Doctors vote for the Royal College of Physicians to adopt a neutral position on assisted dying

Today, doctors voted to change the Royal College of Physicians policy on assisted dying to neutral and not oppose any change in the law.

In responding to whether the Royal College’s position on assisted dying should change, 43.4% voted to continue opposing a change in the law, 31.6% voted in favour of assisted dying reform, and 25% voted to adopt a neutral position.

A clear majority of 60% or more, would have been required for the Royal College to either oppose or support a change in the law.

In 2014, when the college last voted on this issue, 44.4% of doctors voted against assisted dying reform, 24.6% voted in favour of supporting assisted dying reform, and 31.0% voted for the college to adopt a neutral stance. Following this survey, the Royal College opted to oppose all further attempts to change the law, unlike in 2008 when it adopted a neutral stance.

This means, that although the numbers opposing assisted dying have not significantly changed since 2014, there has been a strong increase of those who believe the Royal College should support assisted dying reform from 24.6% to 31.6% and a majority of the Royal College voted against continuing a policy of opposition.

The Royal College of Nursing, Royal Society of Medicine, and Royal College of Psychiatrists have also adopted neutral positions the legalisation of assisted dying.

The figures come a week after the best-selling neurosurgeon Dr Henry Marsh, women’s right advocate Professor Wendy Savage, and acclaimed researcher Dr Iain Chalmers announced the formation of a new medical group, to campaign for a change to provide those who are either terminally ill or incurably suffering the right to an assisted death.

Earlier this week a report from the campaign group Dignity in Dying revealed a hidden network of links between anti choice lobbyists and groups who had been opposed to the Royal College’s decision to poll its members.

The RCP survey also revealed that 40.5% of doctors individually support a change in the law to permit assisted dying, a 25% increase since 2014 when only 32.3% of doctors supported a change in the law.

The Royal College will now wait until its annual general meeting later in April, before announcing any change in the its official policy.

Colin Brewer, Chair of the campaign group My Death, My Decision Medical Group said:

“For some time now, fair-minded medics have wondered and worried about the real organisations orchestrating campaigns against assisted dying and claiming to do so in the name of the medical profession. Some palliative care doctors have been bullied into silence, whilst a vocal and well-funded minority of opponents have questioned the legitimacy of this poll and attempted to sway its outcome. Some of their funds appear to have come from right wing religious extremists in the USA. Happily these attempts have failed.”

“These results are a welcome step towards a more compassionate and common-sense law, which improves trust between patients and their doctors.”

Phil Cheatle, Director of Campaign Policy at the campaign group  My Death, My Decision said:

“These results reflect a wider trend across our country and a growing support for the legalisation of assisted dying. An overwhelming majority of the public now support changing the law to help those who are either terminally ill or incurably suffering.  As this poll demonstrates, opinion is moving; other countries are moving. Other medical colleges now need to move too in order to reflect the changing nature of ageing and death and the changing attitudes of those who are dying.”

Read more

Acclaimed Doctors Call Upon Parliament To Stop Ignoring Assisted Dying Reform

A new medical organisation in favour of assisted dying has been formed in the UK and will work to change the law on assisted dying to allow people in the UK who want the option of a safe and dignified assisted death.

Announced in a column in the British Medical Journal today, “MDMD Medical Group” (MD.MG)has been formed by a group of leading UK doctors. In the article, the best-selling author Dr Henry Marsh, women’s right advocate Professor Wendy Savage and acclaimed researcher Sir Iain Chalmers disputed claims that “pro-choice doctors” opposed changing the law on assisted dying, and called upon Parliament not to ignore the many people in the UK who want the option of a safe and dignified assisted death.

The new group, which is open to any pro-choice clinical professional, will be the first medical organisation in the UK advocating to allow mentally competent adults, who have incurable health problems and an intolerable quality of life, to have the option of a medically assisted death. The group will be Chaired by Dr Colin Brewer and joins the right to die organisation, My Death, My Decision.

In the letter, the three doctors write “as with earlier medical debates about contraception and abortion, [assisted dying evokes] strong feelings on all sides”, but, that, regardless of one’s view “the debate about legalising Medical Aid in Dying (MAID) in Britain is not going to stop”. They claim “whatever form legislation eventually takes, doctors will be the professionals most involved in enabling patients to have more control over the manner and timing of their death” and it is therefore essential for them to “revisit the fundamental issues of patient autonomy and choice”.

