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Portuguese lawmakers have voted in support of legal assisted dying for the incurably suffering, making a change in the law one step closer to reality. My Death, My Decision has welcomed the move as a historic step forward in the predominantly Catholic country, and said it will now add renewed pressure on the UK to follow suit. 

Under the proposed legislation, doctors could soon be able to assist or directly enable adults with ‘extreme suffering and irreversible damage’ to end their lives, provided the person makes the request free from coercion. 136 Portuguese lawmakers voted in favour of the proposals, with 78 voting against and 4 abstentions. The move follows shortly after Spanish lawmakers voted to approve similar proposals in late 2020. 

Having passed approval in Parliament, the Bill will now be considered by Portugal’s President who could either veto it, pushing the proposals back to Parliament, send it for consideration to the Constitutional Court, or enact the Bill into law. 

My Death, My Decision’s Director Claire Macdonald said: 

‘This is a decisive step forward in the international campaign for legal assisted dying, as it shows a respect for personal autonomy cuts across both religious and political ties. It is also significant for adding weight to the growing international consensus that assisted dying should not depend upon a specific life prognosis, but rather an individual’s quality of life’. 

Notes:

For any more information or comment please contact My Death, My Decision’s Campaigns and Communications Manager at campaigns@mydeath-mydecision.org.uk.

My Death, My Decision is a grassroots non-profit organisation that campaigns for a balanced and compassionate approach to assisted dying in England and Wales. As a growing movement, we are at the forefront of social change: nearly 90% of the public now favours a change in the law to allow adults of sound mind, who are either terminally ill or facing incurable suffering, the option of a peaceful, painless, and dignified death.

Read more about My Death, My Decision’s campaign for an inclusive change in the law: https://dev.mydeath-mydecision.org.uk/

Austria’s constitutional court has ruled a ban on helping ‘seriously ill’ people ending their own lives is unconstitutional, in a landmark ruling which has been welcomed by My Death, My Decision. 

The case relates to a claim brought by a series of claimants, including a 56-year-old man who suffers from multiple sclerosis. Under Austria’s criminal code anyone who helped someone end their life could have faced up to five years imprisonment. 

But on Friday, Austria’s top court ruled that the existing law is unconstitutional and that ‘it violates the right to self-determination, because this fact forbids any kind of assistance under any circumstances’; echoing the decision to similar effect made in Germany earlier this year. Notably, the court drew a comparison with the right to refuse life-sustaining medication or other interventions under an advance decision and said that, from a fundamental human rights point of view, there was no difference between that and wanting to end your life by suicide. The key criterion is that the decision is made of the person’s own free will, without coercion.

The ruling means that assisting someone to end their life will not always be a criminal offence in Austria, and it is expected that its Parliament will now debate the matter. The repeal of the relevant law in Austria will come into force on 31st December 2021.

My Death, My Decision’s Chair Trevor Moore said:

‘In 2020 we have seen many countries around the world settle upon laws allowing for assisted dying, including Germany, Austria and New Zealand; and in others, legislation is under serious consideration, such as in Ireland. Yet in the UK, where around 90% of the public now support a change in the law, our politicians are dragging their heels.

So at My Death, My Decision we continue to urge the Justice Secretary, Robert Buckland, to establish an independent inquiry (call for evidence), so that stories such as the oppression of the vulnerable, and of doctors being forced to take part in assisted deaths, can be shown as the scaremongering they are. Only in that way can those with hidden agendas be exposed and the British public acquire a right now available to well over 150 million people worldwide.’

Notes:

For any more information or comment please contact My Death, My Decision’s Campaigns and Communications Manager at campaigns@mydeath-mydecision.org.uk.

The repeal of the relevant law in Austria will come into force on 31st December 2021.

My Death, My Decision is a grassroots non-profit organisation that campaigns for a balanced and compassionate approach to assisted dying in England and Wales. As a growing movement, we are at the forefront of social change: nearly 90% of the public now favours a change in the law to allow adults of sound mind, who are either terminally ill or facing incurable suffering, the option of a peaceful, painless, and dignified death.

