Brexit and the waning days of the United Kingdom

[Sheilbh]

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

I'm more cynical. I think it's so they can say it's two doctors plus a High Court judge, rather than meaningful safeguards. I think it's window dressing which is what I mean by weak safeguards. It's formal stages in a process not substance.

For example, as I say, from what I can see there's no provision for what doctors are to do if they doubt about someone's consent or if there is coercion (that's where I think there could be a role for the courts, but it would need more than a two hour review of an application).

[HVC]

My problem with your view, sheilbh, is that it's an unobtainable ideal. Taking the tainted blood scandal, started in the 70s and ended in the 90s. So it's been 30 years and the NHS still isn't up to your standards. It likely never will be. And while it's a horrible thing, many, many, MANY people were helped with blood transfusions while the tainting was underway. Going back to assisted suicide, refusing to enact legislation means thousands of people will suffer needlessly because of the potential for misuse. Actually, I think potential gives a feeling of greater odds than exist. But, that can be said for many things. some people in jail are innocent, so release everyone. Medications have adverse effects. No meds for anyone.

I think your threshold for safety checks are too high when weighed against the harm endured by people suffering. You've mentioned family history as the impetus for your views. I too have history. My father suffered for weeks waiting for infection to take hold after he decided against further care. A aunt and uncle wasted away with cancer. I was too young to remember much about my aunt, beyond it being the first time I saw a dead body in the hospital. My uncle though, I was very close with. I saw a vibrant man,  who had a full head of black hair at 77 and of which he was very proud of , waste away to a husk of a human being due to colon cancer. He ended his days frail, in pain, and truly utterly tortured. I wouldn't wish witnessing a family member suffer that way on anyone, let alone being the person who actually suffers.

I don't relay that story as a way to shame you into agreeing with assisted suicide, but just as a reminder that this isn't about ideals but real people. Suffering people. Of course there should be reasonable safety checks. And I think doctors fit the bill. but that's the key. Reasonable. not 100% perfect from all faults.

[Sheilbh]

My problem with your view, sheilbh, is that it's an unobtainable ideal. Taking the tainted blood scandal, started in the 70s and ended in the 90s. So it's been 30 years and the NHS still isn't up to your standards.

I think my point is maybe unclear on this (though I'd point out that victims only started receiving compensation this year and the inquiry only started in 2017 and issued its report in 2022) - it's not that because scandals have happened the NHS is irredeemably broken. It's that these scandals are relatively regular and there is a pattern - ordinary people caught up in and suffering because of institutional decisions, then normally a cover-up to protect the institution and then eventual revelation and lengthy public inquiry resulting in solemn declarations that lessons must be learned.

My argument is let's try to learn the lessons and make sure that as we allow assisted dying, build in the protections from the start.

Because as that bill is drafted, I guarantee you that in 30 years there will be at least one public inquiry into people being wrongfully killed, that will lead to a Health Secretary giving a formal apology in the Commons and billions being paid in compensation.

Going back to assisted suicide, refusing to enact legislation means thousands of people will suffer needlessly because of the potential for misuse. Actually, I think potential gives a feeling of greater odds than exist. But, that can be said for many things. some people in jail are innocent, so release everyone. Medications have adverse effects. No meds for anyone.

Estimates are that 350,000 elderly people are victims of abuse in every country in this year - I think that's one vulnerable population, which will be growing every year. So how do we better protect them? At a very simple level if a doctor thinks someone is being coerced - what are they supposed to do? This isn't set out in the bill.

As I say if the supporters can get disability rights activists and civil liberties groups comfortable with this legislation that would address a lot of my concerns. At the minute they don't seem to even acknowledge there are risks here.

I think your threshold for safety checks are too high when weighed against the harm endured by people suffering. You've mentioned family history as the impetus for your views. I too have history. My father suffered for weeks waiting for infection to take hold after he decided against further care. A aunt and uncle wasted away with cancer. I was too young to remember much about my aunt, beyond it being the first time I saw a dead body in the hospital. My uncle though, I was very close with. I saw a vibrant man,  who had a full head of black hair at 77 and of which he was very proud of , waste away to a husk of a human being due to colon cancer. He ended his days frail, in pain, and truly utterly tortured. I wouldn't wish witnessing a family member suffer that way on anyone, let alone being the person who actually suffers.

I don't relay that story as a way to shame you into agreeing with assisted suicide, but just as a reminder that this isn't about ideals but real people. Suffering people. Of course there should be reasonable safety checks. And I think doctors fit the bill. but that's the key. Reasonable. not 100% perfect from all faults.

I totally accept this - and as I say my family experience is on all sides. I have seen family members with awful terminal illness, I've got family in the care system with dementia, I've also seen really horrendous malpractice in the NHS (I would say the need to advocate or have an advocate for you in the system has been universal).

