Round up on Euthanasia and Assisted Suicide – Review of 2014 from Care Not Killing Alliance

As 2015 dawns, pause with us to reflect on an extraordinary year. Despite the many challenges presented, 2014 was a year when, despite many pressures, those at the heart of this debate stood up and dared to say 'no'. It was the year when what proponents of assisted suicide have tried to sell as agreed wisdom was questioned, doubted and often dropped. We look forward to pressing on with you now (Care Not Killing Alliance)

Saying 'no'

2014, then, was the year when to sound concern and opposition once again became acceptable. The Prime Minister and Deputy Prime Minister; prominent figures in the arts and sport; major charities and disabled people's advocates - the list goes on. Lord Falconer's Bill to allow assisted suicide for terminally ill people was rejected both by MPs and - by a 2-1 margin - members of the Welsh Assembly, while the Supreme Court followed the High Court and Court of Appeal in refusing to agree that disabled people should be assisted to die.

Most importantly, those who have real life experience of the often brutal reality of end of life situations spoke ever more clearly of their gladness that assisted suicide is not legal. We heard this especially from the many, many people who massed outside Parliament on the hottest day of the year that far to speak out against Lord Falconer's Bill, and we continue to receive, and welcome, support for our petition concerning the bill before the Scottish Parliament.

Polling

We are all quite used to polls which appear to suggest high levels of public support for a change in the law with much effort going into suggesting that irreversible suffering at the end of life is the rule, not the exception. 2014 saw that perceived wisdom more widely doubted. First, we saw a drop in the level of support for a change in Scottish law, back in January. Then, on the day of the Falconer Bill's second reading, a ComRes poll commissioned by a CNK member organisation found that support for the Assisted Dying Bill plummeted when the reality of legal change and what it would mean for terminally ill and disabled people, and for the practice of medicine.

Perhaps the most dramatic expressions of changing public opinion were found in a further ComRes poll in November, forcing many to consider the context in which legalised assisted suicide would exist: more than four in 10 believe assisted suicide will be extended beyond the terminally ill if the current law is changed; a clear majority of the public says there is no safe system of assisted suicide; and fewer than three in 10 believe changing the law on assisted suicide will not lead to increase in abuse of vulnerable people.

Doctors

Flawed safeguards in the Falconer and MacDonald Bills caused legal experts to deem the draft legislation unsatisfactory even where they accepted principles to which the medical profession has remained overwhelmingly opposed. Key healthcare professionals' bodies were clear in their message to peers in July, and the Royal Colleges of General Practitioners and Physicians both conducted surveys of members, with the response being clearly in favour not only of continued opposition to a change in the law which would fundamentally alter the practice of medicine, but also in favour of continued collegiate opposition. Indeed, there has been a move against isolated but well-placed advocates of legal change who continue to demand that their views be accepted by the majority. This was particularly felt first at the BMA's ARM, and then later when the editorial team of the British Medical Journal sought to use the publication to advance the 'assisted dying' cause. Healthcare professionals are under no illusions: it is never 'just about the debate'.

All the while, those who dedicate their lives to end of life care continue to drive forward innovation, as we saw at the Palliative Care Congress in Harrogate in the Spring, and with positive media portrayals and constantly renewed thinking about palliative care's potential, we can be optimistic about what we are able to do for terminally ill people.

Saying goodbye

The reality of death and dying can never be far away in the debate on assisted suicide and end of life care, and 2014 saw the death of, among others, two people who were totally committed - to two very different points of view. Jim Dobbin MP, grandfather to two disabled grandchildren, was passionately opposed to the 'counsel of despair' inherent in all assisted suicide/euthanasia proposals, and his work in this area should continue to inspire parliamentarians. Independent MSP Margo MacDonald, meanwhile, the prime mover for assisted suicide in Scotland, died of natural causes in the Spring, with her bill being taken up by a Green colleague.

Remaining challenges

The combined threats in Westminster and Holyrood of the Falconer and MacDonald Bills continue to stalk end of life care, and will loom large in 2015.

