RCGP working group to explore implications of assisted dying law change

The Royal College of GPs will undertake research into assisted dying, following the passing of a motion at its Council last week. A working group will now be tasked with ensuring that “the College is prepared for any potential changes in the law on assisted dying across the UK” and to “think through the practical implications of any potential legal change” for GPs.

This comes ahead of a debate and key vote on assisted dying legislation in the Isle of Man next month, introduced by GP and Member of the House of Keys, Dr Alex Allinson, with proposals also progressing in Scotland and Jersey. Westminster’s Health and Social Care Select Committee is due to report on the first ever Commons inquiry into assisted dying, launched in December. An assisted dying bill is expected to be introduced in France and Ireland’s Oireachtas is conducting an inquiry into assisted dying, due to report in March. More than 250 million people worldwide already have access to assisted dying laws.

A survey of RCGP members in 2019 found a range in views on assisted dying, with 41% believing the College should be officially supportive of law change, 10% believing it should be neutral and 46% believing it should be opposed. Other medical colleges and organisations have dropped their opposition in favour of neutrality in order to represent diversity of opinion amongst their members, including the British Medical Association, the Royal College of Nursing, the Royal College of Physicians, the Royal College of Psychiatrists, the Royal Pharmaceutical Society and the Royal College of Surgeons. In 2020 the RCGP announced it would remain opposed to law change following the release of its survey results, a decision that attracted criticism from medics and patients.

Sarah Wootton, Chief Executive of Dignity in Dying, said:

“We welcome the RCGP’s decision to explore what the College must do to prepare for assisted dying reform. This pragmatic move recognises the prospect of law change and the crucial role of doctors in supporting dying people who want greater choice at the end of their lives.

“It comes as jurisdictions across the British Isles take strides towards safer, more compassionate laws on assisted dying, with new research revealing fresh evidence of the harm inflicted by the current blanket ban. The skyrocketing cost of accessing a safe, legal assisted death in Switzerland means Brits are being priced out of this option, with hundreds of terminally ill people every year resorting to taking their own lives – including those receiving specialist palliative care – and thousands suffering against their wishes despite the best efforts of end-of-life care. The experiences of dying patients and their loved ones must play a key role in the College’s research.

“Meanwhile, an increasing body of evidence from around the world shows how assisted dying laws can work in practice. We hope the College will learn from GP colleagues overseas, including in Australia, New Zealand and the US, where laws allowing this choice for terminally ill, mentally competent adults are safe and popular.

“There has been a seismic shift in the views of the medical profession in recent years, with the UK’s largest doctors union and several Royal Colleges dropping their opposition in favour of neutrality. The RCGP is now the only British medical Royal College that opposes law change, a decision taken nearly four years ago after a survey found that a majority of respondents wanted the College to be neutral or supportive of law change. When this decision returns to Council, GPs and patients alike will expect the College to adopt a truly representative position. In the meantime, it is vital that its research into assisted dying is transparent and evidence-based.”

New research from Dignity in Dying has revealed that the average cost of travelling abroad for an assisted death in Switzerland has increased by £5,000 to an average of £15,000 in the past 5 years – a staggering 50%.¹ This option is out of reach for the majority of people in England and Wales, almost two-thirds (63%) of whom could not afford this if they needed it.

A Freedom of Information request to NHS Trusts that record relevant data has revealed that 1 in 7 Trusts in England and Wales have a record of at least one suicide or attempt by patients receiving specialist palliative care. Dignity in Dying research in 2021 estimated that up to 650 terminally ill people take their own life every year, with up to 10 times as many attempts.

New polling has found over half (57%) of people in England and Wales have seen a loved one suffer at the end of life, new research has also found, with four in 10 (42%) believing they would have considered an assisted death had it been a legal option for them in the UK.

Nearly 8 in 10 people (78%) in England and Wales say they would support the introduction of a law that would enable terminally ill, mentally competent adults this choice – the model Dignity in Dying advocates for the UK.

