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Further considerations on assisted dying: assessment boards needed

by
25 July 2014

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From Professor Michael Marsh

Sir, - After last Friday's Second Reading of Lord Falconer's assisted-dying Bill, we know that some law to permit the death of another person in extremis will ultimately be sanctioned. But, apart from this, where do we stand?

Fifty per cent in the Upper House expressed disquiet over this Bill, raising great doubts whether the next Committee stage could ever make a silk purse from a sow's ear. In my view, the old Joffe-Falconer approach is dead; I hope that someone will instantiate a completely new Bill, untainted by either suicidal or murderous intent: that is, leave the Suicide Act intact, and innovate something more thoughtful, if not original.

The key is to establish an assessment board (AB), chaired by a legal person with access to the Director of Public Prosecutions and the police, adjudicating requests from patients and relatives, perhaps with solicitor, GP, or priest. This would immediately eliminate most of the exclusive and contentious aspects of Falconer, such as "terminal", "six months", "two doctors" (unspecified), reporting "independently", and distrust generated between public and doctors (possibly) authorised to kill patients on NHS wards.

Instead, the AB would co-opt chosen specialists (palliative care, analgesia, oncology, etc.) relevant to individual cases, followed by open discussion with all parties, and from which altered management might actually change minds.

Yet assessment of volatile mental states and capacity remains a fraught difficulty, needing expert psychiatric input, and lengthy examinations, perhaps on several occasions, with careful differentiation of "depression" from states of hopelessness and demoralisation, and their treatments. All this and more would have to be concluded and agreed, the paperwork completed, and thus available for accurate follow-up, review, research, and statistical analysis (so to assess "slippery slopes") before dispatching the patient. Undertakers could be on notice not to handle bodies without the correct forms and authorisation.

Parliament must still decide the vexed question of those lawfully certified to administer the lethal cocktail, without the known distressing risks of failure.

The debate revealed death and dying as unknown quantities within society, and that Churches needed to do more in opening up knowledge in this field. We also need far deeper theological reflection to determine the rightness of assisting death, and, importantly, to assuage the sense of guilt, remorse, and shame of relatives after acting in this manner.

Lord Carey, speaking in the debate, suggested Calvary as the ultimate analogy; but this is mere statement, not argument, nor an argument logically extended and developed. Moreover, psychological distress stories only underpin a preceding need for legal change: how odd that an archbishop and former archbishop starting from this same premise have come to differing conclusions. That requires elucidation, besides the meeting of the problems that arise for friends and relatives, post-bereavement. Much obviously needs to be affirmed and refined regarding this aspect of assisted dying.

Finally, would God-as-Father take great offence and displeasure in our ending the life of another human being in these demanding but varied end-of-life contexts?

MICHAEL MARSH

Wolfson College

Oxford OX2 6UD

 

From Professor Peter Davies

Sir, - May I suggest an amendment to the Archbishop of Canterbury's statement that a "sword of Damocles will hang over the head of every vulnerable and terminally ill person in the country"? In fact, it will hang over us all, if the law is changed, as anyone, at any time, may by accident or illness join these ranks.

PETER DAVIES

Liverpool Heart and Chest Hospital,

Liverpool L14 3PE

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