PP12/06 SELECT COMMITTEE OF THE HOUSE OF KEYS ON VOLUNTARY EUTHANASIA SELECT COMMITTEE OF THE HOUSE OF KEYS ON VOLUNTARY EUTHANASIA At a sitting of the House of Keys on 13th May 2003 it was resolved that leave be given to introduce a Bill to enable a competent adult who is suffering as a result of a terminal or a serious and progressive physical illness to receive medical help to die at his own considered and persistent request; and to make provision for a person suffering from such a condition to receive pain relief medication; and for connected purposes. Amendment moved - that after the words “for connected purposes” the following be added - “and that a select committee of five members be appointed with power to take written and oral evidence pursuant to sections 3 and 4 of the Tynwald Proceedings Act 1876 on the subject matter of the proposed Bill and to report to the House before its introduction.” Amendment carried. House divided. Motion as amended carried. Mr Anderson, Mr Corkill, Mr Downie, Mr Gill, Mrs Hannan, Mr Houghton, Mr Quayle and Mr Rimington were nominated. After a ballot Mr Anderson, Mr Downie, Mr Gill, Mrs Hannan and Mr Rimington were elected. Mr Q B Gill MHK (Rushen) Chairman Hon D M Anderson MHK (Glenfaba) Hon A F Downie (until 19th April 2005) Mrs H Hannan MHK (Peel) Hon J Rimington MHK (Rushen) The powers, privileges and immunities relating to the work of a committee of the House of Keys are those conferred by sections 3 and 4 of the Tynwald Proceedings Act 1876, sections 1 to 4 of the Privileges of Tynwald (Publications) Act 1973 and sections 2 to 4 of the Tynwald Proceedings Act 1984. Copies of this Report may be obtained from the Tynwald Library, Legislative Buildings, Bucks Road, Douglas IM1 3PW (Tel 01624 685516, Fax 01624 685522) or may be consulted at www.tynwald.org.im All correspondence with regard to this Report should be addressed to the Clerk of Tynwald, Legislative Buildings, Bucks Road, Douglas IM1 3PW. Select Committee of the House of Keys on Voluntary Euthanasia Covering Paragraphs of the Committee’s Report Your Committee have, as will be seen below, received a very considerable amount of evidence, much of it of a technical medical kind, or relating to difficult and controversial matter of ethics. In the circumstances, we have felt that we could not do justice to this substantial body of material without the assistance of a suitably qualified researcher. Miss J Helps was accordingly invited to read, assess and report on everything which has been put to the Committee. This task was carried out over the summer Recess 2005 and it has been received and studied by your Committee since. The Report which follows has thus been prepared on behalf of the Committee by Miss J F Helps, and minor clarifications only have been made to it at the Committee’s request. Miss Helps has indicated that she accepts that these minor clarifications have in no way undermined the impartiality and academic integrity of her Report. Your Committee record their appreciation of Miss Helps’s work, which they believe presents the House with a thoroughly professional and balanced assessment of the arguments and evidence in this area. Miss Helps’s CV is at Appendix 1 to the Report. Table of Contents 1. Introduction .........................................................................................................2 2. Current Situation in the UK & Crown Dependencies......................................5 3. Jurisdictions with Legalised Assisted Dying ..................................................10 4. The Legal Situation Elsewhere Around the World ........................................33 5. The Ethical Arguments .....................................................................................36 6. Practical Issues...................................................................................................41 7. Opinions of the Health Care Sector .................................................................56 8. Public Opinions .................................................................................................65 9. Hospice & Palliative Care.................................................................................79 10. Issues to Consider in Proposed Legislation ..................................................85 11. Pain Relief & Double Effect Medication ........................................................99 12. Closing Statement..........................................................................................103 13. References ......................................................................................................104 1 1. Introduction 1.1 The Proposed Bill At the sitting of the House of Keys (HK) on Tuesday 13th May 2003 Members of the House