David Gauke: Compassion favours allowing a right to die

25 Oct

David Gauke is a former Justice Secretary, and was an independent candidate in South-West Hertfordshire at the 2019 general election.

The last time the House of Commons voted on assisted dying, I was absent. It was a Friday and I had a longstanding constituency engagement and, truth be told, I was in two minds about it. Instinctively, I favoured giving people autonomy over how they ended their lives as they reached their end but I worried about the risks to the vulnerable who felt pressured.

In the years since, I have regretted not re-arranging my constituency engagement and voting for reform. I missed my chance as a legislator to contribute to changing this law but others now have the opportunity and it is clear that minds are being changed.

Michael Forsyth’s testimony is striking. He tells of how he had always felt hypocritical in voting against assisted dying because, when it came to it, he might want it for himself. What finally changed his mind was a conversation with his dying father. When Michael said to him that he was sorry that he was in pain, his father responded by saying “you’re to blame, Michael,” suggesting that a certain bluntness ran in the family, “for consistently voting against the right to die”.

A further case is Frank Field. It was revealed to the House of Lords on Friday that sadly Frank is terminally ill. In his statement, read by Baroness Meacher, he made the point that the experience of those places which have reformed the law that there is no evidence that the vulnerable have been pressured into taking their lives early. Safeguards can and should be put in place and, where this has happened, are working.

There will be some for whom any suggestion of a person being able to intervene to end their lives provokes profound moral and religious objections but the reality is that the fear of pain can drive people to end their lives earlier than they would otherwise do. This might involve taking their lives whilst they still can or taking themselves off to Dignitas whilst still able to travel.

The current law can also place greater stress on a dying person knowing that there might be a risk that their loved ones may face the risk of prosecution if – out of compassion – they act to help. This happened in the case of Geoffrey Whaley when the police investigated him and his wife (who had booked the flight tickets) as they prepared to travel to Switzerland.

Some years later, when I was Lord Chancellor, I met Mrs Whaley who told me that her late husband had been much more upset at the potential risk to his wife than he was about his imminent death. Presumably, those who support the current law think that Mrs Whaley (or, at least, others in similar circumstances) should have faced criminal prosecution. Alternatively, they believe that the current law should be ignored. Either way, it is an indefensible position.

Public opinion strongly favours reform. That does not mean that MPs and peers should necessarily agree to it (our legislators are representatives not delegates) but it does feel like it is only a matter of time before sufficient numbers of Parliamentarians agree to reform. Rather like gay marriage, once reform has happened, people in the future will struggle to understand why some had previously objected.

– – – – – – – – – –

As it happens, I was in Switzerland last week (not, I should point out, anything to do with Dignitas). It was fascinating to see the different approach to COVID. As with here, life is getting back to normal. Cases and deaths per head of population are much lower than in the UK (as is the case with most of Europe) but behavioural change in response to the virus is greater. On public transport, masks are worn by everyone and restaurants require evidence of being vaccinated.

This may be a case of cause and effect, of course. It is also the case that there are much greater levels of vaccine scepticism than we have in the UK. Anecdotally, it appears that women, especially of child-bearing age, are much less likely to get vaccinated.

One of the advantages that the UK has had in the last year has been relatively low levels of anti-vaccination sentiment. Those arguing that the vaccine is unsafe have found themselves on the fringes and take-up has been high. In part, this may have been as a consequence of the disastrous situation the UK found itself in the early months of 2021 when the Kent variant swept through the country and the level of cases and fatalities were much worse than elsewhere. Rightly, the country as a whole embraced vaccines as the way out. The fact that the UK was ahead of most other countries in its vaccine rollout only helped – it was an act of patriotism to get jabbed.

When there is less of a threat, the public can be more indulgent of vaccine scare stories. We have less of that here, but there has been a degree of complacency with take-up of the booster jab being somewhat slow.

The complacency may come to an end fairly soon. Sajid Javid – having once flirted with lockdown scepticism and having sought to strike a very different tone than his predecessor as Health Secretary – made an effort to shake off public (and, quite possibly, Governmental complacency) last week. We are a long way from the number of hospitalisations and deaths of the darkest days of the pandemic but cases are high and vaccine immunity is fading for those who were jabbed some months ago. It is clear that the Health Secretary is seeing advice that is worrying him.

Living with COVID is not the same as ignoring COVID and neither the Government nor the public can afford to be complacent. We are not out of the woods.

– – – – – – – – – –

A few weeks ago I wrote about the upcoming Budget and spending review. I stand by my previous assessment that the Chancellor will be in the fortunate position of having significantly better borrowing numbers than were predicted by the Office for Budget Responsibility, he will use some of that to ensure no departments face real terms cuts as well as cutting the taper rate of Universal Credit, but that for the most part the lowering borrowing numbers will be used to deliver lower borrowing.