Read more about My Death, My Decision’s campaign for an inclusive change in the law: https://dev.mydeath-mydecision.org.uk/

Credit: gdsteam, source: https://bit.ly/38ymwuL (Creative Commons 2.0)

In an urgent parliamentary question on 5th Nov 2020, the day a second lockdown was introduced in England, Andrew Mitchell (MP) asked the Health Secretary Matt Hancock to make a statement on the impact of new coronavirus regulations on the ability of terminally ill adults to travel abroad for an assisted death. 

In his response, Matt Hancock reminded the house that under the 1961 Suicide Act, it is an offence to encourage or assist the death of another person but that ‘it is legal to travel abroad for the purpose of assisted dying where it is allowed in that jurisdiction.’ He then clarified: ‘The new coronavirus regulations … place restrictions on leaving the home without a reasonable excuse; travelling abroad for the purpose of assisted dying is a reasonable excuse, so anyone doing so would not be breaking the law.’

Andrew Mitchell responded, drawing attention to the significant changes in medical opinion reflected in the recent BMA poll of doctors; the developments in New Zealand and the Republic of Ireland regarding the introduction of assisted dying laws; together with the strong public support in the UK. He recognised the government’s position of neutrality, but requested a greater understanding of three things:

• the extent of suffering that the blanket ban on assisted dying is causing dying people and their families; 
• the challenges that the current law is creating for healthcare professionals, police officers and other public servants; and
• what the UK can learn from international evidence on the operation of assisted dying laws, and their safeguards, in the United States, Australia and Canada.

Although Mr Mitchell made clear that his personal preference was for a law along the lines of the limited law in Oregon, he included Canada in the countries he cited. Canada has a broader approach to assisted dying, without a hard limit on life expectancy, which is strongly favoured by MDMD.

Mr Hancock responded ‘…we acknowledge the changing views of many, including many in the medical profession, and, of course, we observe the changes in the international debate. I think it is absolutely reasonable for this House to have a conversation and discussion on what is an important topic, and it is right that we locate that question within a broader discussion of how we care for people at the end of their lives’.

In the following discussion several MPs raised issues reflecting the growing support for a change in the law, always referencing “terminal illness”, without clarification. 

A particularly insightful contribution came from Noel Conway’s MP Daniel Kawczynski: ‘It is very difficult to tell somebody who is in pain and suffering and who wants to die that the state is going to prevent them from doing that. As a Roman Catholic, I recently changed my mind on the issue because of my constituent Mr Noel Conway, who lives in Garmston near Shrewsbury. I said to him, “Why don’t you go to Switzerland?” and his answer will stay with me forever: “No, I’m an Englishman. I want to die in England.” It is extremely important that our citizens have that right. Will the Secretary of State do me the courtesy of agreeing to a short Zoom call with my constituent Mr Noel Conway, who is getting a national reputation as a leading campaigner on the issue?’ Mr Hancock agreed to that request.

My Death, My Decision’s Lead Campaign Commentator Phil Cheatle said: 

‘This clarification from Matt Hancock regarding travel to Switzerland during lockdown for an assisted death is most welcome. However, it did not clarify the position of anyone who might wish to accompany someone legally travelling to Switzerland for an assisted death during lockdown.’

‘The debate highlighted again the absurdity of requiring those who want a legal assisted death to travel to Switzerland. It was encouraging to see the positive tone of many MPs towards an inquiry with a view to changing the law. However, such an inquiry needs to address the issue for all those who are incurably suffering, regardless of their life expectancy. MPs need to understand that restricting eligibility to those with a life expectancy of six months or less would be discriminatory, as it would exclude people facing years of constant and unbearable suffering such as Tony Nicklinson.’

Notes:

For any more information or comment please contact My Death, My Decision’s Campaigns and Communications Manager at campaigns@mydeath-mydecision.org.uk.

My Death, My Decision is a grassroots non-profit organisation that campaigns for a balanced and compassionate approach to assisted dying in England and Wales. As a growing movement, we are at the forefront of social change: nearly 90% of the public now favours a change in the law to allow adults of sound mind, who are either terminally ill or facing incurable suffering, the option of a peaceful, painless, and dignified death.

