Germany’s top court overturns ban on physician-assisted dying

Germany’s constitutional court has ruled that a law forbidding professional assistance to die is unconstitutional, in a move that is being seen as a major victory for assisted dying campaigners.

The decision centred on a controversial 2015 law, which legalised the right for individuals to purchase life-ending substances for ‘altruistic motives’, but forbade doctors or other professionals from prescribing substances for ‘enterprise purposes’. The court found that to deny adults the right to professional assistance unlawfully denied them a ‘right to a self-determined death’. 

The judgment has been hailed as a major victory for right-to-die campaigners for clarifying the law for those who are terminally ill, since the court had already ruled in 2017 doctors could not always deny adults who were ‘seriously and incurably ill’ access to similar drugs.

Previously, the law had meant that any doctor who assisted a patient to end their life could face up to 5 years imprisonment, resulting in more than 120 people individually applying for life-ending substances to Germany’s Institute for Drugs and Medical Devices without any professional guidance. 

My Death, My Decision which campaigns for assisted dying for people who are terminally ill and incurably suffering, has welcomed the decision. My Death, My Decision is supporting Paul Lamb in his bid to change the law on assisted dying in the UK.

It will now be up to Germany’s government to propose legislation to bring the law into line with the court’s ruling.

Trevor Moore, Chair of My Death, My Decision said:

‘Here in the UK we watch in frustration as more and more jurisdictions around the world settle upon laws that allow the incurably suffering or terminally ill to choose a dignified death at a time and place of their own choosing, surrounded by those they love and who love them. 

As a recent Westminster Hall debate on the subject of assisted dying showed, MPs know full well that they are out of kilter with public opinion – around 90% of the public now support a change in the law. Since Parliament last voted on the subject in 2015 there have been major developments in other jurisdictions that show the way: Canada, for example, introduced legislation in 2016 without any particular controversy, so that an assisted death is seen as one choice on a spectrum end of life options – with robust safeguards.

We at My Death, My Decision urge the Justice Secretary, Robert Buckland, to establish an independent inquiry (call for evidence), so that stories such as the oppression of the vulnerable, and of doctors being forced to take part in assisted deaths, can be shown as the scaremongering they are. Only in that way can those with hidden agendas be exposed and the British public acquire a right now available to around 150 million people worldwide.’

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Canada moves to broaden assisted dying law

The Canadian government has proposed changing the law on assisted dying to extend access for those who are not terminally ill.

Unlike some states in the USA and Australia, under Canada’s current 2016 law, the right to request an assisted death is not restricted to those with a life expectancy of 6 months or less. Instead, adults who are of sound mind can voluntarily request assistance to die if they suffer from a grievous and irreversible condition – provided their death is ‘reasonably foreseeable’.

Some Canadian assisted dying providers are now interpreting these criteria to include those in early-stage dementia, while the person still has mental capacity. This is similar to the approach taken in Switzerland by organisations such as Dignitas and Lifecircle.

Last year the Quebec Superior Court found the requirement of a ‘reasonably foreseeable death’ discriminated against those who are incurably suffering, but not from an illness that will cause death. The Government has now proposed changes to enable those who are incurably suffering the right to request an assisted death as well, without the need for their death to be ‘reasonably foreseeable’. This would be likely to include people with complaints similar to UK campaigners Debbie Purdy, Omid, Paul Lamb and Tony Nicklinson.

The proposed law would not, however, extend to cases where someone was purely suffering from a mental illness.

The Bill also proposes a ‘waiver of final consent for eligible persons whose natural death is reasonably foreseeable and who may lose capacity to consent before MAID can be provided’. (MAID – Medical Aid in Dying, is the term used in Canada to refer to Assisted Dying.) This waiver is important as some people require such strong medication to relieve their pain as they approach death, that they lose their mental capacity as a side-effect of the medication. The current Canadian law requires them to obtain MAID, if they request it, without this level of medication, which means they have to end their life sooner than they might wish. In situations like these it seems much more reasonable for people to be able to pass all the safeguarding checks before they lose capacity due to requiring high levels of medication. This waiver may also apply to those with dementia. (See this article for further discussion of assisted dying and dementia.)

