The 10 main points of concern with the Bill

the basic definition (progressive illness that is incurable) is very broad and potentially includes within it a wide range of conditions, such as HIV and diabetes, which MPs might not want to include. The attempt to exclude mental health and disability as reasons for an assisted suicide may prove a fig-leaf: mental health that causes other symptoms that produce a 6 month prognosis would appear to qualify, for example.This then puts enormous pressure on the 6 months prognosis as the limiting factor, but there are two reasons why it does work work.

such prognoses are notoriously unreliable: according to some studies, the accuracy of such predictions is, according to studies, around 50% (the same as flipping a coin). The Bill only requires doctors to have “a reasonable belief” that death will occur within 6 months – which as set out below has been interpreted by courts as meaning “would not be surprised if they died within 6 months”, thus allowing for a very high error rate.

patients who are otherwise healthy can bring themselves within the 6 months prognosis limit by stopping treatment.

the approach to capacity in the Bill does not take account of how capacity works in English law: the general presumption of capacity means that the requirement to confirm that the patient has capacity may be very easy to satisfy, and the requirement to support people in decision making where their capacity is otherwise doubtful could give rise to perverse outcomes such as actively being supposed to tell a patient about the financial advantages of their death.

this is likely to create a cadre of doctors who specialise in assisted suicide which has dangerous implications, particularly combined with there being no prohibition on any medical practitioner from suggesting assisted suicide as an option to a patient.

if a terminally ill patient wants to die because they feel they are a burden or because they cannot access good palliative care, the doctors and judges have no discretion to refuse the application and must grant it.

a patient could be assisted to die without their next of kin, or relatives being informed. This will cause great familial difficulties and will make it much harder to detect any possible signs of coercion or pressure.

doctors are not required or in practice able to carry out any investigations to determine whether the patient is being coerced or pressured. The assessment is solely based on their conversation with the patient and it is unlikely that a patient who is being coerced will say so. All a doctor has to do is to certify that to the best of his or her knowledge the patient is not being coerced. This is perfectly consistent with a doctor having doubts about it.

the High Court process is not an effective safeguard, as the former President of the Family Division of the High Court has said. Judges, under our system, are not investigators and so will be unable to find out what is really going on. They will have to go based on the evidence presented to them. Furthermore the standard of proof is ‘on a balance of probabilities’: this means that the Court must approve an application even if it thinks there is a 40% chance someone has been coerced.

the process contained in the Bill is biased in favour of assisted death: doubts or indeed the fact that the “independent doctor” (who is not independent from the first doctor) does not think the tests are met do not stop the process (another doctor can be consulted instead). Similarly, a refusal by the High Court can be appealed. but not an approval.