The regime envisaged by the Bill has a general bias towards an assisted suicide. There is a great deal of concern that nobody should be unfairly refused such a death, but much less concern that nobody be improperly forced into one.
For example, compare the “initial conversation” requirements in clause 4 with the “cancellation of declaration” provisions in clause 14.
- At the beginning of the process, any doctor who is asked about assisted suicide by a patient must either explain to them the process or find another doctor who will do so: clause 4(3)-(5). It has been noted above that this provision may drive doctors who oppose assisted suicide out of the profession. However, it is also straightforwardly dangerous because it means that even if the first medic who the patient asks about assisted suicide is of the view that the patient lacks capacity or is under pressure to ask for it, or is in a state of temporary distress after receiving their diagnosis, that doctor must set the ball rolling on assisted suicide by explaining the process and options to the patient or asking another doctor to do so.
- In clause 14, provision is made for withdrawing a declaration of intent to die (the first formal step in clause 5). Note that the importance of this is not that without clause 14 someone might be forced to die against their will: obviously the patient can refuse to take the “substance” that will kill them at the time it is offered. The importance of clause 14 is that it reveals that a patient’s intention to die is changeable: it cancels the declaration but it is also recorded, under clause 17, meaning that if the patient makes a further request the doctors will be warned that their intention may not be settled.
- However, a cancellation under clause 14 only takes effect if made to the coordinating doctor or to the patient’s GP. If they state to any other doctor (e.g. their oncologist) that they no longer wish to die, that doctor is under no obligation to inform anyone else. This is very different to the situation where the patient is asking to die.
If the second doctor, the “independent doctor” under clause 8, decides that the patient is unsuitable for assisted suicide, the process does not stop: the coordinating doctor can then choose another doctor and ask them instead.
Similarly, if a judge refuses to approve an assisted suicide, there is an automatic right of appeal and the patient can ask the Court of Appeal to reconsider the whole application: there is no right to appeal against an approval of an assisted suicide.