In a 2018 editorial, the British Medical Journal declared its support for changing the law on assisted dying and reported that over 55% of UK doctors agreed or strongly agreed that the law should change. A survey by Medix found that 45% of UK doctors believe that some healthcare professionals already assist with the death of patients.

The announcement comes after the Royal College of Physicians polled it’s members on whether it should change its policy on assisted dying reform, and news earlier this month that Jersey’s government will begin looking into whether the law on assisted dying should change.

Recently a new poll released by My Death, My Decision  found that 93% of the public now consider assisted dying acceptable for those who are terminally ill in at least some circumstances, and 88% consider assisted dying acceptable for those suffering with Alzheimer’s in at least some cases, provided this was before they lose mental capacity.

Drs Marsh, Savage and Chalmers go on to say that “in Britain, and in several American states that have legalised assisted dying, there is a debate about whether the right to die should be restricted to patients with terminal illnesses, or be extended to those suffering from medical conditions that are intractable, intolerable and have no prospect of relief from an early natural death.” The letter highlights several British citizens in that category who have attracted “wide public sympathy and support”, such as Omid T who suffered from multiple systems atrophy and ended his life last October by medically assisted suicide in Switzerland, and Tony Nicklinson who suffered from locked-in syndrome and ended his life by starvation in 2012.

Following the High Court’s ruling against Omid T on a preliminary issue, and the Supreme Court’s decision not to grant Noel Conway permission to bring a case in December of last year, the group aims to encourage parliament to explore the “full spectrum of pro-choice views” and change the law to help those who are either terminally ill or incurably suffering”.

The new Chair of My Death My Decision Medical Group, Dr Colin Brewer has said:

“For some time now, doctors and nurses have watched with increasing despair, as the interests of their patients were sidelined and attempts to reform assisted dying faltered. All too often we have watched as debates about the right-to-die were confused by misinformation and myth. We believe it is now necessary for the voices of strongly pro-choice doctors and nurses to be heard.  Our organisation hopes to provide a voice for those clinicians, and the balanced medical perspective that this debate has lacked.”

“The majority of doctors and nurses now believe that the law against assisted dying is unacceptable. Those who face incurable suffering as well as those who are terminally ill, deserve the option of a peaceful, pain-free and dignified death, but instead of strengthening the doctor-patient relationship, the law gags doctors and prevents them from engaging in open conversations.”

My Death, My Decision’s Director of Policy, Phil Cheatle, said:

“The fault lines in this debate have become clear.  We know that an overwhelming majority of the public believe that the law on assisted dying should change, and that the medical profession stands with that of the compassionate majority.  It is time for our decision-makers to heed their voices and legalise assisted dying, otherwise they will remain on the wrong-side of this debate.”

“My Death, My Decision welcomes MD.MG and is excited for such a distinguished group of clinicians to have joined our campaign for a more compassionate approach to dying in the UK. The current law prohibiting assisted dying is unacceptable. It is time for the UK to adopt a more compassionate law, which balances both the need for strong safeguards and a respect for human dignity.”

Read more

The ‘forfeiture’ rule and assisted dying – punishing compassionate families?

Recently, it was reported that Sarah Ninian, the wife of Alexander Ninian who ended his life at the Swiss clinic Dignitas in 2017, was entitled to inherit from her husband.

Mr Ninian, who had been deemed mentally competent, had been suffering since 2013 from progressive supra-nuclear palsy, an incurable disease which can lead to a loss of mobility, difficulty swallowing, and eventually death. In 2016, he decided that he wanted medical assistance to end his life, but without the assistance of his wife he would have been unable to do so.

Under the 1961 Suicide Act, any action which is capable of helping another person to end their life, including assistance to travel, is illegal, and those convicted face up to 14 years in prison.

The key issue for Mrs Ninian, was whether a legal rule (the forfeiture rule) prohibiting individuals from benefiting from unlawful killing, would prevent her benefiting under Mr Ninian’s will from any inheritance.