***ENDS***

For further information and interview requests with case studies and Dignity in Dying spokespeople, please contact Molly Pike, Media and Campaigns Officer at Dignity in Dying, on 07929 731181 or email: molly.pike@dignityindying.org.uk.

Notes to Editor:

Dignity in Dying’s report – Time for Choice: The truth about the UK’s ban on assisted dying – for the first time brings together existing evidence plus brand new research and polling on how the UK’s lack of a legal, safeguarded option of assisted dying causes significant harm to dying people and their families every day. It exposes how the current law is:

• Unsafe. Up to 650 dying people end their own lives in the UK every year. These deaths are often violent and lonely.²
• Unfair. 17 people a day suffer as they die because palliative care, no matter how good, cannot relieve all suffering all of the time.³
• Unregulated. More than 630 dying Brits have travelled to Switzerland for an assisted death. This option is not available to everyone, and the law offers no protection to individuals or loved ones who provide support. ⁴

The report compares powerful real-life stories of dying people in the UK with their counterparts in Australia and the US, where assisted dying laws gave them the ability to control the manner and timing of their deaths within robust legal frameworks. The report also includes, for the first time, data from NHS Trusts in England and Wales documenting suicides and suicide attempts among people receiving specialist palliative care in hospitals. This data shows that, despite the outstanding palliative care offered by hospitals and hospices across the country, there is an urgent need for the safeguards that an assisted dying law would provide.

Time for Choice: The truth about the UK’s ban on assisted dying can be viewed and downloaded at https://www.dignityindying.org.uk/timeforchoice

All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 1,844 adults. Fieldwork was undertaken between 26th – 27th July 2023. The survey was carried out online. The figures have been weighted and are representative of all adults in England and Wales (aged 18+).

The data found that:

• 78% of people support a change in the law to allow assisted dying as an option for terminally ill, mentally competent adults
• 57% of people in England and Wales have seen a loved one suffer at the end of life and 42% think their loved one would have considered an assisted death if legal
• Over half of Brits (56%) would consider an assisted death in Switzerland if terminally ill but less than a third could afford it (28%)

¹ The cost of travelling to Switzerland for an assisted death is based on the average cost of flights, transport in Switzerland, accommodation, food and drink and fees of organisations that provide assisted dying. A direct comparison has been made with an equivalent calculation by Dignity in Dying in November 2017.

² Figures can be found in Dignity in Dying’s research report Last Resort https://www.dignityindying.org.uk/wp-content/uploads/Last-Resort-Dignity-in-Dying-Oct-2021.pdf

³ In research commissioned for Dignity in Dying’s report Inescapable Truth, the Office of Health Economics concludes that, even if every dying person who needed it had access to the level of care currently provided in hospices, 6,394 people a year would still have no relief of their pain in the final three months of their life. This equates to 17 people every day. Stats published here: https://www.dignityindying.org.uk/wp-content/uploads/DiD_Inescapable_Truth_WEB.pdf

⁴ Data collected by Dignity in Dying from assisted dying organisations Dignitas and Life Circle. Not all assisted dying organisations in Switzerland publish data.

Dignity in Dying campaigns for greater choice, control and access to services at the end of life. It campaigns within the law to change the law, to allow assisted dying as an option for terminally ill, mentally competent adults.​

Assisted dying refers to a request by a mentally competent, terminally ill person for medication to end their life at a time and place of their choosing. It is only granted if the person meets strict eligibility criteria, and there are robust safeguards to help protect against abuse or coercion. The person must have full mental capacity from the first request to the point they take the medication – though they can pause the process at any time or choose not to take it.

The law

Assisted dying is prohibited in England and Wales under the Suicide Act (1961), and in Northern Ireland under the Criminal Justice Act (1966) which states that anyone who “encourages or assists a suicide” is liable to up to 14 years in prison. There is no specific crime of assisting a suicide in Scotland, but it is possible that helping a person to die could lead to prosecution for culpable homicide. Assisted dying is not a legal option in any of the British Crown Dependencies but they have power to legislate independently from Westminster.

