Assisted dying for the terminally ill Bill
BGS response to the House of Lords

• The BGS accepts the rights of individuals to determine the choice of treatment and care they receive. We further accept that sometimes, but very, very rarely, some symptoms are difficult to control and that even if they are, people may still find their life unbearable. Yet a policy which allows patients, in certain circumstances, to choose death, and to be helped to die by their physicians, is not the ethically correct answer.
• The BGS believes the duty of the physician to care for his/her patients is incompatible with a duty to bring about death even at the request of the patient. It is argued by proponents of euthanasia that curing disease and bringing about death are not mutually exclusive roles, the intention in both cases being the relief of suffering. It is further argued that the primary role of the physician is to care for his/her patient, which must therefore entail respecting their autonomous wish to die. However, the BGS believes that crossing the boundary between acknowledging that death is inevitable and taking active steps to bring about death changes fundamentally the role of the physician, changes the doctor patient relationship and changes the role of medicine in society. The focus would shift from providing the best palliative care i.e. easing symptoms, to providing death on demand. Such a shift will inevitably dilute the sanctity of life doctrine. Once quality of life becomes the yardstick by which the value of human life is judged, the protection offered to the most vulnerable members of society is weakened.
• In the experience of many geriatricians, the feeling for many older people that life is unbearable in its later stages is a direct result of the reaction of others to their frailty and the care and treatment they are afforded. Our concern then is that many older people, because of the care given to them by society in general and the NHS and Social Care system in particular, will perceive themselves as a burden and feel under pressure to end their lives. The BGS considers the best way of helping these vulnerable people is to maximise their independence and health, rather than acceding to their expressed wish to die.
• The BGS believes that Older People are often unduly influenced by their families and carers. It is important to remember that not all these people will necessarily have the older person’s well being at heart. Even if they do, it is noteworthy that almost all requests to end life – made either directly or indirectly to us as geriatricians - come from the patients’ families and not the older person themselves. Often such requests are then forgotten if such degrading symptoms as urinary and faecal incontinence, depression and unremitting pain are relieved. The BGS thus questions the true need for the bill.
• Whilst many older people are competent to make decisions about their wish for assisted dying, many will not be. The proposal in the Mental Capacity Bill is to appoint a health attorney with the legal authority to take health and welfare decisions for a person in the event of his or her loss of capacity. This could mean, under the terms of the Assisted Dying bill, that a decision to end an older person’s life could be made by a nominated health attorney. The complexities arising from such conditions could therefore lead to serious abuse of this power. Furthermore, such situations might interfere with the beneficial use of the Mental Capacity Bill.
• We are concerned about the addition of Section 15 to the Bill. The right of any individual, whether terminally ill or not, to have their symptoms controlled is undisputed. In our opinion there is no overlap in clinical practice between symptom control and the wilful termination of life (or assisted dying). To muddle the two is to cause considerable confusion and to risk the danger that symptom control becomes an easier way to hasten death than completion of the declaration and all the safeguards therein - especially for people who are deemed incompetent.
• In the same vein, the BGS would emphasise that the right of a patient to choose or decline prolonged treatment and or intervention whatever the consequences, supersedes all other guidance and wishes.
• Finally the BGS is concerned that the ‘Assisted Dying for the Terminally Ill Bill’, whilst it does not apply directly and solely to older people, will lead to a change in attitude to death in society and also within the medical profession. The prohibition on intentional killing is the cornerstone of society and it is worth preserving the notion that all lives are precious. The BGS accepts that this denies a very small number of persons the right to have their life ended by their physician if it is their autonomous wish. However it must be noted that every society puts some limits on respect for autonomy, which must be balanced against the greater good of society. The BGS urges Parliament instead to strive to improve the medical and social care of older people, placing them back in the centre of a society which respects their wisdom and experience. Rather than defining the conditions under which physicians may become killers, our efforts should focus on improving all aspects of palliative care, such that the debate on assisted death becomes irrelevant.
• In summary therefore, the British Geriatrics Society is totally opposed to the introduction of the Assisted Dying Bill.

• A cooling off period of at least 14 days, after the declaration has been signed and witnessed.
• A mandatory psychiatric opinion to exclude a depressive illness – from a specially trained psychiatrist
• Involvement of the patient’s general practitioner in any discussion around the signing of a declaration.
• Written confirmation from the doctors and solicitors involved that neither they, their families nor any charity with which they are associated or connected, will benefit from the patient’s will.
• Obligatory assessment by a specialist palliative care team.
• In the case of older people, where the attending doctor is not a geriatrician, there must be obligatory assessment by a consultant geriatrician.