The Chancellor, I suspect, will have fought off attempts to use this windfall for much higher spending or lower taxes by arguing that a war chest is needed in time for the next election. I think he is right to be cautious about the public finances but I am not sure he will necessarily be in a position for big giveaways in future.

There are real downside risks for the economy – a further COVID wave, a trade war with the EU, higher inflation resulting in higher interest rates, the markets getting even more nervous about the unorthodox way in which we are now governed. Just like the Health Secretary last week, this may be the week in which the Chancellor’s biggest objective is to dispel complacency.

There may be a pattern emerging – Ministers being tough on complacency, if not yet the cause of complacency.

Georgia L. Gilholy: Gordon Brown is right. Legalising euthanasia would spell disaster for the vulnerable.

22 Oct

Georgia L. Gilholy is a Young Voices UK contributor.

Today Lady Meacher’s Assisted Dying Bill will receive its second reading in the House of Lords. As they stand, the plans aim to legalise physician-assisted suicide for patients with a terminal illness and who can be “reasonably” expected to die in less than six months.

Over the past few days, numerous faith leaders including the Archbishop of Canterbury, the Chief Rabbi of the Commonwealth and even former Prime Minister Gordon Brown have spoken against the move, and they are right to do so.

While much of the assisted suicide lobby seems genuinely motivated by the noble cause of reducing harm, jurisdictions, where the procedure has been legalised, show that this is rarely the overall result.

There are two main types of assisted death, and those that end the lives of those experiencing “pain and suffering” are termed euthanasia. Assisted dying generally describes the ending of a patient’s life by a medical professional.

Assisted suicide, though technically a form of assisted dying, involves a medical professional handing a patient the chemical toolkit to end their own life. The narrative of mercy may dominate campaigns to legalise both these procedures, but all too often airbrush their grim reality.

Dr Joel Zivot, a physician who researched the autopsies of over 200 executed US prisoners, has emphasised how the common assisted suicide method of ingesting pills can be “horrendous” and often leads to a paralysing injection being administered “because many individuals are not able to swallow”.

In a process Zivot has described as akin to drowning or being strangled, the patient’s ability to move or breathe is gone, but they are not blocked from potential awareness. This gives the false impression of a person’s ease and consent, while the final moments of their life are characterised by excruciating pain that is in no doubt exacerbated by the psychological distress of physical and verbal paralysis.

This dystopic step has already been banned as part of capital punishment in most US states that still permit the penalty, due to its obvious cruelty. It however remains a staple of assisted dying in the “liberal” state of Oregon, whose framework the Meacher Bill proudly models itself on.

While the Meacher Bill itself does not acknowledge a role for doctors to take over and end life when complications occur — as they do in from 15 per cent to 25 per cent of cases in Oregon — how long until it is suggested that the law be expanded to facilitate this role? How many doctors will do so without fear of an autopsy revealing their criminality, given that the cause of death will be predetermined?

If the supporters insist that the procedure only be legal when consent is given, why do they laud a system in which consent can surely not be truly secured, as so many patients are entirely deprived of their senses while their mortality is set in motion?

In any case, we are wrong to assume that consent and choice are free-floating values, magically disconnected from social realities. Almost all of our choices, from the trivial to the life-altering, are influenced by external factors, including the people we surround ourselves with, and these influences are almost always exaggerated depending on the gravity of the decision we face.

A report published this year by the Oregon Health Authority demonstrated just this. In a study that examined the state’s policy of medical assisted death from its introduction in 1998 to 2020, it was found that out of all patients who underwent an assisted suicide in 2020, over half were motivated by concerns that they were a “burden on family, friends/caregivers”.

Is it hardly a leap, therefore, to suggest that stresses over social and economic support are an overwhelming factor in the majority of assisted deaths and that shoehorning in the policy as another “form of treatment” NHS doctors are obliged to offer the terminally ill at a time of increasing socio-economic crisis would open the door to certain disaster?

Another, disturbing side to this factor is the threat of pressuring vulnerable people to end their lives, and the inadequacy of busy doctors to detect social manipulation and coercion that families and partners wishing for a death they think will work to their financial or social advantage or even doctors who themselves come to see it as merciful to kill.

Indeed, as Professor John Keown, of Georgetown University, explored well over a decade ago, courts in the Netherlands already hold that just as the “relief of suffering” can justify voluntary requests for euthanasia, it can equally justify the termination of those who are in no position to give voluntary consent.

There are also plenty of patients who may simply come to see it as their duty to end their life as they become “too” old, ill or depressed, and will opt for an assisted death due to an internal sense of guilt and obligation. The Meacher Bill itself would not permit such an individual a voluntary death unless a doctor could estimate that they were in six months of death, but given that such legislation has been expanded in almost every jurisdiction where it has been permitted, this Bill if passed, would surely be no exception?