Ultimately, reflecting on specific facts of the case, Chief Master Marsh concluded that Mrs Ninian should be entitled to benefit from her husband’s inheritance. Noting that:

  1. Mr and Mrs Ninian were married for 34 years. It was a first marriage for both of them and all the evidence points towards a strong and loving relationship.
  2. The degree of moral culpability on the part of Mrs Ninian is limited. I have concluded, applying the civil standard of proof, that she committed an offence under section 2 of the Suicide Act. It is a serious offence with a maximum term of imprisonment of 14 years. However, it is I think fair to say that what she did was to assist her husband, who was a man with a strong independent will, who had been assessed by an eminent consultant as having capacity, to fulfil his wish to undertake a lawful act. On one view, although not a course of action the court can endorse, she did what many persons would do for a loved one.
  3. I have already remarked on the nature and gravity of the offence. Mrs Ninian took steps to positively discourage her husband from committing suicide and the help she provided was removed from the immediate steps that were the cause of his death.
  4. Mr Ninian’s intentions were clearly recorded and were unambiguous.
  5. Having regard to the overall financial position, there could be no suggestion that Mrs Ninian was motivated by money in the assistance she provided.
  6. Mrs Ninian’s brothers would be entitled to take the forfeited property if relief is not granted. They have no wish to do so and have supported her application.

Indeed the judge even went as far as to say: “On one view, although not a course of action the court can endorse she did what many persons would do for a loved one”.

The Issues Behind the Headline

At its core, the forfeiture rule, found under Sections 1 and 2 of the Forfeiture Act 1982, is a sensible law designed to deter criminals from committing crimes for personal gain. The rule states that as a matter of “public policy” those who have unlawfully killed another, cannot acquire a benefit as a result of their actions. However, and importantly for Mrs Ninian, the rule also states that where “the justice of [a] case requires” it, the rule can be modified or even not applied at all.

Mrs Ninian’s story should serve as a reminder for many, of the tragic situation the current law on assisted dying can force upon families.

Like so many other families confronted by the same request for help, Mrs Ninian did not want her husband to end his life. It is reported that she pleaded with him to change his mind, and even persuaded her husband to inform a specialist palliative doctor of his plans, to ensure that he understood the full range alternative options. Yet, once Mr Ninian had made it clear that he found his quality of life intolerable, and that it was his persistent wish to control the manner and timing of his own death, Mrs Ninian decided to support her loved one and respect his wishes. Indeed, whilst giving evidence she said:

“For a man of such intelligence, dignity and grace, being unable to speak made life insufferable for Alex. Alongside this his mobility was bad, leading to frequent falls and his swallow was showing the first signs of going. The thought of losing his swallow as well as his speech terrified Alex. A few months before his death, I asked him if he got any enjoyment out of life at all and he gave me the thumbs down. I spent a year trying to get Alex to change his mind but he was solid in his decision that he wanted to be dignified to the end which is why he chose to end his life. He faced a future that he did not want. Alex was my soul mate for 40 years and it is very hard to cope with losing him. Everything that I did for him I did because he asked me to, and because I loved and cared for him too much to refuse.”

As a result of this, the CPS determined, in accordance with the Director of Public Prosecution’s guidelines, that it was not in the public interest to bring a case against Mrs Ninian, and chose not to impose a criminal penalty for her compassionate actions.

An Unnecessary Punishment

Against this backdrop, it is worth considering the impact this case may have on cases of families travelling abroad in the future.

One option, is that Chief Master Marsh’s judgement will now crystalise a rule which states when the criminal law brings no sanction, then the forfeiture rule will not take effect either. In support of this view, authority could be drawn from Lord-Justice Phillips, who wrote in the authoritative case governing this area of the law, “where the public interest requires no penal sanction, it seems to me that strong grounds are likely to exist for relieving the person who has committed the offence from all effect of the forfeiture rule”.

Alternatively, it could be argued that Chief Master Marsh did not adopt such a strong rule, citing instead a list of factors, along with the DPP’s guidelines, as guides on whether discretion should be used to disapply the forfeiture rule should be applied e.g

“The court is entitled to take into account a whole range of circumstances relevant to the discretion, quite apart from the conduct of the offender and the deceased; the relationship between them; the degree of moral culpability for what has happened; the nature and gravity of the offence; the intentions of the deceased; the size of the estate and the value of the property in dispute; the financial position of the offender; and the moral claims and wishes of those who would be entitled to take the property on the application of the forfeiture rule.”