Read more about My Death, My Decision’s campaign for an inclusive change in the law: https://dev.mydeath-mydecision.org.uk/

Credit: New Zealand Flag
https://bit.ly/34CZ1yh

New Zealand has overwhelmingly voted to legalise assisted dying by 65.2% to 33.8%, according to the preliminary results of a nation-wide referendum. My Death, My Decision has welcomed the result as a decisive victory for campaigners, which will add renewed pressure on the UK to follow suit. 

Nearly two thirds of voters in New Zealand opted to support proposals which would allow doctors to help adults of sound mind end their life, provided they are terminally ill and have a settled and un-coerced wish. In My Death, My Decision’s view these results represent yet another sign of support for assisted dying elsewhere in the world, coming just four years after another commonwealth country, Canada, voted to legalise assisted dying for the terminally ill and incurably suffering. 

The official results of New Zealand’s referendum will be released on 6 November and a change in the law is expected to come into effect a year after that date. 

Reacting to the result My Death, My Decision’s Chair Trevor Moore said: 

‘We congratulate New Zealand for voting to endow those at the end of their life with the dignity, compassion, and autonomy that they deserve. 

‘These results will add renewed pressure for the UK to change its law on assisted dying. When more than 150 million people  worldwide already have the option of an assisted death, reflecting that such reforms can be achieved in a safe and compassionate way, it is hard to see why the UK should deny its citizens the same basic human right. 

‘Repeated polls have now demonstrated assisted dying is overwhelmingly supported in the UK, and nearly 90% of the public favour a change in the law for the terminally ill or incurably suffering. New Zealand shows the depth of popular support a compassionate assisted dying law has when the public are actually given a say. We urge all MPs to take notice of the groundswell of support for assisted dying in the UK and to take long overdue action to review our law. An important first step would be to hold an inquiry to examine the evidence, as has already happened in countless other countries. That way, politicians can make a properly informed decision, divorced from lobbying that too often is not founded on evidence.’ 

Notes:

For any more information or comment please contact My Death, My Decision’s Campaigns and Communications Manager at campaigns@mydeath-mydecision.org.uk.

More about New Zealand’s referendum 

A nationwide binding referendum on whether to enact the End of Life Choice Act A nationwide binding referendum on whether to enact the End of Life Choice Act 2019 was held in New Zealand on 17 October. The referendum followed after a parliamentary inquiry reviewed the evidence on assisted dying and New Zealand’s Parliament subsequently voted 60-59 in favour of the Act subject to a referendum.

Voters were asked whether they supported the proposed law or not and preliminary results show a majority of 65.2% to 33.8% of voters supported it. 

Under the proposed law doctors will be able to assist someone with six or fewer months left to live to end their life, if they are 18 years old, a citizen/resident of New Zealand, experiencing unbearable suffering that cannot be eased and an ongoing decline in physical capability, and provided they are able to make an informed decision. 

The option of an assisted death would be subject to safeguards including a requirement for any request to be made in writing, a requirement for an independent doctor to verify an individual’s eligibility (as well as a psychiatrist specialist confirming their capacity if there were any doubts), and an oversight body review to ensure the law was complied with. 

The official results will be released on 6 November and if more than 50% vote yes in the referendum the End of Life Choice Act will come into force 12 months after this date. 

Wider developments

The UK Parliament last voted on assisted dying in 2015, rejecting by 330 against to 118 a private members’ bill to legalise assisted dying for those who are terminally ill and likely to die within six months. 

Last month, in one of the largest surveys of medical opinion ever, half of doctors said they personally supported changing the law on assisted dying. In the British Medical Association members’ survey on assisted dying, 59% of doctors also felt that, if the law is to change, then patients with physical conditions causing intolerable suffering which cannot be relieved should be able to access assisted dying; whereas only 24% thought that only patients suffering from a condition likely to cause death in six months or less should be eligible.

Recently, the families and living claimants of most of the previous assisted dying cases came together for the first time, to urge the UK Secretary of State for Justice to instigate a review into assisted dying or call on the UK Parliament to conduct one, similar to the process which began New Zealand’s path to legislative reform.