Although, unlike in the Netherlands, Belgium and elsewhere, the Meacher Bill outlines strict preconditions for assisted suicide that do not include “suffering”, it is clear that the thrust of the euthanasia campaign is based on the premise that this is the reason why the practice must be legalised.

Ask the average supporter why they support the procedure, and their first answer will probably revolve around helping people escape pain. Even the article in which The Sunday Times announced it would be campaigning on behalf of the Meacher Bill, led with the claim that it aims to stop “unbearable suffering”.

So either campaigners for the Meacher Bill are arguing — quite irrationally — that mental and physical anguish only qualify as “unbearable” when a patient has a terminal illness likely to kill them within six months, and whom can give “voluntary consent” — the conditions for assisted suicide the Bill sets out — or these more moderate plans are geared toward getting their foot in the door by ensuring we first accept that assisted death is legally and morally permissible before they can then argue that it ought to be expanded? Alas, whether naivety or dishonesty is to blame, they must be stopped.

Given that any measurement of suffering and pain is somewhat arbitrary and subjective, how can one comfortably claim that the anguish of grief or clinical depression, for example, is less painful than an injury or physical disease? These sensations cannot be measured in litres or decibels, and every person reacts differently to them.

It follows that the natural result of permitting state-sanctioned suicide due to ‘suffering’ is the extension of the permission for any person who judges themself to be suffering sufficiently to feel suicidal, whether it be a 90-nine year old with terminal cancer, or a 14-year-old girl starving herself due to anorexia. The question of obtaining “clear” consent also persists in both situations. Is it even possible for a person with clinical depression, or say, a depression prompted by a major disease, to make an uncompromised choice to pursue death?

This is already a reality in places many Britons are so apt to envision as progressive paradises. In October 2020, a healthy 90-year-old Canadian named Nancy Russell ended her life by euthanasia after stating she wished to die rather than endure another Coronavirus lockdown.

Canada’s Bill C-7, passed in March, further opened up euthanasia legislation to people of any age with disabilities or mental health conditions. Belgian law allows euthanasia if the patient is in a state of constant physical or psychological pain; while in the Netherlands doctors can secretly sedate patients who have dementia before euthanising them, and euthanasia for anyone over the age of 16 is legal.

Already, throughout the pandemic, we have seen elements of the health system betray the dignity and right to life of persons with disabilities or mental conditions by issuing “do not resuscitate” orders without consulting patients or their families.

These decisions were not just likely to have been unlawful, but are directly connected to several deaths, including that of a 58-year-old woman with schizophrenia and a deaf man in his sixties. If our strained system has lowered itself to this point while healthcare professionals are still legally required to preserve life, what will be the knock-on impact of further cheapening the regard for human life, and the Hippocratic oath, by legalising assisted death?

I do not doubt that most euthanasia campaigners are likely motivated by a genuine desire to reduce suffering, but I believe they are misled about what the true impact of this legal and cultural watershed would be.

There are, obviously, a small number of compelling cases that make it easy for people to support the theoretical liberty of euthanasia, however, it is right that a small fraction of individuals in exceptional cases not be permitted to legally access assisted suicide if by doing so we would put vast swathes of vulnerable people at risk of unwanted and unwarranted deaths. The hypothetical liberties of a select few cannot be permitted to trump all other considerations.

Interview. Therese Coffey – “An element of a kinder politics is not calling other people bigots because you don’t agree with them.”

19 Mar

Thérèse Coffey runs a major front-line department yet is hardly ever seen on our television screens. As Secretary of State for Work and Pensions, she has administered one of the great successes in the official response to the pandemic, the extension of Universal Credit, coping at one point with an extra 100,000 claimants in a single day:

“I always think of that train scene in Wallace and Gromit, the one with the penguin, and Gromit’s on the front of the train laying down the track in front of it, and that’s how it felt like for a little while.”

In this interview she refuses to say there will be any further extension of the £20 a week uplift in Universal Credit, and instead indicates that she wishes to concentrate on promoting the DWP’s various schemes to help people get back into work:

“Big thanks to the Jabs Army, we are the Jobs Army, and I’m keen that you will see more of me, also more of my colleagues like Kwasi Kwarteng and Oliver Dowden.”

Coffey says there hasn’t been “as much interest as I would expect from local government” in the “flagship” Kickstart Scheme for placing young people in jobs.

She also discusses what it is like being a Catholic in politics, says one of her “proudest days” was when she voted against the Assisted Dying Bill, recalls seeing Tony Blair at Mass in Westminster Cathedral, and calls for an end to calling opponents “bigots”:

“People do talk about having a kinder politics. An element of a kinder politics is not calling other people with different views bigots because you don’t agree with them.

“People are bigots for calling other people bigots in a way, if that makes sense.

“It genuinely is about just accepting that other people may have different views to you. We seem to be candidly better at doing that in the Conservative Party than perhaps some of the other political parties.

“Being respectful to each other even if you completely disagree with their perspective or their viewpoints, and just accepting that people can have different views. I think politics could be a lot gentler.”

