Brexit and the waning days of the United Kingdom

[Tamas]

I honestly find it weird this is such a big issue for you two. It's just not engaging to me at all.

It's a combination of emotional connection and self-interest. Seeing loved ones and acquitances suffer and experience dehumanising degradations when all they wished for is to die and go on their own terms cuts deep.

And the selfish part is to have this option available by the time I may want to use it.

[The Brain]

It's a somewhat weird situation when a person is in a condition where, had they been a housepet, it would have been illegal NOT to kill them, and it's illegal to help them die with their consent. Do the people behind the rules care more about pets than humans, or less? It's not obvious to me.

[Gups]

There is nothing to convince opponents with. Concerns over minutea is an excuse. For example Sheilbh you as one of the more reasonable opponents of it can you give actual examples of what would convince you to switch and start supporting a bill like this? Not stuff like "better projections" but an example of what thst convincigly better protection would be.

Again the Health Secretary voted for assisted dying last time it came up. He's changed his mind and now opposes it. Diane Abbott has shifted from unsure to opposition. I don't think opinions on this are very fixed.

For me, better protections is key. There are fewer and weaker safeguards in this bill than for live organ donation or getting a mortgage. I don't think that's right. I say I think it should looked at as a policy in the context of a royal commission or something similar addressing social care, palliative care and assisted dying. So there is a wider reform to improve death for people and within that context consider assisted dying.

But to be honest the biggest change would be self-administered which I believe is the case in Austria, Switzerland and a few US states around effectively physician supported assisted suicide, not assisted dying which is where the fatal drugs are administered by a physician. Because the moment of decision is in the individual's hands and not within a process which (particularly in the NHS) can inexorably go on to its conclusion.

Edit: And, on support, as I say the assumption at the start of this parliament was that this would easily sail through - opinions have changed even in the time we've been having the debate in public and I actually suspect some MPs will have their mind made up in the debate in the chamber.

To stay fair, this hypocrisy I think applies to the pro-dignity side as well, or at least it applies to myself. I will not want assisted suicide to stop at this level. I want it to reach the canadian/Swiss levels where essentially I am given assistance to check out like a fucking human being when existing becomes unbearable.

Yeah. So this is one of the issues I have with the current bill. Leadbeater today said it would not in any circumstance be possible for anorexia to be a condition where assisted dying is available - problem is that has happened, through regulatory and legal process (not legislation), in Oregon, which is the jurisdiction with the closest safeguards in the bill.

And I think we have to be very, very careful about the circumstances when assisted dying is allowed. For example one of the Dignity in Dying patrons has said that in his view it should be expanded beyond this bill (also the Economist's position) and in particular said it should be available for "the wheelchair bound" and people with mental health issues. I think that has profound implications for the dignity and worth our society places on people with disabilities and mental health problems. Which again goes back to the slippery slope and need for a very robustly drafted law and solid safeguards.

Oh, and Brown's argument freaked me out. I am sorry about his personal tragedy but to let others suffer because his newborn daughter wasn't able to convey to them what she was going through while they had this emotional copium of witnessing her dying as the only time they spent with her (which is a heart-wrenching thought), is just twisted.

I think that's an insanely uncharitable reading of his article.

There is nothing to convince opponents with. Concerns over minutea is an excuse. For example Sheilbh you as one of the more reasonable opponents of it can you give actual examples of what would convince you to switch and start supporting a bill like this? Not stuff like "better projections" but an example of what thst convincigly better protection would be.

Again the Health Secretary voted for assisted dying last time it came up. He's changed his mind and now opposes it. Diane Abbott has shifted from unsure to opposition. I don't think opinions on this are very fixed.

For me, better protections is key. There are fewer and weaker safeguards in this bill than for live organ donation or getting a mortgage. I don't think that's right.

Really? You need two separate doctors' opinions and approval from a high court judge to get a mortgage?

[Sheilbh]

Really? You need two separate doctors' opinions and approval from a high court judge to get a mortgage?

Very little in the legislation of how to protect against undue influence or indeed any obligation to evidence the person isn't being pressured (and total civil immunity - including for negligence).

You can doctor shop and once you've found a doctor who agrees, they choose the second doctor (and if they disagree, the first doctor can choose another - I don't think there's any limit). If we assume similar take-up as in other countries every Family Division judge would be hearing 400 of these applications a year, so I'm not sure that's an effective safeguard - my guess is it would need to go to District Judges or just be a rubber-stamp.

Forms can be signed by proxy and, from what I've read, seem to have fewer formalities than a power of attorney (having recently had to be involved in my parents').

Shabana Mahmood, in her letter to constituents, has flagged that the provisions covering coercion are "particularly weak". This has also been the point made by former judges.

There is nothing to convince opponents with. Concerns over minutea is an excuse. For example Sheilbh you as one of the more reasonable opponents of it can you give actual examples of what would convince you to switch and start supporting a bill like this? Not stuff like "better projections" but an example of what thst convincigly better protection would be.

Just to follow up on this again, I'd like a royal commission around reform and end of life in general. But a really basic thing is that the French legislation on this (being considered now) and I believe the Austrian legislation was part of a package. Assisted dying was brought in along with measures to protect rights, such as increased funding for palliative care and a requirement that one of the doctors signing off is a specialist in palliative medicine.