On this reading, a perverse outcome is possible. Assuming that a loved one is equally opposed to a family member ending their life abroad, pleads with them to continue living, informs the police of their acts, but is in an unstable financial position, it is possible the civil law may punish something that the criminal law considers to be against the public interest to prosecute. Granted whilst this situation would most likely be rather rare, the very possibility that the criminal law may find no principled justification to punish someone for acting compassionately, but the civil law might,is cause for alarm.

For those who cannot afford to forfeit their inheritance, this judgement may create yet another divide within the law on assisted dying. Not only will the right to die be restricted to those who can afford the costs of travelling abroad to end their lives, the right to die might now be restricted, even further, to only those whose loved ones can afford to sacrifice an inheritance.

My Death, My Decision believes that a law which puts the well-being of those who want to die at its core, and treats their loved ones with compassion should not be restricted to those with financial means; or force families to choose between letting their loved ones suffer, or supporting them to travel abroad, and risk criminal investigation.

Mrs Ninian’s case serves as a worrying reminder, even if the DPP’s guidance can mollify the worst effects of the criminal law, it is possible the civil law could punish compassionate families regardless.

Read more

93% think that assisted dying is acceptable in at least some situations

My Death, My Decision’s Campaign Policy Director, Phil Cheatle, breaks down the new research commissioned by MDMD.

MDMD has released the results of research it sponsored through the National Centre for Social Research (NatCen). The work tested public acceptability of various forms of assisted dying. In all cases considered the person is suffering from an incurable illness and feels their quality of life in below the level they are prepared to accept (or will soon become so). They have sufficient mental capacity to make a life-ending decision and have considered this option carefully, discussing it with professionals who have agreed that their request is within the (hypothetical) law. The different conditions tested were:

  • Those who are suffering from an illness which will eventually cause their death (regardless of timescale).
  • Those who are expected to die from their illness within 6 months.
  • Those whose illness will not cause death
  • Those suffering from Alzheimer’s disease before they lose the mental capacity to make a life ending decision.

The results are discussed in detail here.

What is astounding about these results is the very high level of support for all these forms of assisted dying. Depending on the scenario, between 88% and 93% of respondents thought it acceptable in at least some situations. Comparing results between the scenarios, it demonstrates clearly that public opinion is strongly in favour of the sort of broader approach to assisted dying favoured by MDMD, as opposed to narrower approaches based on the law in Oregon which limit assisted dying to those who are within 6-months of dying. MDMD is proud to be a founder member of the newly formed Assisted Dying Coalition which brings together the UK organisations campaigning for this broader approach to assisted dying.

We were surprised that the research found that the strongest support was for those whose illness would eventually kill them, regardless of timescale. In this situation 93% of respondents thought that a medically assisted death was acceptable in at least some situations. That is a huge majority.

The current law in the UK prevents assisted dying in all situations. Our new research shows that the doctors and politicians who continue to oppose a change in this law are even more out of tune with the people they are supposed to be serving than was previously thought. How can we have confidence in the medical profession if they do not respect our rational end-of-life wishes? How can we have confidence in our politicians if they refuse to change a law which makes some people suffer unnecessarily, against their will at the end of their lives – making others decide to go to Switzerland for medical assistance to end their lives, often too soon?

Palliative care is a wonderful service that helps many people – and could help even more with increased funding. But even the best palliative care can not help in all situations. I recently asked Baroness Finlay, a leading professor of palliative care and strong opponent of assisted dying, how I could avoid an unpleasant end of life like my mother’s, if I too was diagnosed with dementia. Her answer – to look on the internet for illegal lethal drugs – is totally unacceptable and shocking. 88% of people in our poll think that in some situations like this, assisted dying is acceptable. We demand a more compassionate, patient-centred approach to avoiding end-of-life suffering, an approach that includes medical assistance to die as a last resort.

Of course, agreeing that it would be “acceptable for someone to have medical assistance to die” is significantly different from agreeing to a specific change in the law, where all the safeguards have been carefully thought through. But what is clear is that the debate now needs to move on. We should be no longer discussing whether or not assisted dying should be permitted, but instead be working on the details of how assisting dying can be safely and comprehensively introduced, ensuring adequate protection for those who may be vulnerable. In doing so we should learn from other jurisdictions where some form of assisted dying is permitted.

