Assisted Dying

dudleyowenDeputy's Blog 2018

On 1st May, I hosted an event at Les Cotils at which the matter was debated by experts in this subject who had kindly visited Guernsey (2 of these guests I know at their own expense) to debate the subject.

I felt very strongly that the such a serious moral issue, which would not only derail States priorities at a sensitive time during BREXIT negotiates, but would also raise potentially serious constitutional issues for us, had received insufficient exploration by the public before the debate. This is why I paid for the room hire at my own expense, invited UK speakers and encouraged the Requerents also to join in the discussion.

Here is a link to some press coverage at the time which documents the context:

This is a record of my Speech from 17th May 2018 on Assisted Dying.

Deputy Dudley-Owen: Firstly, sir, I would like to record my apologies to anyone whose correspondence I have not yet responded to. The sheer number of representations for and against have been huge and I thank each and every one who has taken the time to share their view.

I will not rehearse arguments today either for or against the principle of assisted dying in my speech.  I think some will be surprised by the views I hold in the matter, but I am not opposed to the principle of doctor-assisted suicide. But I do contest the assertion made by Deputy Roffey in his speech that this is purely a matter of conscience. It is absolutely not; certainly not for me. If that was the case, I am sure this matter would not have received the amount of air time it has, and, for me, this would have been a very easy decision. Whether or not I agree with the principle of assisted dying has in fact faded almost into little material consequence over the past two months. This is because I have been unsatisfied by the approach to this debate.

I would like first to discuss the foundations on which this debate has been laid by those leading the Requête.

Notwithstanding the media coverage and the email correspondence, I do not believe that this subject has received anywhere near the amount of constructive, sophisticated level of community engagement that it should have. This is a nuanced, complex and multi-layered issue that requires far more than just conscience to unpick and understand.

In an attempt to address that, I organised an event trying to give both sides of the argument actual notice, to give some balance and get more expert information out there.

I am very pleased that this was well received by fellow Deputies and the community, because I put a lot of time into the exercise and am grateful for the involvement of four speakers who came to Guernsey under their own steam to help us to form our view.

The last-minute amendments laid by the signatories have added to my unease because, for me, they demonstrate a lack of clear and strategic thinking from the Requérants as to exactly what they want and how exactly they want it to be implemented. A move such as we are being asked to consider requires a very clear vision to be presented to the community, so they can see very clearly what it is we, in this Chamber, are being asked to agree to. The Requête has undergone what, at a glance, may seem like substantial revision via the amendments. As others have already stated, I do not think in its substance, however, much has changed.

It promises various measures, including review of palliative care provision, the mental capacity Law, the rights to protect people with disabilities. But its central purpose that an assisted dying regime should be developed remains unchanged. The revised Requête suffers from the same defect as its predecessors. It asks us to agree to launch a study and charge the Policy & Resources Committee into how the Law should be changed. But it does not seem to think there is any need for an inquiry into the all-important question of whether the Law should be changed. I possibly would have been prepared to agree with the launch of a detailed study into whether the Law should be changed and, if that should conclude and the States should agree that the Law does need to be changed, then I could be willing to support a detailed study of the second question of how it should be changed. That, in my view, should be the proper order in which to holistically approach this matter. But that is not the way in which this Proposition has been laid. What we have in this Requête is a cart-before-the-horse situation.

Like Deputy Parkinson, a further concern I have with the proposal is that the working party would be intended to report back to the States with recommendations to develop a regime that would permit assisted dying.

A recommendation, as Members know, is a commendation, an endorsement, a positive way forward. This is not the approach I would have taken and is not the approach I want our States, or any government in fact, to look into the feasibility of developing a legal regime to permit assisted dying. Such a profound cultural shift.

The working party, as part of their inquiry, needs to consider the pros and cons, the disadvantages and advantages, the SWOT analysis – the strengths, weaknesses, opportunities and threats of introducing assisted dying. The principles of corporate governance need to be applied. They are glaringly missing from the proposal.

I recognise and respect that the signatories want to see an Assisted Dying Law as soon as possible and I have no doubt of their sincerity. But as I have mentioned earlier, on the whole I am disappointed with the rather simplistic approach to this matter.

This is of the utmost gravity involving, literally, life and death decisions on which there needs to be careful and painstaking collection of expert technical and specialist evidence and sober reflection by the States.

A particular characteristic of the debate which I have also been unhappy about was mentioned yesterday by Deputy Stephens. I am expressing my disappointment now at some of the comments made during the debate towards the views of those with a religious conviction.