There's not one single thing but I think a number of different measures that would help get me comfortable.

I honestly find it weird this is such a big issue for you two. It's just not engaging to me at all.

A bit like Tamas, but the reverse. I think this goes to how we, as a society, treat and value some of our most vulnerable people. I think it's really core. Plus, in my view, our treatment of the elderly and disabled is already pretty shameful (see all the scandals in care homes, covid) which is an added concern if you then introduce this law.

Again I go back to the concerns being raised by disability rights activists, by Liberty (for non-Brits, like our version of the ACLU), by judges and people in the care sector about how this will work in practice - and I just don't think Leadbeater or others are even acknowledging there's an issue.

If we had vulnerable people who might be affected by this like disability rights groups saying they were confident that this legislation would increase their autonomy, then I'd be hugely more comfortable with it. They're not, they're saying it's a threat.

Edit: And also at a really basic level I look at infected blood, maternity safety, Alder Hey organs and Bristol heart scandals etc in the NHS alone and I think we need to be careful with this type of legislation.

[HVC]

So there are safe guards, but you just don't trust doctors. That's veering pretty close to anti vax conspiracy land


How many division judges do you have that they would see 400 petitions each a year? Looking at canada 12k requests were made in 2022. So that means the UK only had 30 division judges? PS i don't know what a division judges is, for transparency.

[crazy canuck]

So there are safe guards, but you just don't trust doctors. That's veering pretty close to anti vax conspiracy land


How many division judges do you have that they would see 400 petitions each a year? Looking at canada 12k requests were made in 2022. So that means the UK only had 30 division judges? PS i don't know what a division judges is, for transparency.

That's what opposition to this sort of legislation always boils down to.  We can't possibly trust doctors to carry out their ethical obligation.

But of course, we trust them every time we go in for treatment, take the medications they prescribed for us, and heck we even voluntarily get knocked out and go under the knife, trusting that they are going to do everything they're supposed to do ethically.

Are there outliers that don't comply with that high obligation? Yes.  But that doesn't stop us from doing all kinds of things that are beneficial to society as a whole.

[Gups]

The expectation is that there would be 400 applications a year in total. Not per judge. The idea that any single high court judge would deal with 400 applications a year is laughable for anyone with any familiarity with our judicial system.

Let's face it Sheilbh, there are no safeguards that would satisfy you. You are being (uncharacteristically) disingenuous in hiding behind alleged process deficiencies when in fact you object to the proposals in principle.

[crazy canuck]

So there are safe guards, but you just don't trust doctors. That's veering pretty close to anti vax conspiracy land


How many division judges do you have that they would see 400 petitions each a year? Looking at canada 12k requests were made in 2022. So that means the UK only had 30 division judges? PS i don't know what a division judges is, for transparency.

There were 12,000 requests for MAID. not 12,000 petitions to court.

I haven't found good data for you as to how many petitions were made.  But at least in this Province, there are few.

I have no idea where the number of 400 petitions per judge comes from.  That would be ridiculous. 

[Sheilbh]

So there are safe guards, but you just don't trust doctors. That's veering pretty close to anti vax conspiracy land

I've never said there aren't safeguards, I've said I don't think they're adequate.

On trusting doctors, or judges, I'd go back to the former President of the Family Division said on this (in relation to the judicial element): "only those who believe implicitly in judicial omniscience and infallibility – and I do not – can possibly have any confidence in the efficacy of what is proposed".

I also don't believe in judicial omniscience and infallibility. In a country that's had many medical scandals such as infected blood, Alder Hey organ scandal, the scandals at Bristol, the current maternity care inquiry etc I'm also not willing to say we can specifically rely on various NHS and care bureaucracies producing the correct outcomes.

How many division judges do you have that they would see 400 petitions each a year? Looking at canada 12k requests were made in 2022. So that means the UK only had 30 division judges? PS i don't know what a division judges is, for transparency.

So it might be worse then - I just looked it up and there's about 20 Family Division judges (divisions are within the High Court for different types of civil claims, one of those divisions which this would go through is the Family Division).

Which is fine - but the MP proposing this bill is pointing to the fact that there'll be a High Court judge involved as a great safeguard. That's untrue. It'll either be a rubber stamp, or go to the lower courts, which may be fine but you should stop saying a High Court Judge will be involved.

But of course, we trust them every time we go in for treatment, take the medications they prescribed for us, and heck we even voluntarily get knocked out and go under the knife, trusting that they are going to do everything they're supposed to do ethically.

Are there outliers that don't comply with that high obligation? Yes.  But that doesn't stop us from doing all kinds of things that are beneficial to society as a whole.

I think this is why I'm not a liberal, because I don't really think it's about outliers or bad apples or individuals failing to meet their individual ethical obligations. I think problems tend to arise in systems - I think that goes for all of those medical scandals I mentioned above. I don't think any of them were really about bad doctors, but the system and the outcomes it created despite good doctors and nurses (this is also why the "individual autonomy" argument doesn't work for me because I think unless you look at the medical and care system it's just begging the question of whose individual autonomy).