Phil Cheatle, MDMD’s Lead Campaign Commentator said:

‘This is another very welcome development from Canada. The Canadian government is rightly considering modifying its assisted dying legislation to overcome some limitations. They are attempting to carefully protect vulnerable people while at the same time providing access to an assisted death for those who want to use it when this is the only way to end their suffering. Canada should now be seen as the country to watch as an excellent example of well-considered assisted dying legislation.’

‘Those who oppose this sort of careful, evidenced-based approach are forcing many to suffer against their will at the end of their lives, or to take drastic, unregulated and possibly illegal action themselves. This is totally unacceptable in a caring, compassionate society.’

MDMD is delighted that Dr. Stefanie Green, one of Canada’s leading MAID providers and the President of the Canadian Association of MAiD Assessors and Providers, will be giving a lecture hosted by MDMD and FATE in London in April 2020. Further information and tickets are available here.

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Distinguished Doctors and Philosophers urge BMA members to support assisted dying

Credit: https://ab.co/2Tfnjrm

A diverse range of thirty doctors, philosophers, academics, and campaigners have signed an open letter, which appeared in the Guardian today, urging members of the British Medical Association to support assisted dying in the ongoing survey.

The joint letter was organised by the UK Assisted Dying Coalition, of which My Death, My Decision is a founding member, and follows just days after the Royal College of GPs voted to maintain their opposition to assisted dying, despite a majority of GPs wanting to move to a neutral or supportive position. 

Among those who have signed the letter are My Death, My Decision’s Chair Trevor Moore, Professor A.C. Grayling, Professor John Harris, Dr Henry Marsh, Dr Wendy Savage, Melanie Reid MBE, Dr Michael Irwin, The Revd Dr Scott S McKenna, and Professor Raymond Tallis. 

The full letter and list of signatories can be found here. 

Trevor Moore the chair of My Death, My Decision said:

‘In the last decade, there has been an overwhelming shift in popular support for assisted dying, which the BMA’s policy has lagged behind. More countries than ever now have legal, safe, and compassionate assisted dying – and it is time we follow suit’. 

‘By choosing to remain opposed to assisted dying and retaining a position which closes down debate and discourse, the BMA will not be stopping the public or our decision-makers from continuing to consider reform. Instead, they will prevent themselves from constructively contributing to a national conversation and send a signal which risks alienating doctors from the wishes of their patients’. 

‘We were proud to have lent our support to the voices of doctors and leading ethicists who would like to see a change in the BMA’s policy, and hope doctors who support reason, compassion, and empathy will vote in favour of assisted dying’. 

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Royal College of General Practitioners maintain opposition to assisted dying

The Royal College of General Practitioners has maintained its 14-year opposition to assisted dying, despite a majority of GPs voting to support a change in the law or adopt a neutral stance.

The college announced the decision of its executive council, after surveying its 50,000 members on the topic last year.

More than 6000 GPs voted in the online poll:

  • 47% of respondents said that the RCGP should oppose a change in the law on assisted dying;
  • 40% of respondents said the RCGP should support a change in the law on assisted dying, providing there is a regulatory framework and appropriate safeguarding processes in place;
  • 11% of respondents said that the RCGP should have a neutral position and;
  • 2% of respondents abstained from answering

The results mean that the College will continue to lobby MPs against changing laws which make assisted dying punishable by up to 14 years in prison, despite a majority preferring to support reform or set out both sides of the argument.

The Royal College of General Practitioners has opposed assisted dying since 2005 and affirmed its opposition in 2014.

In 2013, after a similar survey, 77% of GPs voted to oppose a change in the law, 18% voted to adopt a neutral stance, and only 5% voted to support changing the law.

The news follows after the Royal College of Physicians voted to drop their longstanding opposition to assisted dying in a similar poll last year, and as members of the British Medical Association, the doctors’ trade union body, continue to vote on whether the BMA should change its stance on assisted dying.

The College will now not review the RCGP’s position on assisted dying for at least five years unless there are significant developments.

Trevor Moore chair of the campaign Group My Death, My Decision said: 

‘We are extremely disappointed that the executive council of the RCGP have decided to ignore the preference of a majority of GPs to either support assisted dying or adopt a neutral stance. This seems undemocratic, given that those who voted in support would obviously agree with at least a neutral position’.

‘The overwhelming shift in support for assisted dying among GPS reflects a wider trend across our country, as nearly 90% of the public now support legal, safe, and compassionate assisted dying.

