Legislation on assisted dying, and the College's position

Earlier this year, we started work to develop a College position on assisted dying/assisted suicide (AD/AS), taking a considered and evidence-based approach to weigh up the complexities of the issues.

Following a snap UK General Election in July, and with a new Labour Government in place, AD/AS became a focus of the political agenda in Westminster. The pace of change in Parliament was unexpected and we adapted to the changing landscape.

Thankfully, we had already established a comprehensive and experienced working group looking at this area. It is comprised of representatives with relevant specialist knowledge from across the College.

We brought forward our plans for a member survey in England, Northern Ireland and Wales to gather your views on this sensitive issue, and held a debate on whether AD/AS should be available to people whose sole underlying condition is a mental illness. I also personally met with Kim Leadbeater MP, who introduced her Private Members Bill – Terminally Ill Adults (End of Life) Bill, which is currently passing through Parliament – to discuss the issues that require more careful consideration.

The RCPsych in Scotland is ahead on this issue as they surveyed their members earlier in the year and have submitted written and oral evidence on the separate Assisted Dying for Terminally Ill Adults (Scotland) Bill to the Committee in Holyrood that is considering the legislation. Separate legislation has also been put forward in Jersey and the Isle of Man while the RCPsych in Wales briefed stakeholders ahead of a debate on AD/AS in the Senedd last month.

A vote on the Terminally Ill Adults (End of Life) Bill will take place in the House of Commons tomorrow (29 November) and if passed will affect England and Wales. We have shared a briefing with parliamentarians ahead of the debate, which has been informed by all the efforts outlined above.

I’m conscious there are a wide range of views among our members which reflect the complexity and sensitivity of this issue. I therefore want to be transparent about the content of this briefing, particularly as it is my view that outstanding questions remain around the potential implementation of the Bill.

First and foremost, we have made it clear that the introduction of AD/AS would represent a significant societal shift and, as such, it is right that this decision is made by parliamentarians for their respective jurisdictions. The briefing urges MPs to give careful consideration to the safeguarding of patients and their doctors as well as the reliability of consent procedures.

As clinicians, we know that people who have a terminal physical illness are more likely to have a mental illness and it is also common for them to experience emotional distress. Mental health professionals are best placed to assess whether someone has a mental illness or is experiencing psychological distress and to what extent this is impacting their desire or ability to consent to AD/AS.

However, under the current Bill, it is our interpretation that a person with a terminal physical illness, and co-occurring mental disorder, that is impacting their wish to end their own life, would not necessarily be deemed ineligible if the terminal physical illness was deemed to not affect their capacity to decide to end their own life.

The broader issue of consent is also particularly intricate and complex. If passed, the Bill would require patients to have the mental capacity and relevant information needed to give valid consent and it would need to be clear no coercion was involved in their decision.

We have highlighted that assessing someone’s mental capacity can be a complex process, particularly for people with physical and mental illnesses, and that it can fluctuate over time. Respondents to our recent members survey in England, Wales and Northern Ireland made it clear that decisions around capacity must reflect the weight of the consequences of those decisions and more debate is needed on how this might be addressed.

The Bill also focuses on external coercion but does not address more subtle forms such as when a person internalises a feeling of being a burden to others. Additional consideration must be given as to the point at which this would amount to coercion, how it can be identified and responded to.

While the decision to introduce AD/AS should be made by parliamentarians, all clinicians must be afforded the right to refuse to take part in an AD/AS service for any reason. This should include those who object on moral, religious or spiritual grounds as well as for professional reasons.

If there is an AD/AS service in the future, it would need to operate on an opt-in model. It also needs to be made clear whether medical professionals will be required to refer people on for an assessment, even if they do not wish to take part in the delivery of such a service. Many clinicians may view this as a form of participation and find it to be unacceptable.

The introduction of AD/AS has the potential to place further pressure on mental health services which must be considered, both in regard to service provision and training. In areas with limited staffing, this may significantly affect their ability to provide timely assessments.

I hope to see many of these issues discussed during the debate on Friday and we will monitor the outcome of the vote closely. The College will also continue to work closely with parliamentarians and other stakeholders on this important issue.

I would also like to assure you that the full results of our member survey will be released in due course, and we will share the final outcome of our working group’s efforts next year.