It is also my experience in the NHS which we've talked about here before around needing to advocate for yourself or have someone else advocate for you. That's not because of anyone being bad or failing to meet their ethical obligations. I think many, if not most, bad things and scandals happen with everyone being good and trying to do their best.

The expectation is that there would be 400 applications a year in total. Not per judge. The idea that any single high court judge would deal with 400 applications a year is laughable for anyone with any familiarity with our judicial system.

There's 400 applications a year in Oregon (which, I believe, has the system most closely resembling the proposed bill) with a population of 4 million (although that would be roughly 6,000 applications here for the Family Division). There's 12,000 requests in Canada.

I think the expectation of 400 application a year in total is not plausible based on experience in every jurisdiction.

I think the 400 per judge number might come from Kim Leadbeater's suggestion that about 3% of the population might choose assisted dying. As a proportion of deaths that's about 17,000 a year.

This is why I think it either won't be High Court, or it'll be a rubber stamp. Either of which may be fine, but the argument that a High Court judge is involved is a meaningful safeguard isn't true.

Let's face it Sheilbh, there are no safeguards that would satisfy you. You are being (uncharacteristically) disingenuous in hiding behind alleged process deficiencies when in fact you object to the proposals in principle.

I don't - I'd happily make that argument, but I don't necessarily have an issue with it in principle (though I am a lot more comfortable with assisted suicide by self-administration).

Edit: As I say I think I'm the opposite of Tamas on this. I think his view is the principle is really important and the details are just minutiae. Mine is that I've no problem with the principle but the detail of how it's implemented is really important.

I have no idea where the number of 400 petitions per judge comes from.  That would be ridiculous. 

From the former President of the Family Division on this:

A final matter to consider is the impact the proposed judicial involvement will have on the judicial system and the administration of justice. Kim Leadbeater MP suggests that as many as 3% of the adult population might eventually choose assisted dying. In 2023 there were 577,620 adult deaths in England and Wales (total deaths 581,363 of which 3,743 were of children under the age of 18): 3% of that is 17,328 – I round it down to 17,000. Let us assume, in order to illustrate the scale of the problem, that each application takes an average of 2 hours (I make clear that I do not accept that 2 hours would be sufficient). That would require a total of 34,000 hours of judicial involvement. A High Court judge sits in court for 40 weeks a year, 5 days a week, the court day being 5 hours (to be clear: this is the 'sitting time'; High Court judges work for much more than 5 hours a day). So a High Court judge sits for a total of 1,000 hours a year. Including the President of the Family Division there are 19 judges in the Family Division, between them sitting a total of 19,000 hours a year, a figure far short of the 34,000 hours of judicial involvement required on this calculation. The figure speak for themselves. Where are the judges to be found? And what of the impact on the wider administration of justice which, as is unhappily notorious, is already under enormous strain?   

I believe supporters of the bill have today said it wouldn't just be the Family Division but basically across the High Court. I think the reality, as I say above, is that it would need to be at a lower level to be possible.

[crazy canuck]

Again, there were not 1200 request for judicial review in Canada.  There were 1200 request for MAID.

[Sheilbh]

And the proposed legislation is that the approval process is two doctors and a judge (according to supporters of the bill a High Court Judge, which I don't think is plausible even if we don't hit Canadian levels).

[crazy canuck]

Or could it be two doctors with the possibility of applying to court if there is disagreement by somebody involved?


If the legislation truly requires a judge to consider each case, then the legislation is deeply flawed. Would it be possible for you to post the part of the legislation that actually requires a judge to be involved in every single application for MAID?

I just can't believe somebody would be so inapt as to put that into a draft piece of legislation.

[Josquius]

Agreed. Two doctors seems the most sensible thing to me. Maybe some sort of rule where they can't be associated and must be totally independent of each other?
Not sure why a judge would need to be involved. Wouldn't a social worker or something be more appropriate.

[Sheilbh]

Or could it be two doctors with the possibility of applying to court if there is disagreement by somebody involved?

From my reading I can't see that that process/eventuality is covered in the draft (ie I'm not sure what the independent doctor can do under 8(5) if they don't agree with that assessment, though I get what the coordinating doctor can do under section 10), which I think is a problem.

If the legislation truly requires a judge to consider each case, then the legislation is deeply flawed. Would it be possible for you to post the part of the legislation that actually requires a judge to be involved in every single application for MAID?

I just can't believe somebody would be so inapt as to put that into a draft piece of legislation.

Not consider, but approve. As I say the former President of the Family Division estimates that would probably take about two hours of a judge's time, assuming that it's straightforward.

Clause 12 - as I say I don't think it's a very good bill (supporters have defended it pointing out that the former chief Parliamentary Counsel drafted it, I think I'd query the instructions she received):
https://publications.parliament.uk/pa/bills/cbill/59-01/0012/240012.pdf

As I say it's not realistic - either it needs to go into lower courts (but I doubt they have the capacity) or it's just a rubber-stamp. Either way I do not think it's a plausible safeguard.

[Tamas]

So are we switching to being concerned about there being toosny failsafes in the system?