Assisted dying is now permitted for terminally ill and incurably suffering people in Canada, Belgium, Italy, Germany, Luxembourg, and the Netherlands. It is also permitted specifically for terminally ill people in Colombia, ten US jurisdictions, and the Australian state of Victoria, and will soon become legal in Western Australia. Following these results, it is also expected to become legal in New Zealand. An assisted dying bill for the terminally ill and incurably suffering is also currently going through the Dáil in the Republic of Ireland.

Read more about nearly 90% of the public supporting assisted dying.

Read more about our campaign to legalise assisted dying. 

My Death, My Decision is a grassroots non-profit organisation that campaigns for a balanced and compassionate approach to assisted dying in England and Wales. Founded in 2009, we represent the interests of those who face constant and incurable suffering and advocate on their behalf to secure a lasting change in the law. As a growing movement, we are at the forefront of social change: nearly 90% of the public now favours a change in the law to allow adults of sound mind, who are either terminally ill or facing incurable suffering, the option of a peaceful, painless, and dignified death.

Read more about My Death, My Decision’s campaign for an inclusive change in the law: https://dev.mydeath-mydecision.org.uk/

A 34-year-old man who is on life-support will be allowed to die following a ruling from the Court of Protection. The man, known as ‘MSP’ for legal reasons, has suffered from ‘painful and complex abdominal problems’ for more than a decade. His life could only continue if he had a permanent stoma inserted. This was something that he had tried but found unacceptable and had removed. Shortly afterwards he was readmitted to hospital as an emergency.

MSP had carefully considered his future and wrote a detailed advance decision which explicitly refused a permanent stoma. The judge pointed out that ‘there are procedural deficiencies in MSP’s Advance Decision, for example, the signature was not witnessed by a second person as required’. However, having carefully considered the situation and heard evidence from his family and doctors Mr Justice Hayden chose to overlook the deficiencies as the advance decision still provided strong evidence regarding what was in MSP’s best interests.

The case was complicated as, when MSP was readmitted to hospital, the consultant on duty was not aware of the background of the case or of the advance decision. The consultant impressed upon MSP that his condition was life-threatening and that he required a stoma to be formed immediately. Surprisingly MSP agreed and the operation was performed. He remains unconscious, on life-support with artificial feeding and hydration. The intervention of a consultant who knew MSP’s case well seems to have been the reason why the case went to court to establish, under the circumstances, what is in MSP’s best interests.

In analysing the situation the judge concluded: ‘this is not a case about choosing to die, it is about an adult’s capacity to shape and control the end of his life. This is an important facet of personal autonomy which requires to be guarded every bit as jealously for the incapacitous as for the capacitous’.

MDMD’s Lead Campaign Commentator, Phil Cheatle said:

‘The case is clearly complex, though there are important lessons to be learned. As this case demonstrates, advance decisions are powerful legal documents, but they must be completed correctly, to ensure that a patient does not get treatment they do not want, when they are unable to communicate that wish. It is also important to ensure that in an emergency, doctors are aware of an advance decision before emergency treatment is given. 

This case highlights that intolerable suffering is highly personal. For MSP, a stoma was intolerable, but many other people may be able to adjust to life with a stoma and are pleased to have this treatment. It is the individual’s well-considered, well-informed decision that doctors have to respect, and courts uphold, even if they might think it is unwise. I’m pleased to see that the courts are standing up for individual autonomy’. 

Update 11th June 2020: MSP has now died, after his life support systems were turned off by hospital staff, following the legal ruling.

The Canadian government has proposed changing the law on assisted dying to extend access for those who are not terminally ill.

Unlike some states in the USA and Australia, under Canada’s current 2016 law, the right to request an assisted death is not restricted to those with a life expectancy of 6 months or less. Instead, adults who are of sound mind can voluntarily request assistance to die if they suffer from a grievous and irreversible condition – provided their death is ‘reasonably foreseeable’.

Some Canadian assisted dying providers are now interpreting these criteria to include those in early-stage dementia, while the person still has mental capacity. This is similar to the approach taken in Switzerland by organisations such as Dignitas and Lifecircle.