of Keys (MHK) voted fifteen to seven in favour of Mr J Rimington MHK being given leave to introduce a Bill to - “enable a competent adult who is suffering as a result of a terminal or a serious and progressive physical illness to receive medical help to die at his own considered and persistent request; and to make provision for a person suffering from such a condition to receive pain relief medication; and for connected purposes.” The leave to introduce the Bill was qualified by the requirement that a Select Committee of five members be appointed with the power to take written and oral evidence pursuant to sections 3 and 4 of the Tynwald Proceedings Act 1876 on the subject matter of the proposed Bill and to report to the House before its introduction. After a ballot Mr D M Anderson MHK, Hon A F Downie MHK, Mr Q Gill MHK, Mrs H Hannan MHK and Hon J Rimington MHK were elected, and at the first meeting Mr Gill was elected as chairman. Hon A F Downie MLC was an original member of the committee but ceased to be a member when he was elected to the Legislative Council on 19th April 2005; he was not replaced. It should be noted that the Mover (Mr J Rimington MHK) and the Seconder (Mr Q Gill MHK) of a Bill are not automatically elected to any committee appointed to investigate it (HK Select Committee meeting 26/01/04). The Select Committee took the title Select Committee on Voluntary Euthanasia. The use of the term ‘Voluntary Euthanasia’ was decided upon as a working title for the Committee, both for ease of reference and the fact that it is a term that is widely understood. It should be considered however that the remit of the Committee is the long title of the proposed Bill as quoted above. 1.1.1 Mr P Kneen The Bill was proposed following a campaign by Mr Patrick Kneen. Mr Kneen was a Port Erin resident who was suffering from prostate cancer. Both he and his wife were members of the Voluntary Euthanasia Society (VES, please note that a list of all abbreviations used throughout this report can be found at Appendix 2) and campaigned for the legalisation of euthanasia in the Isle of Man (IOM). Mr Kneen, speaking on ‘Right to Die’ a Border TV production, said, “Surely people who feel this way should have the freedom to follow their beliefs and to be able to choose” (Border TV, broadcast 08/01/2004). 1.2 Definitions & Terminology 1.2.1 It is important to define the language of the debate if the debate is to inform meaningfully. Many definitions have been formulated for euthanasia and assisted suicide; therefore the meaning of terms used must be made clear in every case. The literal meaning of euthanasia is a good death as the word is derived from the Greek words ‘ef’ meaning good and ‘thanatos’ meaning death (Mystakidou, 2003). However, the term ‘euthanasia’ is now taken to mean a deliberate intervention whose primary intention is to end another’s 2 life; this is the definition adopted by the British Medical Association (BMA). The term voluntary euthanasia is commonly understood to mean “a doctor intentionally killing a person by the administration of drugs at that person’s voluntary and competent request”. 1.2.2 There are many prefixes added to the term euthanasia, such as voluntary, involuntary, nonvoluntary, active and passive. The distinction between ‘active’ and ‘passive’ euthanasia is inappropriate as euthanasia is by definition active. Furthermore the prefixes of voluntary, involuntary and nonvoluntary can be complicate matters unnecessarily. In this report the term ‘euthanasia’ will be used to mean the intentional killing of a person by the administration of drugs at that person’s voluntary and competent request. The prefix ‘voluntary’ will not be used as the killing of a person without their consent (involuntary or nonvoluntary) is not euthanasia it is murder. “Hence, euthanasia can be voluntary only. Accordingly the frequently used expression ‘voluntary euthanasia’ should be abandoned since it is by logical implication, and incorrectly, suggests that there are forms of euthanasia that are not voluntary” (Materstvedt et al. 2003). 1.2.3 Physician-assisted suicide is defined as a doctor intentionally helping a person to commit suicide by providing drugs for self-administration, at that person’s voluntary and competent request. Assisted suicide is defined as a doctor or another person intentionally helping a person to commit suicide at that person’s voluntary and competent request. 1.2.4 Prof. Baroness Finlay of Llandaff considered euthanasia and physician- assisted suicide to not merit distinction, “Should we be talking of euthanasia and physician-assisted suicide as two separate entities, or should we be talking of physician-assisted death only? In other words, is there any real difference in ethical terms or in