I think people supporting and advocating for assisted dying in general and this bill in particular are well motivated. But I think people concerned about the risk are the same.

It's why I think a free conscience vote is the right approach. I'd vote against this bill for all the reasons I've said, which make me think the risk to people with disabilities and the elderly and people in the care system generally (especially the care system - I think there's real risk of coercion there) is too high on this bill. I don't think they're insurmountable - I've listed here a few things that I think would help: requiring one of the doctors to be a palliative care specialist, increasing funding/reform of the care system, self-administration etc.

[HVC]

Going back to assisted suicide, refusing to enact legislation means thousands of people will suffer needlessly because of the potential for misuse. Actually, I think potential gives a feeling of greater odds than exist. But, that can be said for many things. some people in jail are innocent, so release everyone. Medications have adverse effects. No meds for anyone.

Estimates are that 350,000 elderly people are victims of abuse in every country in this year - I think that's one vulnerable population, which will be growing every year.

And that's unconscionable. Having said that, there are different levels. As far as I recall, and I can be mistaken, in Canada the number one category of elder abuse is neglect. Which is a far cry from giving someone the Inuit retirement plan.

So how do we better protect them? At a very simple level if a doctor thinks someone is being coerced - what are they supposed to do? This isn't set out in the bill.

Say no? The bill does allow a doctor to say no, does it not? What's the point of doctor approval if they can't deny?

[Grey Fox]

Sheilbh, are you sure your problem isn't more with the ineptitude of the UKs legislators and their inability to actually draft good legislation.

[Sheilbh]

And that's unconscionable. Having said that, there are different levels. As far as I recall, and I can be mistaken, in Canada the number one category of elder abuse is neglect. Which is a far cry from giving someone the Inuit retirement plan.

Is it? I feel like the gap between neglect and implicit pressure to just die/stop being such a burden are not that far apart.

Say no? The bill does allow a doctor to say no, does it not? What's the point of doctor approval if they can't deny?

It allows doctors to make an assessment that they're satisfied that someone is eligible - and what happens in that case. The flow to assisted dying is clear.

What it doesn't say is what a doctor can or should in the case where they think someone isn't eligible, or, in particular, if they think there is coercion. The bill is silent on that - and I think there should be duties on anyone if they think there's coercion and a way to escalate that in some way.

I think it's basically a process flow for a case that should be allowed under the law and where there are no issues, but doesn't envisage different opinions, possibilities of dispute or appeal, any obligations to investigate if there's a doubt - all of which, to my mind, is the purpose of a law. It should set out what the parties have to assess, what the standard is, what happens if there's a dispute or, say, a suspicion of undue pressure.

Sheilbh, are you sure your problem isn't more with the ineptitude of the UKs legislators and their inability to actually draft good legislation.

Hugely - but this is the law that'll get voted on.

As I say the supporters of this bill are running two contradictory arguments. One is that this has the strictest safeguards in the world (two doctors and a judge), so there is no concern, but also MPs should vote on the principle and let the Lords fix issues and practicalities when they get to amend it (and in any even the Secretary of State can issue regulations clarifying lots of points). I don't think that's good enough for this type of law and that's also the reason Liberty oppose it - legalise the principle and sort out the details later is not a sound process when we're talking about literal life and death that disproportionately impact specific vulnerable communities. I don't agree with it when it comes to other areas like civil liberties either.

As mentioned in the Abbott and Leigh letter, last time there was a vote on assisted dying the bill was published seven weeks before the debate and there was a lot of time allocated for that debate. It also came towards the end of a parliament so MPs were all relatively experienced. This time it's 12 weeks into a new parliament with a record number of new MPs, the initial plan was to publish it a week before the debate (which will be short), following pressure from MPs it was published about two weeks before the debate. As they say I think there was a strategic decision to try and do it fast and quick, I think that was a mistake.

[crazy canuck]

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.

I was assuming the judge would have to consider it before approving it.

Regardless, I can't believe that legislation has drafted that way.  It would be an impossible strain on judicial resources.

[Admiral Yi]

Two Brits discussing the differences between UK and the US.

[garbon]

I went to a party this weekend thrown by English folj that involved a Thanksgiving theme. It was interesting to see their cultural interpretation. I had never thought about decorate with American flags (plates, cups, banners) nor singing the US national anthem for that holiday.

[Tamas]

I went to a party this weekend thrown by English folj that involved a Thanksgiving theme. It was interesting to see their cultural interpretation. I had never thought about decorate with American flags (plates, cups, banners) nor singing the US national anthem for that holiday.

I am not an American but that sounds weird to me as well. 