Last year the Quebec Superior Court found the requirement of a ‘reasonably foreseeable death’ discriminated against those who are incurably suffering, but not from an illness that will cause death. The Government has now proposed changes to enable those who are incurably suffering the right to request an assisted death as well, without the need for their death to be ‘reasonably foreseeable’. This would be likely to include people with complaints similar to UK campaigners Debbie Purdy, Omid, Paul Lamb and Tony Nicklinson.

The proposed law would not, however, extend to cases where someone was purely suffering from a mental illness.

The Bill also proposes a ‘waiver of final consent for eligible persons whose natural death is reasonably foreseeable and who may lose capacity to consent before MAID can be provided’. (MAID – Medical Aid in Dying, is the term used in Canada to refer to Assisted Dying.) This waiver is important as some people require such strong medication to relieve their pain as they approach death, that they lose their mental capacity as a side-effect of the medication. The current Canadian law requires them to obtain MAID, if they request it, without this level of medication, which means they have to end their life sooner than they might wish. In situations like these it seems much more reasonable for people to be able to pass all the safeguarding checks before they lose capacity due to requiring high levels of medication. This waiver may also apply to those with dementia. (See this article for further discussion of assisted dying and dementia.)

Phil Cheatle, MDMD’s Lead Campaign Commentator said:

‘This is another very welcome development from Canada. The Canadian government is rightly considering modifying its assisted dying legislation to overcome some limitations. They are attempting to carefully protect vulnerable people while at the same time providing access to an assisted death for those who want to use it when this is the only way to end their suffering. Canada should now be seen as the country to watch as an excellent example of well-considered assisted dying legislation.’

‘Those who oppose this sort of careful, evidenced-based approach are forcing many to suffer against their will at the end of their lives, or to take drastic, unregulated and possibly illegal action themselves. This is totally unacceptable in a caring, compassionate society.’

MDMD is delighted that Dr. Stefanie Green, one of Canada’s leading MAID providers and the President of the Canadian Association of MAiD Assessors and Providers, will be giving a lecture hosted by MDMD and FATE in London in April 2020. Further information and tickets are available here.

Under its current rules, Canadian adults who are of sound mind can voluntarily request an assisted death, if they suffer from a grievous and irremediable medical condition, and are in a state of irreversible decline – resulting in intolerable suffering and a reasonably foreseeable death.

But, following a judgment from a court last September, the requirement of a ‘reasonably foreseeable death’, which had prevented adults with an incurable but non-life threatening illness from having an assisted death, was struck down. The decision, which was suspended until 11 March to allow the Government to appeal, ruled such a narrow restriction discriminated against those living in constant and unrelievable pain.

Deciding not to appeal the judgment, the Government has now given Canadians until 27 January to indicate whether the change in the law should be accompanied with additional safeguards, including:

A requirement that a patient has exhausted all other treatment options before requesting an assisted death
Mandatory psychological or psychiatric evaluations
Special training for doctors to assess the risk of vulnerability

Among other questions, the consultation also asks Canadians whether assisted deaths should be permitted for: patients with Alzheimer’s who indicated they wished to die prior to losing capacity, adults solely suffering from a psychiatric illness, and patients under the age of 18 but who are deemed able to make their own medical decisions.

Even without the court ruling, these questions were due for investigation in 2020 as part of a mandatory five-year review. It is expected they as well as issues such as the state of palliative care will be covered by a parliamentary committee later in June.

Robert Ince, a spokesperson for the campaign group My Death, My Decision said:

‘In any modern and compassionate society, adults who face constant and unbearable suffering shouldn’t be forced to endure unnecessary pain – regardless of how long they are expected to live. Fundamentally, they deserve a right to decide how, where, and when they die.

We warmly welcome Canada’s decision to embrace this reality and commend their commitment to ensuring the right balance between respecting autonomy and robust safeguards.

For too long, whilst progressive nations including Canada have forged ahead, Britain’s politicians have dragged their feet on assisted dying – preferring to leave it in the too-hard to resolve category. But, with public opinion at a record high ( nearly 90% favour a change in the law) and more than one person a week now travelling abroad to end their life, the time has now come for Parliament to take action.