• Consideration of the Falconer Bill in committee will resume in January; have you read the guides circulated by CNK among members of the House of Lords?
• Oral evidence will shortly be taken in relation to the Assisted Suicide (Scotland) Bill, and CNK will be among the contributors. Have you read our earlier, written submission?
• The appallingly high (and growing) numbers of assisted suicide and euthanasia deaths abroad keep coming, with significant former supporters of euthanasia in the Netherlands joining the chorus of concern over the path the country is taking.
• The effect of a recent change to prosecution guidelines in England and Wales, highlighted at the time by CNK, remains to be seen, but we will continue to monitor this closely.
• As a nation, we remain, quite simply, bad at talking about death. This is a debate often framed as being about 'choice', but patients and families are already able to empower themselves, provided that they are offered the right support, educate themselves - and discuss openly their hopes and fears. We are at our strongest when we are honest with others and when we are prepared to accept support from others just as we have ourselves supporters others. Is end of life care the elephant in the room for you? Begin the conversation today.

Care Not Killing – June 2014 Update on euthanasia and assisted suicide

The final year of this current Parliament opened today with the Queen's Speech, in the wake of which we expect Lord Falconer's 2013 Assisted Dying Bill to be retabled. In Scotland, Holyrood's Health and Sport Committee are accepting evidence on Margo MacDonald's Assisted Suicide Bill until Friday 6 June. And the ruling of nine Supreme Court justices who sat last December on the Nicklinson case is expected any day now. With more appalling evidence pouring in from abroad, this is one of those weeks when the euthanasia threat is palpable.

Westminster

Lord Falconer's Assisted Dying Bill, first introduced in May 2013, fell at the close of the Parliamentary year last month, but he is set to reintroduce his proposals in coming days, following the State Opening of Parliament. Disability activists have initiated a petition calling on David Cameron to act on his personal opposition to assisted suicide, which we encourage you to sign; debate has been ongoing, and carer Colin Harte's recent radio interview is very much worth listening to.

Holyrood

Following the death of Margo MacDonald in April, the Green MSP Patrick Harvie has assumed responsibility for the Assisted Suicide (Scotland) Bill. The Bill's underlying principles constitute a counsel of despair, while a meeting of lawyers in Scotland recently agreed that 'the Bill as drafted... would be unworkable'. The Health and Sport committee are taking evidence until 6 June: read the call for evidence here, CNK's submission here and our brief overview of the bill here.

Supreme Court

Despite most Supreme Court rulings being handed down around three months after the relevant hearing, the nine justices who heard the appeals in the cases of Nicklinson/Lamb and 'Martin' are yet to rule five and a half months on. This, it is to be hoped, is a sign that the gravity of the cases is being fully acknowledged. The ruling's delivery will be streamed live online; until we know when, remind yourself of some of the key questions.

Foreign news

Reports last week suggest that Belgian euthanasia deaths rose 26.8% in 2013 to 1,816, representing five people every day having their lives ended, and a Brussels nurse has recently written of 'what really happens in Belgium's healthcare system with euthanasia'. The head of the regulatory commission, Wim Distelmans, who is already the subject of high profile official complaints, has sparked controversy by announcing an instructional tour of Auschwitz. If you are concerned about the situation in Belgium, please sign EPC Europe's petition calling for the suspension of the euthanasia law there.

In Switzerland, meanwhile, extraordinary cases of non-terminally/chronically ill patients undergoing assisted suicide are increasingly becoming part of standard practice. EXIT, one of the more prominent assisted suicide organisations, has recently announced that it will now accept non-terminally ill elderly people, in a worrying but sadly unsurprising move.

Care

Our Campaign Director, Dr Peter Saunders, raised over £5,000 for Help the Hospices running the London Marathon - you can still donate here. A number of very positive reports have highlighted the value and dynamism of care for those with terminal and progressive conditions, including a BBC feature on hospice care and press coverage given to a new initiative concerning dementia.

There have however been less agreeable reports concerning failings in care for elderly and dying people, further careless celebrity endorsements of euthanasia and evidence of a need for more frank discussion of death and dying. A challenge for all of us is: how do we build up a culture of care which not only responds to the needs and rightful expectations of those around us but which also guards against attempts to offer death as a 'sensible alternative'?

In a foreword to a recent photo project featuring dying people, Alain de Botton wrote: 'The dying are the great appreciators... They notice the value of the sunshine on a spring afternoon, a few minutes with a grandchild, another breath… And they know what spoilt ingrates we are, not stopping to register the wonder of every passing minute. They were once like us of course. They wasted decades but now they are in a position to know of their folly and warn us of our own.'

For Rosa Monckton, patron of Together for Short Lives (the umbrella organisation for children's palliative care), charity fundraiser Stephen Sutton was the epitome of de Botton's idea, and an example to us all.

