“The current legal status of assisted dying is inadequate and incoherent...” THE COMMISSION ON ASSISTED DYING The Commission on Assisted Dying was set up in September 2010 to consider whether the current legal and policy approach to assisted dying in England and Wales is fit for purpose. In addition to evaluating the strengths and weaknesses of the legal status quo, the Commission also set out to explore the question of what a framework for assisted dying might look like, if such a system were to be implemented in the UK, and what approach to assisted dying might be most acceptable to health and social care professionals and to the general public. The Commission’s terms of reference are as follows: · to investigate the circumstances under which it should be possible for people to be assisted to die · to recommend what system, if any, should exist to allow people to be assisted to die · to identify who should be entitled to be assisted to die · to determine what safeguards should be put in place to ensure that vulnerable people are neither abused nor pressured to choose an assisted death · to recommend what changes in the law, if any, should be introduced. The Commission on Assisted Dying engaged in a wide-ranging inquiry into the subject, which included: a public call for evidence which received over 1,200 responses from practitioners, professional bodies and members of the public; six public evidence meetings to gather oral evidence from experts and individuals with relevant experience; international research visits to four jurisdictions in which some form of assisted dying is legally permitted; original research on the relationship between suicide and serious physical illness and into attitudes on assisted dying among people from ‘vulnerable groups’; and commissioned research on the effectiveness of legal safeguards, and the quality of palliative care, in jurisdictions that permit some form of assisted dying. As far as possible the Commission has published all of the evidence received on its website at www.commissiononassisteddying.co.uk. The Commission alone is responsible for the conclusions published in this report, which are based solely upon the evidence it has received. First published in 2011 © Demos. Some rights reserved Magdalen House, 136 Tooley Street London, SE1 2TU, UK ISBN 978-1-906693-92-3 Copy edited by Susannah Wight Series design by modernactivity Typeset by modernactivity Set in Gotham Rounded and Baskerville 10 THE COMMISSION ON ASSISTED DYING Open access. Some rights reserved. As the publisher of this work, Demos wants to encourage the circulation of our work as widely as possible while retaining the copyright. We therefore have an open access policy which enables anyone to access our content online without charge. Anyone can download, save, perform or distribute this work in any format, including translation, without written permission. This is subject to the terms of the Demos licence found at the back of this publication. 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To find out more go to www.creativecommons.org Contents Acknowledgements 9 Note from the Chair 11 The Commissioners 13 Executive summary 19 A summary of the Commission’s analysis 23 Introduction 37 The assisted dying debate in the UK 1 The current legal position on assisted dying 47 2 The ethical basis of the assisted dying debate 69 3 Perspectives on the current legal status of assisted suicide 89 4 The assisted dying debate in the context of UK health 107 and social care services 5 Assisted dying and vulnerable groups 161 Practical issues posed by a legal framework to permit assisted dying in the UK 6 Determining eligibility for assistance 193 7 Identifying what safeguards might be needed in legislation 219 8 Procedural issues 251 The way forward 9 Reflections on the evidence 283 10 Core principles 295 11 Principles to underpin a legal framework for assisted dying in the UK 299 12 Changes to law and policy 321 Appendices 1 Individuals and organisations that gave evidence to the Commission 327 2 A proposed framework to underpin assisted dying legislation in the UK 337 3 Statement by the Reverend Canon Dr James Woodward 347 4 The Demos Secretariat 349 Notes 353 References 403 7 9 Acknowledgements First and foremost, we would like to thank the many individuals and organisations who gave evidence to the Commission. This includes those who submitted written evidence, took part in the Commission’s public evidence hearings, or participated in the interviews and focus groups that Demos conducted in the UK. We are also very grateful to the many experts and practitioners who generously gave their time to the Commissioners during their research visits to Belgium, the Netherlands, Oregon and Switzerland. The Commission