The current CPS guidelines, covering England and Wales, state that a prosecution for assisting a suicide is less likely if the deceased individual had reached a voluntary, settled and informed decision to end their life and if the suspect was motivated wholly by compassion. In 2022 the CPS announced it was considering adopting similar guidelines for cases of so-called ‘mercy killings’ and suicide pacts, which would be tried as murder or manslaughter charges under the current law. However these guidelines do not change the law – assisted dying in any form is illegal and still carries the risk of investigation, prosecution and serious jail time.

Westminster

The Health and Social Care Select Committee is currently conducting the first ever House of Commons inquiry into assisted dying and is expected to issue a report later this year.

Baroness Meacher’s Assisted Dying Bill passed its Second Reading unopposed in the House of Lords (Friday 22 October 2021). Further time for consideration at Committee Stage was not allocated before it fell at the prorogation of Parliament on 28th April 2022.

The Bill was selected seventh in the House of Lords private members ballot in May and received its First Reading on Wednesday 26th May 2021. The full text can be found here: https://bills.parliament.uk/bills/2875. It is based on a bill introduced by Lord Falconer in 2014. Rob Marris MP introduced a similar bill in 2015 which was defeated in the Commons.

In July 2022, Dignity in Dying’s government petition, which was signed by more than 155,000 people, was debated in the House of Commons. Supporters of reform outnumbered opponents two-to-one in the debate and MPs from all parties expressed support for an inquiry on assisted dying. The last private members bill heard in the Commons was in 2015 and was rejected at the time.

Holyrood

On Thursday 8th September 2022 Liam McArthur MSP lodged his Assisted Dying Bill, which would legalise assisted dying for terminally ill adults with mental capacity. The final proposals were lodged on the same day a report analysing the responses to the public consultation on the Bill’s proposals was published. The proposals received the highest number of responses to date for a consultation on a Members Bill in the Scottish Parliament with 14,038 valid consultation responses submitted. The report’s findings showed that a clear majority of respondents, 76%, were fully supportive of the proposal, with a further 2% partially supportive.

On Monday 10th October 2022, the Bill was granted the right to be introduced in Parliament. Within two hours the Bill received backing from 36 MSPs, double the 18 signatures needed. The drafting stage is now underway, followed by committee scrutiny and a Stage One vote.

Jersey’s States Assembly

The States Assembly on November 25 2021 voted in favour of a proposition to support a change in the law on assisted dying by 36 to 10. A public consultation was held and a report was released in April 2023. The government is now refining detailed assisted dying proposals and an ethics review is underway. The refined proposals will be lodged in December for a States Assembly debate in February 2024, with law drafting to begin in March if approved.

This follows a citizens’ jury in Spring 2021 on the subject, comprised of a random representative sample of islanders, which strongly recommended a change in the law to enable islanders who are terminally ill and unbearably suffering to be able to request medical assistance to end their own life.

Isle of Man’s Tynwald

On 24 May 2022 Members of the House of Keys voted overwhelmingly (22-2) to allow a private member’s bill on assisted dying to be introduced in Tynwald, the Isle of Man’s parliament, by Dr Alex Allinson MHK, following a public consultation. A draft bill has been prepared, which had its First Reading in Tynwald in June and its Second Reading will take place in the autumn of 2023.

The Republic of Ireland’s Oireachtas

The Dáil launched a Special Committee on assisted dying in June 2023. This follows the Dignity in Dying Bill 2020, a private member’s bill introduced by Gino Kenny TD, which despite receiving strong public and political support, the Justice Committee decided not to progress, announcing instead that a Special Committee would be established to examine the issue.

Healthcare professionals

The British Medical Association (BMA) dropped its official opposition to a change in the law on assisted dying in favour of neutrality, following a debate at its Annual Representative Meeting in September 2021. The largest ever poll of British doctors on assisted dying, conducted by the BMA last year, found overwhelming support for a change to the BMA’s former stance of opposition to an assisted dying law (61%), and that half of doctors personally support a change in the law (50%). This position was affirmed in 2022.