All the latest news on euthanasia and assisted suicide

Here is the latest update from the Care Not Killing Alliance about recent developments with euthanasia and assisted suicide.

Care Not Killing is a mainstream UK-based alliance of over 40 organisations and thousands of individuals which campaigns for better care and support for those who are sick, disabled and dying and against any weakening of the law to allow euthanasia or assisted suicide. The Alliance works in Parliament and in the courts and with health professionals, carers, general public and media.

Court of Appeal

From 13-15 May, three of England's top judges heard the appeals of Nicklinson, Lamb and 'Martin'; Paul Lamb joined the case after the death of Tony Nicklinson, whose widow Jane remains a party to the case. The Lord Chief Justice told the appellants that 'we are acutely aware of the desperate situation in which the appellants find themselves and we are very sympathetic. But we know, and they surely know, that we cannot decide this case as a matter of personal sympathy. We have to decide it as a point of law'.

Media interest in the case has allowed many members of the general public to hear from disability rights campaigners Katherine Araniello, Dr Kevin Fitzpatrick and Dr Colin Harte, who spoke eloquently about the risks posed to vulnerable people - notably disabled people - by a change in the law. Media coverage allowed our spokespeople to confront advocates with the unsettling facts of what legalisation would mean - summed up by discussion of the Groningen Protocol, which allows disabled babies in the Netherlands to be euthanised, in a heated Radio Fivelive exchange. It is crucially important that the dangerous reality of incremental extension not be allowed to be swept under the carpet, but exposed to public view.

Falconer Bill

On the final day of the Court of Appeal hearing, Lord Falconer tabled his 'Assisted Dying Bill' in the House of Lords. The first reading received virtually no press attention, and there is no date yet scheduled for second reading. The bill is the successor to Lord Joffe's failed attempt in 2006 and Lord Falconer's own failed previous attempt in 2009, and the Labour Peer is now seeking to use the findings of his stacked 'commission' to justify a third attempt, despite the continued opposition of those who would be directly affected by such legislation - doctors and disabled people - as well as his democratically elected colleagues in the House of Commons.

Legislation around the world

Evidence of how dangerous euthanasia and assisted suicide laws are for those who are most vulnerable continues to pour out of countries like Belgium - where euthanasia deaths increased by 25% in just one year - and Oregon - where suicide contagion has been proven by the daunting escalation in non physician assisted suicide rates since legalisation.

New South Wales in Australia and the US state of Maine have both decidedly rejected bills that would have permitted (respectively) euthanasia and assisted suicide in recent weeks, and Irish Taoiseach Enda Kenny has ruled out assisted suicide legislation in the light of the Fleming Supreme Court ruling. The US state of Vermont has, however, passed a law permitting physician assisted suicide, and becomes the first US state to pass such a law through its legislature. The law is based on that of Oregon, but with fewer 'safeguards' which will in any case expire after three years to be replaced by codes developed by doctors themselves. Quebec, meanwhile, has announced a euthanasia bill for the Canadian province, and Belgium has also moved one step closer to extending euthanasia to children.

Medics

The majority of the professional medical bodies have been strongly opposed to any change in the law which would change the nature of medicine, and the vast majority of individual medics across the board support this stance. The Royal College of General Practitioners (RCGP) has announced a consultation on assisted suicide, having last opened up the issue six years ago, and while we remain assured that the daily experience of GPs leaves them firmly opposed to any weakening of the law, we welcome an opportunity for practitioners to publicly reaffirm their stance. The consultation is restricted to members of the RCGP, who we would be delighted to hear from and to discuss the recent developments with.

The British Medical Association (BMA) saw attempts by advocates for change to press a neutral stance at last year's Annual Representative Meeting which was decisively rejected, and while we are glad that emerging end of life issues such as the Liverpool Care Pathway have been given priority at this year's ARM, we are pleased that the other important issues for the practice of medicine are unlikely to be sidelined due to further efforts by a determined minority so soon after the BMA last upheld its stance.

Liverpool Care Pathway

Lady Neuberger and her panel of experts have concluded oral evidence sessions, and are now considering the input from these, alongside written submissions and the findings of parallel inquiries. Care Minister Norman Lamb has announced that the Neuberger Inquiry will report in July, and we await its findings, hopeful that these will reflect the recommendations of our own submission.