Coffey, MP since 2010 for Suffolk Coastal, is originally from Liverpool, and explains why the Conservatives have declined in that city. She remains an ardent supporter of Liverpool Football Club and ends by comparing Boris Johnson to Jurgen Klopp: “I’m a great fan of very visible leadership.”

ConHome: “What difference does your background as a scientist, your doctorate in chemistry, make to the way you operate as a politician, indeed as a senior minister? Most of your colleagues have a background in politics, economics, history, law, or, in one prominent case, the classics.”

Coffey: “I think just generally the approach of being pretty data-driven, evidence-based, analytical, good use of statistics, challenging sometimes things which people aren’t familiar with – perhaps I’m more confident, even though I don’t pretend to be a medical scientist or anything like that.

“But the ability to ask good questions is very helpful.”

ConHome: “Do you think there should be more people in the Cabinet who are scientifically literate?”

Coffey: “Well I think everybody has different strengths. You don’t need to be a scientist to be able to have that analytical ability. I’m just conscious that that’s led to a particular way of how sometimes I approach matters.

“I think it also helped, I really value my industrial experience and learning at one of the best companies in the world [Coffey worked for Mars].

“All that sort of experience we each bring as members of the Cabinet, and other people will have other life and work experiences too. So it’s the combination of strengths that help us.”

ConHome: “The uplift in Universal Credit is going to be extended for six months. Isn’t it absolutely inevitable that after that six months is over it’s going to be extended again?

“And if that’s so, why not cut out all the bother and just announce that now?”

Coffey: “I don’t think it is the case that we wanted to make sure, close discussions with the Chancellor and the Prime Minister, undoubtedly the response at the time, like a lot of the responses, what could be done quickly and effectively to support people, particularly those who we think were very much impacted by the effects of the pandemic.

“And I do think that we are in a good place, that the economy will be opening up, we have to get confidence back into the economy, back into employers to create jobs, and the investment that’s already gone into DWP and across government more broadly for the Plan for Jobs means that we’re well-placed to encourage and get people taking up those vacancies as quickly as possible.

“This has been a long time now for quite a lot of people being out of work. The furlough has kept that link, and we need to encourage employers to make sure that those people still on furlough are now being prepared to be trained, to be refreshed to get back into their workplace as soon as possible, when conditions allow them to resume their normal activities.”

ConHome: “Do you think there will be a case for an extension at the end of six months? Given the fact that unemployment will be rising.”

Coffey: “Yes I’m conscious about that. And I think that we’ve been clear about the value of this extension. I think that the Chancellor’s always said that we’ll wrap our arms around, but we do believe genuinely in economic terms the large effects of the pandemic will be over, and the investment of people into skills, to get people working again, and that training I think will be important in order to take full advantage of the vacancies that arise.

“So the decision’s been made about the up to six months extension of a variety of schemes, and we’ve got the full six-month extension for people on Universal Credit.”

ConHome: “Can you say more about what your department’s broad plans are for dealing with the unemployment challenge as it will be when lockdown is lifted, particularly for younger people coming into the labour market as they hope, people who lost their jobs immediately before the first lockdown happened.”

Coffey: “Yes, well, already across the country we’ve nearly 27,000 work coaches, we’re not far off now, we’ll have recruited our extra 13,500 by the end of the month.

“And they’re already making interactions with people who’ve been looking for work. We reintroduced Claimant Commitments last year, which is our contract on behalf of the taxpayer with the people receiving benefits.

“People are already taking advantage of more tailored support through a variety of schemes under the Plan for Jobs. So for example probably our flagship scheme is the Kickstart Scheme focussed on young people, and the intention is to have a quarter of a million Kickstart placements by the end of this year.

“And we’ve already approved over 150,000. I don’t know when we’re publishing this information, just over 6,000 young people have now started that role, since November, and we have vacancies, I think there’s over 40,000 vacancies at the moment, which we’re now starting to process with employers and the young people, to get the start.

“I think it’s fair to say that some of the sectors and some of the areas it’s been challenging for them to get the start dates agreed, because they just want to make sure it’s in line with when their sectors can open up.

“But I’m also looking into the fact, I had hoped that more councils would take up the offer of programmes like that. We haven’t had as much interest as I would expect from local government and very few people have started in local government, so that’ll be an area of emphasis.

“But it’s not just about the young people. We’ve got schemes called SWAPs, sector work-based academy programmes, where there are vacancies, employers set these schemes up with us, they get some training, they get some work experience, and they get a guaranteed job interview.

“And that’s often important for people whose sectors aren’t particularly recovering in the way we would like, and we are focussing on some of the growth sectors, or sectors where there are well-known vacancies.

“So that can be a mixture of different levels, including health and social care. We’ve got some other opportunities. There’s something called JETs. This is where people have been unemployed for a while and they get more specialist support.