In March 2019, the Royal College of Physicians (RCP) dropped its longstanding opposition to assisted dying in favour of neutrality following a member survey. The Royal Society of Medicine, Royal College of Nursing (and Royal College of Nursing Scotland), the Royal College of Psychiatrists and the Royal Pharmaceutical Society all hold neutral positions on assisted dying.

The Royal College of Surgeons of England announced in March 2022 that it would be surveying its members for its views on assisted dying and reviewing its current opposition to law change, a stance held since 2014. It voted to drop its opposition in favour of a position of neutrality in June 2023.

In June 2022 the Royal College of Nursing (RCN) voted to update its neutral position statement on assisted dying to reflect the changing landscape of the debate and to explore how it can best support and inform nurses on the issue, maintaining the neutral stance it first adopted in 2009 and reaffirmed in 2014.

The Academy of Medical Royal Colleges, Association of British Neurologists, General Medical Council, General Pharmaceutical Council, Royal College of Anaesthetists, Royal College of Obstetricians and Gynaecologists, Royal College of Ophthalmologists, Royal College of Paediatrics and Child Health, Royal College of Pathologists, Royal College of Physicians of Edinburgh, Royal College of Radiologists and Royal College of Surgeons of Edinburgh have no stated position on a change in the law on assisted dying.

In September 2020, Eminent GPs Prof Aneez Esmail and Sir Sam Everington launched a legal challenge to the Royal College of GPs (RCGP) alongside the Good Law Project and Dignity in Dying over RCGP Council’s decision to maintain opposition to assisted dying despite its own survey showing a dramatic shift in GP opinion. The Association for Palliative Medicine also holds a stance of opposition to a change in the law on assisted dying.

International developments

In September 2022, French President Emmanuel Macron announced a national debate on assisted dying will take place in France with the launch of a citizens’ convention, with a view to legalising assisted dying by the end of 2023. The citizens’ convention began in October, and an initial report in February 2023 found that the vast majority of participants were in favour of the legalisation of assisted dying. The French Government will concurrently work with Parliamentarians to develop draft legislation.

In the US, assisted dying as an option for terminally ill, mentally competent adults in their final months of life is legal in 11 jurisdictions: Oregon (1997), Washington, Vermont, Montana, the District of Columbia, California, Colorado, Hawaii, New Jersey, Maine and New Mexico (legislation approved April 2021).

In Australia, assisted dying is a legal choice for terminally ill citizens in all states: Victoria (June 2019), Western Australia, Tasmania, South Australia, Queensland and New South Wales. A Bill is currently being drafted in the Australian Capital Territory, with only the Northern Territory remaining.

In November 2021 New Zealand implemented an assisted dying law which legalised this option for terminally ill, mentally competent citizens, following a public referendum on the End of Life Choice Act in October 2020.

In May 2023, Portugal’s Parliament approved an assisted dying bill which the President signed into law, having previously twice rejected legislation. The Bill is expected to come into force in autumn 2024.

Spain passed a law allowing euthanasia in March 2021.

Austria’s Supreme Court ruled in December 2020 that its blanket ban on assisted dying is unconstitutional. Assisted dying became legal for adults who are terminally ill or have a permanent, debilitating condition in Austria in January 2022.

In November 2021, an Italian ethics committee approved for the first time an assisted dying request, after a 2019 Constitutional Court ruling that assisted dying is lawful for terminally ill people and those with chronic and irreversible conditions that cause suffering the person considers intolerable. In February 2022 Italy’s Constitutional Court rejected a petition to hold a referendum on assisted dying.

Germany began considering potential assisted dying legalisation in January 2021 after its Constitutional Court struck down the ban in 2020.

Canada introduced assisted dying legislation in 2016 permitting those suffering from a grievous and irremediable medical condition.

In Colombia legislation was passed in 2015 which permits those with terminal illness or unbearable suffering to request access to life-ending medication.

Assisted dying is permitted in Switzerland, including for foreign nationals, and broader right-to-die laws are in place in Belgium, the Netherlands and Luxembourg.