It is bitterly disappointing that the palliative care medical community are so reluctant to talk constructively about improving end-of-life choice when it includes assisted dying. In the eyes of 93% of the people surveyed, that can only undermine the reputation of palliative care. That is unfortunate, as good, comprehensive, patient-centred, palliative care is an important component in ensuring that as many as possible have, what for them, is a good death.

You can read our full description of the poll and results here, with technical information here.

Update August 2019:

MDMD are pleased to see that our poll methodology was replicated by End of Life Choices, Jersey. They commissioned 4insight to run a poll with the same questions for 1,420 Jersey inhabitants. The results are in line with the MDMD results and in some cases show slightly stronger support. The Jersey report can be read here.

Read more

The Legacy of Debbie Purdy – Radio 4 programme

BBC Radio 4 recently broadcast a 2 part programme about Debbie Purdy. The first part is a dramatisation of the story of how Debbie took her legal case to the House of Lords and as a result caused the director of public prosecutions, (DPP), to issue guidelines clarifying the facts to be considered when deciding whether someone should be prosecuted for assisting suicide. Debbie was concerned that her husband might be prosecuted if he helped her to go to Dignitas in Switzerland, where she could have a medically assisted suicide. (The DPP at the time was Keir Starmer, who is now a front bench Labour MP, and shadow Brexit secretary.) It is 10 years ago this year that Debbie won her case.

In the second part of the programme, The Legacy of Debbie Purdy, Deborah Bowman discusses the issues raised by Debbie’s case with her husband, Omar Puente, her solicitor, Saimo Chahal, and Lord Falconer, the barrister and Labour peer who campaigned on the issue in Parliament.

In recalling the day of the House of Lords ruling on the Purdy case, Lord Falconer said, ‘What Debbie and Omar achieved was absolutely epochal in relation to the struggle because it forced the government, the DPP, to set out what were the circumstances which would lead you to be prosecuted for helping someone to take their own life and what would be the circumstances that would mean you wouldn’t be prosecuted.‘ The resulting DPP guidelines are available here.

The programme raised the recent case of Geoff Whaley, in which his wife, Ann, was interviewed by the police under caution, prior to assisting Geoff to go to Switzerland for a medically assisted death there. The presenter asked ‘Why are friends and family still vulnerable to investigation and potential prosecution given Debbie’s case?‘

Lord Falconer explained that ‘there are still lots of problems because they are dependent on the discretion of the DPP. He decides if there is any bad motivation on the part of the family or friends who helped their loved one take their own life.‘

Asked why his attempts to change the law failed when Debbie Purdy’s case was won, Lord Falconer went on to say ‘I think parliament is totally out of tune with the public’s view… Politicians come into politics to deal with schools and hospitals and issues like that and this is a side issue for them.’

In 2014 Lord Falconer put forward a private member’s Bill in the House of Lords for an assisted dying law along the lines of the Death with Dignity law in Oregon USA. His Bill made significant progress by passing its second reading, but it ran out of time due to the general election of 2015. (Essentially the same Bill was re-introduced in the House of Commons by Rob Marris following the election, but was defeated at its second reading.)

Saimo Chahal, Debbie’s solicitor, went on to represent Tony Nicklinson, who suffered from locked in syndrome. More recently she represented Omid in his legal challenge for assistance to die. She raised the issue of people with degenerative diseases which mean that they would not be helped by the kind of Bill proposed by Lord Falconer as they are not expected to die within six months, but have much longer to suffer. She quoted Lord Neuberger, one of the law lords who ruled in the Nicklinson case, saying surely these people are even more deserving of our sympathy than those who only have a few months to suffer.

Although the Nicklinson and Omid cases failed, the Nicklinson case did help persuade ex Archbishop of Canterbury, Lord Carey to change his view on assisted dying, so that he now supports assisted dying for cases such as these.

Lord Falconer was asked why he proposed a law that would only help those with six months or less to live. He replied ‘Authorising people to assist somebody to die should be limited to those who are dying already. I think that by and large being opposed to helping people to commit suicide is the right policy position for the state to be in, however if you are dying you should have choices as to how you die.‘

The presenter pointed out the medical difficulties of making an accurate life-expectancy prognosis, which Lord Falconer accepted, but said that doctors had to make difficult decisions all the time.