A rally for better palliative care and against assisted suicide and euthanasia - 3 July

Dignity in Dying, the former Voluntary Euthanasia Society, are planning a mass lobby of parliament on Wednesday 4 July as part of their plan to soften up MPs prior to a new attempt to change the law.

So Care Not Killing have planned a lobby the day before aimed at promoting better palliative care and resisting any change in the law.

Speakers include Ann Widdecombe, Lord Alton of Liverpool, Jim Dobbin MP, Fiona Bruce MP, Prof Lord McColl of Dulwich, Dr Peter Saunders, Brian Iddon, Kevin Fitzpatrick and others

What can you do?

Come and listen to the speakers and be equipped to defend the law and protect the vulnerable.

Visit your Member of Parliament during the day to express your opposition to any liberalisation in the law in England and Wales.

When: 10am-4pm, Tuesday 3 July 2012
Where: Emmanuel Centre, 9-23 Marsham Street, London, SW1P 3DW

Organized in collaboration with Right to Life and CARE

Parliamentary Briefings available from Care Not Killing
Print a flyer
Contact: info@carenotkilling.org.uk or 02072349680 for more details.

Margo Macdonald’s criticisms of the Care Not Killing Alliance are without foundation

In the two hour debate that immediately preceded the overwhelming 85-16 defeat of her End of Life assistance (Scotland) Bill in the Holyrood Parliament last Wednesday, Margo Macdonald MSP spent almost her entire opening and closing speeches launching a scathing attack on the Care Not Killing Alliance (CNK).

In statements that were widely reported by the media, she condemned CNK’s campaign as ‘cheap and unworthy’, its literature as ‘tacky’ and said that she wanted to get her ‘retaliation’ in first’.

Care Not Killing is actually a broad alliance of over 40 organisations including human rights groups, faith groups, professional groups, disabled peoples organisations. It was founded in 2006 to oppose Lord Joffe’s Assisted Dying for the Terminally Ill Bill’ which was defeated in the House of Lords on 12 May that year.

CNK’s two aims are to promote good palliative care and to oppose any weakening of the law to allow assisted suicide or euthanasia. Operating as a cobelligerent coalition it has been extremely effective.

CNK has been engaged at every stage in the debate surrounding Margo Macdonald’s Bill. It produced a detailed briefing paper and written submission for the committee scrutinising the bill and was invited also to give oral evidence. Later it coordinated a campaign encouraging ordinary Scots to write to their MSPs and send postcards outlining objections to the bill.

In this way CNK placed an active part along with many other individuals and organisations in the democratic process that ultimately led to the bill’s heavy defeat.

But we need to remember that CNK’s submission was just one of 601 written submissions sent to the committee and that 86% of all submissions opposed the bill with only 6% in favour. We also need to remember that five out of the six MSPs on the committee recommended that the bill be rejected at the first stage debate.

We need to give MSPs the credit they deserve. They decided to reject the bill after an exhaustive democratic process during which both sides were given ample opportunity to present their arguments and after an objective, dispassionate review of the issues.

Margo Macdonald’s bill was rejected because it was judged by MSPs overwhelmingly to constitute a real danger to vulnerable people.

CNK outlines the failings of the bill on its website and I would recommend this concise analysis to anyone wanting to see quickly what its deficiencies are:

I leave the final words to Gordon Macdonald, CNK Scotland’s Policy Officer, who has formally responded to Margo Macdonald’s criticisms in a letter to the Herald.

You report Margo MacDonald’s condemnation of Care Not Killing (CNK) for our campaign against her Bill. In particular she seems to object to our response cards, which enabled people to express their opposition to her proposals.

We did not misrepresent the proposals in her Bill. Indeed, many of our criticisms of the Bill were shared by the parliamentary committee that considered the matter. Euthanasia and assisted suicide are highly charged and emotive issues. It is no surprise our campaign should provoke such a vehement reaction.

Ms MacDonald cannot dismiss the 21,000 people who responded to her Bill, using material provided by CNK, to indicate their opposition to her proposals. Of the 601 written responses to the parliamentary committee, some 86% were opposed to her Bill.

Ms MacDonald quotes opinion polls when they support her Bill, but cries foul when those who are opposed to her Bill express their opinion in substantial numbers. This is democratic politics in action and Ms MacDonald has to accept there is also a substantial and considered public and political opposition to her proposals.

The vast majority of MSPs considered her proposals and concluded that they should not be supported.