[Gups]

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

The article in the Economist this week looking at the system in Victoria, Australia (on which the Bill is based) said that was the main issue. Subsequent Australian states who have introduced assisted dying have fewer safeguards.

[garbon]

I went to a party this weekend thrown by English folj that involved a Thanksgiving theme. It was interesting to see their cultural interpretation. I had never thought about decorate with American flags (plates, cups, banners) nor singing the US national anthem for that holiday.

I am not an American but that sounds weird to me as well. 

My boss is married to an American and they hosted a sort of Thanksgiving this weekend too. Their invite neighbours brought them wrapped gifts.

[Valmy]

I guess the British don't do feasts of thanksgiving anymore because they seem weird unaware of how they work.

At least google or something first. 

Washington, D.C.
October 3, 1863

By the President of the United States of America.

A Proclamation.

The year that is drawing towards its close, has been filled with the blessings of fruitful fields and healthful skies. To these bounties, which are so constantly enjoyed that we are prone to forget the source from which they come, others have been added, which are of so extraordinary a nature, that they cannot fail to penetrate and soften even the heart which is habitually insensible to the ever watchful providence of Almighty God. In the midst of a civil war of unequalled magnitude and severity, which has sometimes seemed to foreign States to invite and to provoke their aggression, peace has been preserved with all nations, order has been maintained, the laws have been respected and obeyed, and harmony has prevailed everywhere except in the theatre of military conflict; while that theatre has been greatly contracted by the advancing armies and navies of the Union. Needful diversions of wealth and of strength from the fields of peaceful industry to the national defence, have not arrested the plough, the shuttle or the ship; the axe has enlarged the borders of our settlements, and the mines, as well of iron and coal as of the precious metals, have yielded even more abundantly than heretofore. Population has steadily increased, notwithstanding the waste that has been made in the camp, the siege and the battle-field; and the country, rejoicing in the consciousness of augmented strength and vigor, is permitted to expect continuance of years with large increase of freedom. No human counsel hath devised nor hath any mortal hand worked out these great things. They are the gracious gifts of the Most High God, who, while dealing with us in anger for our sins, hath nevertheless remembered mercy. It has seemed to me fit and proper that they should be solemnly, reverently and gratefully acknowledged as with one heart and one voice by the whole American People. I do therefore invite my fellow citizens in every part of the United States, and also those who are at sea and those who are sojourning in foreign lands, to set apart and observe the last Thursday of November next, as a day of Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens. And I recommend to them that while offering up the ascriptions justly due to Him for such singular deliverances and blessings, they do also, with humble penitence for our national perverseness and disobedience, commend to His tender care all those who have become widows, orphans, mourners or sufferers in the lamentable civil strife in which we are unavoidably engaged, and fervently implore the interposition of the Almighty Hand to heal the wounds of the nation and to restore it as soon as may be consistent with the Divine purposes to the full enjoyment of peace, harmony, tranquillity and Union.

In testimony whereof, I have hereunto set my hand and caused the Seal of the United States to be affixed.

Done at the City of Washington, this Third day of October, in the year of our Lord one thousand eight hundred and sixty-three, and of the Independence of the United States the Eighty-eighth.

By the President: Abraham Lincoln

William H. Seward,
Secretary of State

Will do Mr. President

[Josquius]

So whens the right time to burn the totem pole? Is that before or after the root beer float?

[Barrister]

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.

So I have spent my entire life arguing against "slippery slope" arguments - the idea that just because you allow a little bit of something, suddenly a whole lot of something will happen sooner or later.

Yet that's what has happened in Canada.

We can all think of the typical example pf what we think the typical patient seeking MAID would be (Medical Assistance in Dying, Canadian terminology but shorter to type).  Someone with a terminal diagnosis nearing the end of their life who wishes to pass sooner rather than suffering.

Problem is that mental picture you have is wrong. You don't need a terminal diagnosis.  You don't need to be near the end of life.  And "suffering" is incredibly subjective.  So all we're left with is you have to have a diagnosis for a physical condition and be suffering to an extent you find intolerable.

And soon the "physical" part is going to be dropped.  It's now been delayed until 2027 (because finally Canadians are getting queasy about MAID), but it's set that if you're suffering from a purely mental health diagnosis that can't be treated to your satisfaction (and let's face it - MH can be managed but never cured) you can seek MAID.

Plus some of the concerns Sheilbh mentions.  You can totally doctor shop.  There's no requirement to notify family.  And as MAID becomes more and more normalized my fear is there becomes less need to provide other services for people suffering from long-term illness or disabilities.  Why do we need to pay for really expensive home care - that person has MAID available to them if they don't like their current situation.

In 2022 Canada was up to 4.1% of all deaths being from MAID - and the number was rapidly increasing every year.