And indeed something called JFS, Job Finding Support, it’s very light touch, because quite a lot of the people who’ve turned to us for help are people who haven’t had to look for a job for the last 20, 25 years, may not have a LinkedIn profile, may not have their CV quite up to date, and some of that probably just needs some finessing, and an element of confidence and interview practice.

“So we’re trying a whole series of ways in order to get people back into the habit of this, getting them ready, and then steering them, as part of their Claimant Commitment, towards jobs that are available. And we need people to keep going for those vacancies.”

ConHome: “Were you as baffled as we were that you weren’t tasked with fronting any of the daily Government press conferences over the last year?”

Coffey: “Well it’s kind of you to say that. I think the way the process worked was largely if there were announcements to be made in particular areas, and then you had some of my other colleagues, like the First Secretary of State, or the Chancellor of the Duchy of Lancaster, running the Cabinet Office, who would actually have a broader remit I suppose to make announcements on behalf of the Government.

“So I think that, I’ll be open with you, I’m quite happy to, we’ve got this enormous jobs army, as I call us now, at DWP, we’re growing to nearly 100,000 people, and you know we have the most connections with communities right around the country.

“We’re increasing the number of Job Centres by 200, so we’ll have well over 800 Job Centres. So we have enough to do, to actually deliver the day to day services that we need.

“And who knows in the future. We’ve got the press briefing starting, but the shift of the Government away hopefully from Covid and actually onto the jobs recovery.

“So big thanks to the Jabs Army, we are the Jobs Army, and I’m keen that you will see more of me, also more of my colleagues like Kwasi Kwarteng and Oliver Dowden, as we really push and bang the drum alongside the Chancellor and the Prime Minister for job creation.”

ConHome: “Last year has been full of Government successes, and frankly some Government failures. But one of the big successes has been Universal Credit.

“It’s stood up. It didn’t fall over. If it hadn’t been there, goodness knows what would have been done in terms of support. Why was it you weren’t allowed out at a press conference to talk about this?”

Coffey: “Well I think quite a lot of Government, quite rightly, citizens expect it to work. And I’m conscious that perhaps colleagues and dare I say it the commentariat might have been surprised that UC didn’t fall over.

“It took a lot of effort. I’m really proud of what our civil servants did. I have to say there was a particular day when over 100,000 claims were made and we had some really intensive work undertaken to increase the capacity of our IT, our servers.

“I always think of that train scene in Wallace and Gromit, the one with the penguin, and Gromit’s on the front of the train laying down the track in front of it, and that’s how it felt like for a little while.

“But we did cope, we did manage, we made some effective decisions, and we worked together very well, and how can I put it, it was a great success story in a way, that DWP was not in the news for it falling over.

“We’re happy to be the unsung heroes, but it’s nice to get some praise as well, and we’ve certainly been given that by the Chancellor and the Prime Minister in the last year.”

ConHome: “The manifesto commitment on the Winter Fuel Payment and the older person’s bus pass, that’s all very clear, but those payments have aroused controversy recently. Can you rule out the possibility of the age at which they’re received being raised?”

Coffey: “I haven’t been involved in any policy discussion about that. It’s not on the agenda, as far as I know.”

ConHome: “Do you think you were right, in retrospect, to vote both in 2013 and in 2019 against same-sex marriage?”

Coffey: “Well I’m a practising Catholic, we have a diversity of people and their views in Parliament, and think it’s fair to say, I’m a great believer in democracy, I’ve not sought to try and block anything further.

“But I will say the thing about the 2019 [vote], which is the Northern Ireland situation, I felt that was a devolved matter, to be dealt with by the Northern Ireland Assembly.

“As did I think you’ll find some other people who voted against that at the time, who actually support same-sex marriage, but respect devolution. I didn’t agree with the situation that forced that through, but again, I’m a democrat. The vote went through and it’s now been delivered.”

ConHome: “You’re part of the quite sizeable tribe of Tory politicians from Liverpool who don’t sit for Liverpool. Why do you think the Conservatives have basically been driven out as an electoral force, not only of Liverpool now, but the whole of Merseyside pretty much, with one exception.”

Coffey: “As you say, Southport was there, and we came close in Wirral West to regaining that in 2019. I wasn’t born there, but I grew up there, I was in a place called Formby from about six months old and then proper Liverpool if you like from the age of six, to the point that I actually had a Conservative Member of Parliament when I lived there, for a while.”

ConHome: “Who was that?”

Coffey: “I’m trying to think. Malcolm Thornton it was at one point. I know he then moved constituency to Crosby, but I don’t have entire recollection of that time.

“I think that what happened, especially when Militant took over, that’s when I got interested in politics, or I realised politics mattered, I think with the rule of Militant about 20 per cent of the population actually just left Liverpool.

“And I’m conscious that some of the economic impact there was pretty tough on the city. The issues that had happened earlier in that decade with the riots and so on.