Saimo Chahal agreed with Lord Falconer that there was an underlying principle of personal autonomy over end of life wishes which should be respected, but she said ‘I personally cannot understand why people who have 6 months or less should be helped but not people who have a degenerative condition which is life shortening, who have years and years of pain and agony ahead of them. It seems to me that those very people deserve to have autonomy over when they bring their lives to an end.‘

Lord Falconer responded that ‘the problem is that if suffering becomes the test, you are asking the law to make quite difficult decisions’. He went on to highlight the difficulties with people who are suffering from extreme depression.

Clearly there are difficult decisions to be made – both medical and legal. What seems to be missing is agreed guidelines to tackle them both, while providing adequate protection from those who may be coerced to act against their “true” wishes. It is unfortunate that the programme was not able to explore this point further. It is instructive, for example, to compare the existing right of someone to refuse life-sustaining treatment, or to refuse food and liquid, in order to end their life, but the absence of a right to request medical assistance to die when faced with incurable suffering. Two recent cases highlight this issue, both with motor neurone disease. John King ended his life by removing his ventilator, but Noel Conway’s legal challenge was refused, partly because he has this option of removing his ventilator which he could choose. We should note that the criteria which separate these very similar cases do not involve issues of the risk of coercion, nor any estimate of life-expectancy. Surely it cannot be acceptable to force people to suffer from incurable conditions against their will when they are not dependent on life-sustaining treatment which they could refuse, or where such refusal of treatment could lead to a protracted and unpleasant death.

One thing that wasn’t pointed out was that in her final interview Debbie’s views on the six month issue were very clear: ‘I think Lord Falconer, in saying that if you’re within the last six months of your life, misses the point that Tony Nicklinson, myself, Paul Lamb – the people whose cases have all been public – all have to face decades of a life that we don’t consider acceptable, and that is the thing I find hardest.‘ Saimo Chahal was clearly echoing Debbie’s point of view.

Despite these limitations, the programmes are both fascinating. It is particularly helpful to hear a discussion on the issue of the six month criterion – something that MDMD has strong views on.

The progammes are available for a limited time here:

https://www.bbc.co.uk/sounds/play/m0002r4f

https://www.bbc.co.uk/sounds/play/m0002r4h

Read more

Jersey Government Will Research Assisted Dying Reform

Last week, Jersey’s Council of Ministers announced that a new commission will research end of life options, including the legalisation of assisted dying and dying well The announcement follows after more than 1,800 people signed a petition from End of Life Choices Jersey (MDMD’s partner in the newly formed Assisted Dying Coalition).  

Tanya Tupper, whose terminally ill mother Roberta is planning to end her life in the Swiss clinic Dignitas, began the campaign to change the law. Last year, after contacting Jersey’s’ election candidates she found that around a third of Jersey’s candidates would have supported changing the law to permit assisted dying in Jersey.

In answer the petition, Health Minister, Deputy Richard Renouf said that “much of the debate in other jurisdictions has been underpinned by shared values of care, freedom of choice and compassion. It is these shared values that we should now draw on in reviewing our own laws on end-of-life care to understand if a change is needed, and, if so, how to make that change”.

Jersey’s research will aim to bring together international research and focus upon: eligibility criteria for an assisted death, protection and safeguards for patients, the registration of medical practitioners, and ethical codes of conduct.  

Jersey, an island of over 100,000 people, would be the second channel Island to consider legalising assisted dying, after Guernsey’s parliament voted against a similar proposal in May 2018.

Responding to the announcement, MDMD’s Campaign Policy Director, Phil Cheatle, who delivered a talk to the Jersey campaign group last year, said:

“My Death, My Decision is delighted by the by Council of Ministers’ decision, and congratulate our partners End of Life Choices Jersey on their process. It could give dignity to those, whose illness steals it from them; freedom to those, otherwise condemned to years of suffering and peace to families, forced either to let their loved ones suffer or risk imprisonment.”

“Having opened the door to a more compassionate approach to dying, I urge the Council of Ministers to review the evidence on an objective basis, and adopt a law which strikes a kinder balance between empowering individuals, respecting their dignity, and protecting the most vulnerable with stringent safeguards. Many in the UK and channel Islands will now look to Jersey to lead the way on this issue. Now is the time for the law to change.”

Read more
Privacy Policy | Conditions of Use | Press Office
campaign in parliament
champion legal cases
broaden the debate

My Death, My Decision is a company limited by guarantee, registered in England company number 11758121 and located at Unit A 39 Moreland Street, London, EC1V 8BB.