could not have produced such a rich and comprehensive report without these hugely valuable contributions, and we feel privileged to have had so many informative, thought-provoking and often moving conversations during the course of our inquiry. We would also like to thank the Demos research and communications secretariat for their valuable assistance in coordinating the Commission’s call for evidence, organising the Commission’s public evidence hearings and outreach activities, processing and synthesising the many forms of evidence received and managing press and communications for the Commission, including the Commission on Assisted Dying website. In particular our thanks go to Louise Bazalgette, Secretary and Lead Researcher to the Commission; William Bradley, Researcher to the Commission; Beatrice Karol Burks, Demos’s Head of Communications; Sarah Kennedy, Demos’s Head of Events and Partnerships and to Julia Margo, Demos’s Deputy Director for her role in initiating the project and providing guidance throughout. We would also like to thank Richard Reeves for providing the original impetus for the project, Phillida Cheetham for her support with the Commission’s consultation and outreach activities, Sophie Duder for her assistance with the Commission’s meetings and international visits and Ralph Scott for recording and disseminating the evidence sessions and managing the publication process for this report. In addition to these Demos staff members, a huge number of Demos research and events interns made very valuable contributions to the Commission’s work, including Joanna Farmer, Matthew Fraser, Poonam Pattni, Jenny Ousbey, Luqman Meedin, Nicolette Stickland, Emily Benbow, Roisin Watson, Jamie Morgan Evans, Alexandra Paget, Jumoke Akintola, Ellie Brawn, Jennifer Brindisi, Gerard Corvin, Emma Sinclair, Samantha Freitag, Paris Gourtsoyannis, Beth Hacche, Ronley Kirwan, Sarah Taylor, Daniel West, Sebastian Mann, Rory Cronin and Ewan Wright. We would like to thank Celia Grandison-Markey for her role in supporting the Commission on Assisted Dying in its early stages, including her thoughtful contributions at early evidence hearings and in the research visit to the Netherlands. Finally, we could not have undertaken this extensive independent inquiry without the generous financial support of Sir Terry Pratchett and Bernard Lewis and we are very grateful them for making the Commission on Assisted Dying possible. The Commission on Assisted Dying January 2012 11 Note from the Chair It has been a great privilege being the Chair of the Commission. I can’t thank each individual Commissioner enough. The contribution each individual Commissioner has made from different standpoints has been immense. We have gone together on a journey, and although we did not all end up at precisely the same place, I could not have had more talented and congenial travelling companions. Louise Bazalgette and Will Bradley have done a simply stupendous job in organising our programme and reflecting our thoughts. My thanks to them and the individual Commissioners is profound and long-lasting. Lord Charles Falconer Chair of the Commission on Assisted Dying 13 The Commissioners Lord Falconer, Chair Charles Falconer is an English qualified barrister and a partner in the US law firm, Gibson, Dunn & Crutcher, working out of their London office. He spent 25 years as a commercial barrister, becoming a QC in 1991. He became a peer and the solicitor general in May 1997. He was a minister in the Blair government from 1997 to 2007 as Lord Chancellor, Minister of State for Criminal Justice, Sentencing and Law Reform and Minister for Housing, Planning and Regeneration. He is chair of Amicus Horizon Housing Association, One Newcastle Gateshead Ltd, the John Smith Memorial Trust, Ravensbourne College and the Visitor of Queens’ College, Cambridge. He sits as a Labour peer in the House of Lords. Professor Sam H Ahmedzai Sam H Ahmedzai is chair and head of the Academic Unit of Supportive Care at the School of Medicine in the University of Sheffield. He is an honorary consultant physician in palliative medicine, working in a hospital supportive care team for 15 years. Before that, he was medical director of the Leicestershire Hospice for nine years. He led the Adult Cancer Survivorship Project in Sheffield. He chaired the European Association for Research and Treatment of Cancer groups ‘Quality of Life’ and ‘Pain and Symptom Control’. He was founder of the Association for Palliative Medicine Science Committee. He is editor of the Oxford University Press book series on supportive care; the journal Current Opinion in Supportive and Palliative Care; the section on supportive and palliative care for BMJ Clinical Evidence; and he is expert adviser to NICE NHS Evidence.