“Candidly, other bits of the North West, like Manchester, instead of having a row with the Government, just got on with it and did better economically.

“There are several of us, as you say, from Liverpool who’ve ended up in other parts of the country. I didn’t go back after university, I got a job elsewhere in the country.

“But I’m still very fond of what I consider to be my home city, and very keen to try to make sure it does prosper, which is one of the reasons why earlier this week I was doing a fundraiser with Gillian Keegan for Jade Marsden, our candidate for the LIverpool City Region.”

ConHome: “Where are we on the Government review of women’s pensions?”

Coffey: “Well the Government’s policy has been consistent on women’s pensions. We won our latest court session, to keep the fact that we wanted to have the age of pensioners to be the same, whether a man or woman.

“However, we’re awaiting a legal process. A further appeal was made by others and we’re waiting to hear if the Supreme Court is going to take it on.”

ConHome: “Do you feel it’s tougher in any way for Catholics in politics than it was? Some Catholics say so though others disagree.”

Coffey: “I don’t know because I’ve only had ten years of experience. Probably the famous one was Alastair Campbell saying ‘we don’t do God’.

“Before I was an MP I actually remember, I think it’s the only time I’d seen Tony Blair in the flesh, I was at Mass at Westminster Cathedral and all of a sudden he appeared with his daughter, and it was quite amusing, at the shake of the hands of peace there were people clambering over the pews to shake his hand.”

ConHome: “That must have been before the Iraq War.”

Coffey: “I can’t remember when, but it can be a difficult balancing act, I appreciate that. And sometimes people of faith just have different views on certain matters.

“I’m a great believer in live and let live, and not condemning other people for choices they make or for approaches they take. I have very different views to some of my friends say on assisted suicide.

“That day, 11th September 2015, is one of the proudest days in my time as an MP, to stop that Second Reading [of the Assisted Dying Bill].

“And I’ve got friends who completely disagree with me, and that’s OK.

“People do talk about having a kinder politics. An element of a kinder politics is not calling other people with different views bigots because you don’t agree with them.

“People are bigots for calling other people bigots in a way, if that makes sense.

“It genuinely is about just accepting that other people may have different views to you. We seem to be candidly better at doing that in the Conservative Party than perhaps some of the other political parties.

“Being respectful to each other even if you completely disagree with their perspective or their viewpoints, and just accepting that people can have different views. I think politics could be a lot gentler in that way.

“How I explain it sometimes to members of the public or indeed schoolchildren is that in the Chamber, you tend to only discuss largely the things where you disagree.

“Frankly on most things, all the parties probably agree on about 70 per cent of matters.”

ConHome: “Do you have any advice for Jurgen Klopp? You’re a Liverpool supporter we believe.”

Coffey: “I’m a huge supporter of Liverpool Football Club. Clearly the impact of injuries on defenders, particularly Virgil van Diyk, has knocked confidence.

“But it’s about having self-belief, and recognising it’s only one match at a time. That’s all it takes, and I’m a great fan of Jurgen Klopp, and his enthusiasm, his visible leadership, and I’m a great fan of very visible leadership.

“And we’ve got that in bucket loads in Liverpool, and we’ve got it in bucket loads in our Prime Minister Boris Johnson as well.”

ConHome: “The Jurgen Klopp of politics.”

Coffey: “Well, you know, it’s the style that I really like.”

Desmond Swayne: Same old Assisted Dying plan, same old unsolved problem – that it would put the lives of the vulnerable at risk

4 Dec

Desmond Swayne is a former International Development Minister, and is MP for New Forest West.

The pressures are being ramped up yet again to legalise what’s being called ‘assisted dying’ for terminally ill people.  No one can doubt the sincerity of those concerned, but the idea just hasn’t been thought through.

We are told not to worry, because there would be strict safeguards.  But when you look more closely at these, you see they are little more than vague phrases.  Let’s examine some of them.

Doctors can diagnose terminal illness and offer a prognosis, but their judgements and forecasts are vulnerable to error.  Lord Mackay’s Select Committee, which looked at the proposal, was told of errors, including misdiagnosis of terminal illness, revealed in around one in twenty post mortems.

Doctors pointed out to the committee that prognosis is far from being an exact science and that, at a range of six months, it was, in the words of one doctor, “pretty desperately hopeless” (House of Lords Report 86-I (2004-05), Paragraph 118).

But doctors would be expected to do more than diagnose and offer a prognosis.  They would be expected to make decisions on whether a wish to die was a settled wish, or whether there were any family or other pressures underlying a request.  These are not medical matters, and many doctors are in no position to offer a knowledge-based opinion on them.  Gone are the days when the ‘family doctor’ is a regular visitor to our homes and knows us and our families well.