I am not a person of faith, but I find the suggestion of shutting down the views of people with faith pretty offensive. I believe strongly in the freedom of speech and respect the arguments and opinions of all, no matter what their faith, their beliefs or their experiences.

The irony is not lost on me, sir, that having stated that religion has no place in this debate by one of the Requérants, Rabbi Jonathan Romain came to argue the case in support of the Requête. Now we have had a deluge of media interest and consequently many statements from stakeholders and interested parties.

At this stage and in the interest of balance, I would like to read out the following statement, which has been received in the last day or so, from the Royal College of Physicians. The Royal College of Physicians does not support a change in the Law on assisted dying. In the event that the States of Guernsey were to decide to legalise assisted dying, the Royal College of Physicians would be willing to provide advice in regard to the implications of such a law for medicine and for clinical practice on the Island, and to provide guidance as necessary to doctors.

This will not in itself change the position of the Royal College of Physicians with regard to assisted dying and should not be interpreted as implying any change in the policy either now or in the future. Some headlines around their stance in the last couple of days may have been easily misinterpreted, so I hope that this serves to clarify their position.

In conclusion, it follows in my logic, and also proved somewhat by the disagreement yesterday over the facts between Deputies Roffey and Le Tocq, that an apparent lack of funding over decades towards States-funded palliative care services has meant that end of life care has not been given the support and resources that it should have.

I base my opinion on various conversations with local medical professionals and also information stated on Les Bourgs Hospice website. Despite being told that there was no need for a residential hospice locally, as a population of Bailiwick size was only 0.74 of a bed, they believed differently and, when told by the authorities that they would get no help initially, or in the future, their resolve to create a hospice strengthened.

So, in 1991, the hospice founders were told that they would get no help then or in the future and that the requirement of the Bailiwick’s population for residential hospice accommodation was less than a bed per year, so not even one patient a year would require hospice admission in the final days of their life.  Les Bourgs Hospice has understandably filled a gap in provision in Guernsey.

If this centre did not exist, if it were to close, I wonder if the President of Health & Social Care would be able to comment when she speaks whether they would be able to accommodate those patients at the PEH. In fact, if palliative care services were not offered in the various privately funded charitable institutions in our Island, how would we cope?  We know that Les Bourgs is expanding its remit to day care and respite care. It is arguably a centre of excellence in palliative care and is funded from private donations.

The position of no support was made just under 30 years ago, but how far has the palliative care team had to struggle on straitened resources, due to not being seen as a priority, those few decades ago, by the powers that were there?  Of course, I have seen vigorous nods from those in the Chamber over the last couple of days who sit on the Committee now and have no reason to doubt that this area has now been prioritised. However, we know that out of the 2004 debate came a recommendation, an endorsement to improve our palliative care.

Has this been maintained and how far has this been prioritised? Why are palliative care professionals who know our system well saying it could and needs to be improved? We heard Dr Susan Wilson last night, on the television, saying that amongst other things, we had no hospice beds for children and we need a 24/7 wraparound care regime.

Is it just this Requête that has brought this matter into sharp focus? Would it otherwise have remained the same? I will be supporting Deputy Le Tocq’s Proposition, which seeks to redress the balance and improve the quality of end of life care here in Guernsey.

One email which I received from a locally based doctor, which I think we all received, particularly resonated with me. We are often told, after all, to listen to the professionals. I will read from this now, her email, in finishing my speech:

“Listen to the medical profession, the majority of whom do not support assisted dying, instead of compassionate individuals who have had an unusually bad personal experience. To help these people, we would be much better placed to invest our money in palliative care than change laws. Give Government support to Les Bourgs Hospice to fund a palliative care consultant, or at least look at giving tax breaks to charities, which would have a huge impact on their ability to raise the massive amount of money required to provide this incredibly valuable, free service.”

Supporting this doctor’s claim, is the 2016 BMA in-depth study of the public and doctors, entitled ‘End of Life Care and Physician Assisted-Dying’. The majority of doctors in the union who were studied felt that legislation would do more harm than good. It is noteworthy that the more people understood what is involved, the less supportive they were of a change in legislation. This was also borne out by my research locally.

The vast majority of doctors I have spoken to or have been contacted by are not in favour of a change in the legislation, because they believe it could do more harm than good. That it was not compatible with their role and that the matter was being over-simplified. Whether or not they are in agreement with or have sympathy with the principle.

I will not be able to support the amended proposals to ultimately change our legal regime to allow assisted dying. I have not been convinced beyond reasonable doubt that a strong enough case has been made for us to change. Thank you. (Applause)