If a patient says they are wanting to do it because they feel they are a burden or because they do not have access to palliative care, there is no provision in the Bill to refuse their application. Indeed, it must be granted.
Once it is established that a patient has a “terminal illness” and has capacity, their wish to die needs to be “clear, settled and informed” (clauses 7(2)(f), 8(2)(d) and 12(3)(g)). The meaning of these terms is not clear. “Clear” presumably means there has to be some degree of determination, “settled” that it isn’t (to the knowledge of the doctors signing the forms) frequently changing, but it is totally unclear what “informed” means in this context.
Beyond that, any reason to die is acceptable as long as it is the patient’s actual view, and they have not been coerced or pressurised into it by another person (clauses 7(2)(g), 8(2)(e) and 12(3)(h)).
Therefore, to take sort of the abuses that have been documented overseas, a patient whose explicit reason is that:
- they are afraid of poverty as a disabled person; or
- they have been told they cannot return home without a stairlift but the waiting list for a stairlift is 9 months; or
- they are ashamed of the money being spent on them by the NHS; or
- they are afraid that the money their children hoped to inherit from them will disappear into care home fees;
would all qualify. It might be that these could be characterised as self-pressure or pressure by circumstances but as the Bill’s provision on coercion and pressure is limited to pressure from another person, this would not disqualify those reasons.
There would be no basis to refuse approval by the medical professionals or courts for any of these grounds.
In that context the fact that it is permitted for medical professionals to raise the issue of assisted dying with a patient who has not previously expressed an interest is very alarming. Even telling someone that they are wasting valuable space in a hospital, if it fell short of “pressure”, would not be an impediment to suicide. If a patient is successfully persuaded by their family that it is best that they die and the house doesn’t need to be sold to pay for a nursing home, or is successfully persuaded by their doctor that it is best that they die so their hospital bed can be used by someone more deserving, there is no flexibility in this legislation: the doctors, and the judge, must approve the suicide. They can only refuse to approve the suicide if they come to the view that the patient has been coerced or pressurised by another person into their decision. A patient who has been successfully persuaded to seek an assisted suicide, but has not been coerced or pressured, must be approved.