We are told that doctors’ decisions would be referred to a High Court judge for confirmation. It’s one thing to ask doctors to give the Court their professional opinion on medical matters: they do this already in other contexts.  But they cannot be asked to make judgements beyond these.  If assisted dying were ever to be legalised, it must be on the basis that the sole decision-maker would be the High Court, and that doctors would be involved only to give the Court expert advice on matters strictly within their professional expertise.

Surveys of medical opinion reveal that there is no majority of doctors willing to participate in ‘assisted dying’.  Among doctors who specialise in care of the dying nine out of ten say they would not touch it.

Oregon has encountered just this problem.  People seeking lethal drugs there often have to shop around for doctors willing to assess them.  Yet a doctor introduced to a patient solely for this purpose is ill-placed to make a knowledge-based assessment of a request.

The inevitable result is multiple prescribing by a minority of doctors.  In 2019, one doctor in Oregon wrote no fewer than 33 prescriptions for lethal drugs.  The involvement of doctors in ‘assisted dying’ simply hasn’t been thought through.  

It’s easy enough to say a request for assisted dying must be voluntary.  But how is such assurance to be found?  The proposals being advanced are silent on this.  Freedom from pressure is presented as an aspiration, but there are no minimum steps mandated to ensure that valid judgements can be made about it.

And it’s not just pressure from others.  There’s also internal pressure – feelings of guilt in a terminally ill person at being a (perceived) care or financial burden on the family.  Such feelings can be much harder to uncover, yet they can be a major factor in a request for ‘assisted dying’.  Among people in Oregon who ended their lives through swallowing legally-supplied lethal drugs last year, nearly three out of five gave as one of their reasons that they felt a burden on family or caregivers.

It is proposed that assessing mental capacity for ‘assisted dying’ would follow the principles of the 2005 Mental Capacity Act (MCA).  But the MCA proceeds from the principle that a person must be assumed to have capacity unless it is established that he or she lacks it.  While this is a reasonable principle for the purposes for which the Act was designed, it’s a dangerous principle on which to proceed where people are seeking assistance to take their own lives.  Given the gravity and irrevocability of such an act, the burden of proof surely needs to be the other way round.

That aside, there’s the matter of depression.  It’s possible to have our thinking processes intact, but to have our judgement impaired either by illness or by circumstances.  Transient depression is a common feature of terminal illness.

This serious issue cannot just be brushed aside, as some of the advocates of ‘assisted dying’ do, by saying that a degree of sadness is inevitable in someone who is terminally ill.  We are not talking about sadness here, but about depression.  The Mackay Committee was told of “episodes of reactive depression as a result of the diagnosis of a life-limiting illness” and that “there is a significant incidence of moderate to severe depression and anxiety at various stages throughout the course of many diseases” (House of Lords Report 86-I (2004-05), Paragraph 124).

Proposals for assisted dying skate over this problem.  They require a doctor to consult an expert in capacity assessment only in cases of doubt.  Yet Oregon’s experience has shown that this ‘if in doubt’ approach can fail.  A study of a small number of persons expressing interest in ending their lives with legally-supplied lethal drugs found that one in three of those who had ended their lives in this way had been suffering from clinical depression, which had not been picked up by the assessing doctor or referred for an expert opinion.

It’s been proposed that an assisted dying law should empower the relevant Minister to issue ‘codes of practice’ to provide guidance on how those assessing a request should go about doing so.  These codes would, however, be issued only after Parliament had agreed to change the law.

Yet the nature and robustness of safeguards is of the essence of any decision to agree to such legislation.  Parliament needs to see how any proposed safeguards would work before, not after, agreeing to change the law.  The proposals we have seen are effectively inviting Parliament to sign a blank cheque.

These are just some of the unthought-through problems in the proposals for licensing doctors to supply lethal drugs to terminally ill patients.  There is nothing new about what is written here.  These serious deficiencies have been drawn to attention time and again, but nothing has been done to resolve them. The time is well overdue for the assisted dying lobby to address these and other issues seriously, rather than to be wheeling out the same failed ideas over and again.  Parliament deserves better.

Andrew Mitchell: I used to be adamantly opposed to all forms of assisted dying. Here’s why I changed my views.

22 Jul

Andrew Mitchell was International Development Secretary from 2010 to 2012. He is the MP for Sutton Coldfield.

The All Party Group on choice at the end of life – composed of members of both the Commons and the Lords – held its first ever virtual meeting last week.

That more than 60 members of Parliament chose to attend at 9am is an eloquent testimony to the seriousness with which Members of Parliament are examining the issue. At the meeting I agreed to be the co-Chair of the group along with my Labour colleague Karin Smyth, the Member of Parliament for Bristol South.

When I entered the House of Commons in 1987, I was adamantly opposed to all forms of assisted dying. But over the years (perhaps it is part of the ageing process) I have completely changed my mind.

Let me explain why.

It is first and foremost because of my experience as a constituency MP. I have sat in my office in the Royal Town of Sutton Coldfield and heard stories from so many of my constituents. Often with tears pouring down their faces, they have given me deeply intimate details of the last days of someone they loved but who died a miserable and sometimes very painful death.

