variability in decision-making.

• Proposals were made to ensure that doctors consider all relevant medical records during assessments, and amendments were suggested to mandate consultations with other health and social care professionals involved in the patient’s care.

• An amendment was proposed requiring doctors to ask patients directly why they are seeking an assisted death, aiming to provide a better understanding of their motivations and to enhance safeguarding measures.

• Concerns about privacy and the relevance of medical records to the decision-making process were debated, with specific considerations for vulnerable groups and those with past mental health issues.

• The session highlighted ongoing debates about balancing patient autonomy with the need for robust safeguards to prevent coercion and ensure informed decision-making in the context of assisted dying.

The session displays a moderate level of disagreement among the participants, warranting a rating of 3 on a scale of 1 to 5. The debate centers around several amendments to the Terminally Ill Adults (End of Life) Bill, focusing on the process and safeguards surrounding assisted dying. Although the session is structured and follows parliamentary procedure, there are clear instances of differing views and arguments over the proposed changes to the Bill. Below are detailed examples and explanations of the disagreements observed in the transcript:

1. Debate on Reflection Periods: There is disagreement over amendments 301, 317, 314, and 315, which propose to extend the reflection periods before a patient can proceed with an assisted death. For instance, Naz Shah argues that longer reflection periods should be granted to ensure patients have adequate time to consider their decision and explore all options, saying, “Issues of such intensity as someone planning to take their own life should not be rushed.” In contrast, Kim Leadbeater counters this view, expressing confidence in the existing periods as being adequate, stating, “I remain confident that the periods of reflection are adequate as set out in the Bill.”

2. Concerns About Doctor Shopping: Amendments 303, 458, 459, and 460 focus on preventing ‘doctor shopping,’ where patients seek multiple assessments to find a favorable outcome. Danny Kruger is a proponent of these amendments to ensure that the process is not manipulated by seeking multiple opinions, citing examples from other jurisdictions where this has occurred. Conversely, Dr. Simon Opher argues against these amendments, believing that a patient should have the right to a second opinion under normal medical practice conditions, stating, “In medical practice, it is normal and fair that a patient has one second opinion on any assessment.”

3. Access to Medical Records: The debate around amendment 201 reveals disagreement over how much access doctors should have to patients’ medical records during assessments. Danny Kruger emphasizes the importance of complete records to prevent misclassifications and to ensure thorough assessments, saying, “The risk is that potentially crucial medical history, including past mental health concerns, poor coercion indicators or undisclosed diagnoses, might be overlooked.” On the other hand, Rachel Hopkins argues for restricting access to relevant records only, to avoid unconscious biases and to focus the process, stating, “Relevance is very important, because there will be a high level of record keeping in the process.”

4. Asking the ‘Why’ Question: The discussion around amendment 468, proposed by Rebecca Paul, which asks doctors to inquire about a patient’s reasons for seeking an assisted death, showcases a split in opinion. Rebecca Paul and Naz Shah support this approach as a critical safeguard to understand the patient’s motivations and potential coercion. However, Rachel Hopkins opposes the amendment, viewing it as unnecessary and possibly intrusive, arguing, “The requirement to ask why someone wants an assisted death is a requirement to police the conversation…setting it out in primary legislation would lead to a tick-box exercise.”

These examples illustrate a range of disagreements on procedural and ethical issues within the Bill. The intensity and frequency of these disagreements do not reach the level of high conflict but are significant enough to impact the decision-making process, hence the moderate rating.