By the end of these meetings, often with tears coursing down my own face, I was invariably left with two overwhelming feelings: the first is that we would not let an animal we loved be treated in such a way and, second, I do not myself wish to go through the sort of end of life experience that my constituents have so often eloquently described.

And just as I would not want it for myself, I no longer want members of my family or those I represent in Parliament to have to navigate so awful an end.

I believe the time is approaching when Parliament must examine this again. This is not a party political issue subject to whipping; it is an issue of conscience where members of the House of Commons hold different views reached entirely honourably on the basis of their own personal beliefs.

Assisted dying could be the great liberal reform achieved by this government. Public support for assisted dying is overwhelming and consistent across all parts of society. Out of the British public, 84 per cent support assisted dying including 86 per cent of Conservative voters. Of Conservative Party members, 67 per cent support assisted dying. It is interesting also to note that 79 per cent of people of faith and 86 per cent of people with disabilities support assisted dying.

Support is also highest in the North East, East Midlands and Yorkshire and Humber. It is lowest in London. So this is not a liberal metropolitan issue; it is one that unites the country.

Assisted dying is legal in 10 states in the United States of America (some for more than 20 years), two states in Australia, nationwide in Canada and likely to be nationwide in New Zealand later this year. It is interesting to note that in no country with legalised assisted dying has the law been repealed. And in Britain we now have the opportunity to look at the differing legislative approaches in all of these countries, evaluate them, and deliver the best possible results for our constituents.

Consider these facts:

  • Everyday 17 people in the UK will die in pain and distress that cannot be prevented by even the very best palliative care.
  • Hospices now acknowledge that some dying people are in so much pain medication doesn’t work.
  • One Britain travels to Switzerland for assisted dying every week at a cost of around £10,000, the expense, the difficulty of traveling when terminally ill and the challenges of obtaining the necessary documentation put this option out of the reach of all but a few.
  • Those who accompany their loved ones to Switzerland run the risk of police prosecution. Ann Whaley, married to her husband Geoffrey for more than 60 years, was interviewed under caution by police officers.
  • Around 300 terminally ill people take their own lives every year behind closed doors. The effect of these suicides on their family and on responders can be devastating. Some of them have gone wrong, which has added to the immense distress. Mavis Eccleston helped her husband of almost 60 years, Dennis, who was dying in agony to take his own life and was later prosecuted for murder. She was acquitted by a jury but only after 18 months of investigation. This brought huge distress to her and her family.

There is also a risk in maintaining the status quo as attitudes among the public change. The increased reporting of cases undermines public confidence in the law. Almost half of police and crime commissioners including five Conservative PCC’s have called on the Government to review the law saying the current law does not protect vulnerable people.

The medical profession’s views are shifting too: the Royal College of Physicians moved its position to neutrality in 2019 and the Royal College of General Practitioners who surveyed their membership this year found a surge in support for assisted dying – 41 per cent compared to just five per cent in 2013.

As assisted dying becomes more established and understood in other English-speaking countries, demands in the UK for the law to change will continue to grow.

Many of us hope that the Health Select Committee under Jeremy Hunt, its distinguished and experienced Chair, might consider an inquiry which took evidence from the various sections of society that are most affected: dying people and their families, police officers, healthcare professionals and coroners, so that the issue can be explored further.

The Health Select Committee will currently be heavily preoccupied with the Covid crisis but perhaps in due course they may feel this is a subject which they are well placed to examine.

So finally, what are the modest changes those of us who want reform are seeking?

  • We want to give people who are terminally ill (and also in the final months of their lives) the option of dying on their own terms. We want this to be an active choice by a rational person to end their own life as they wish.
  • The change in the law we propose would contain stringent safeguards to protect people; it would only be accessible to mentally competent adults.
  • Two doctors would assess the person making the request to ensure that they met the eligibility criteria under the law. They would explain all other care options in full.
  • A High Court judge would examine the person’s request and make sure that it was being made voluntarily – free from any pressure or coercion.
  • Once the request was approved, a doctor would be able to prescribe life-ending medication for the person who would then take it themselves under the supervision of a doctor or another healthcare professional.
  • Healthcare professionals who wanted to exercise conscientious objection would, of course, be able to do so.
  • There would be clear reporting procedures for doctors as well as monitoring through an annual report published by the Government.

The law change that we propose is based on one that has operated in Oregon in America for 23 years. We would like to add additional safeguards built in to make it right for the UK. There have been no cases of abuse of Oregon’s law and no extension of its eligibility criteria throughout these 23 years. This model of assisted dying legislation has since been adopted in nine other US states and passed by lawmakers in Australia and New Zealand.

Wherever you stand on this issue, let us now have a calm and measured debate on the best way forward. I believe this is a reform whose time is approaching.