Whilst more countries than ever have now legalised assisted dying, including Canada, and demonstrated that the best way to protect everyone is through an open and robust system of safeguards, it is disheartening that the RCGP has adopted a position which will continue to silence many in the medical community who have a conscientious commitment to respect their patients’ autonomy and exercise compassion for those who are incurably suffering or terminally ill.’

‘The current law on assisted dying simply isn’t working. It forces those who are incurably suffering or terminally ill to suffer, or choose to die abroad – often putting their loved ones at risk of prosecution. There is a better way forward. We will continue to campaign for the adoption of a system akin to that in Canada.’

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Dark money anti-assisted dying ad taken down from Facebook

A Facebook advertisement by the anti-assisted dying organisation Our duty of care UK has been taken down for failing to disclose who paid for it. 

The advert, which encouraged doctors to vote against changing the British Medical Association’s stance on assisted dying, was seen by more than 3,000 people before it was removed by Facebook. 

The group ‘Our Duty of Care UK’ now states on its website that it is funded in part by the anti-assisted dying group Care not Killing, though reportedly failed to disclose any connection when it unsuccessfully lobbied the Royal College of Physicians last year against dropping their long-standing opposition to assisted dying. 

The news that anti-assisted dying advertisements have been funded by undisclosed backers follows after it was reported last year that dark money groups – who campaign to restrict abortion rights in the USA – had been funding campaigns against assisted dying in the UK. 

According to Facebook’s website, the advert ‘ran without a disclaimer. After the ad started running, we determined that the ad was about social issues, elections or politics and required the label. The ad has been taken down.’ 

Trevor Moore the chair of the campaign group My Death, My Decision said:

‘Assisted dying is a complex and emotive topic, which demands sensitivity and careful discussion. It is incumbent upon those who advocate either for and against changing the law to make sure we hold ourselves to the highest standards and engage in an open, transparent, and honest debate.’

‘To gain trust in the public debate we all need to ensure that statements are supported by verified evidence and are not alarmist or ideological. That means keeping sight of what drives the debate – compassion for real people.’

‘It is a national disgrace that adults of sound mind, who are incurably suffering or terminally ill, do not have the benefit of a law that gives them the option to choose how and when they die. But, there is a better way forward. New evidence from countries, including Canada, demonstrates a balance between respecting autonomy and robust safeguards can be achieved.  I encourage doctors who believe in empathy and dignity to vote in support of legal, compassionate, and safeguarded assisted dying.’

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MDMD urges BMA to vote in favour of compassion and empathy

My Death, My Decision has called on the British Medical Association (BMA) members to consider compassion and empathy by voting in favour of assisting dying in the association’s consultation which closes on 27 February. 

Last year, the BMA announced it would survey its members after a motion was passed at its annual policymaking meeting to hold a consultation and ‘support patient autonomy’. 

The BMA had previously adopted a neutral stance on assisted dying in 2005 but then changed and became opposed in 2006. This is the first time all 160,000 members of the BMA will be polled on the issue. 

Later this month, the results of a similar consultation by the Royal College of General Practitioners will be announced. 

Doctors will be asked whether the BMA should actively support, oppose, or neither actively support nor oppose (take a neutral stance) on a change in the law to permit doctors to prescribe drugs for adults of sound mind, who are either incurably suffering or terminally ill, to end their life. The survey will similarly ask what position members think the organisation should take in regard to doctors administering lethal substances (often known as euthanasia). 

Dr John Chisholm, BMA Medical Ethics Committee chair, said:

‘Doctors and medical students have a particular interest in discussions around legislation because any change in the law would impact on them not just personally but professionally. Therefore, this poll will allow us to gather information about the breadth of views held by our membership, which will then inform any future policy decisions and how we respond to any proposals for a change in the law.’

MDMD urges BMA members to vote in favour of assisted dying reform, and for others to encourage their doctors to support a change in the law. 

Trevor Moore chair of the campaign group My Death, My Decision said: 

‘We strongly welcome the British Medical Association’s decision to give their members a say on this issue. 

The right to choose how, where, and when we die is a fundamental human right, and it is unacceptable that the law forces those facing unbearable pain or terminal illness to suffer in ways that often cannot be palliated. More than one person a week now travels from the UK to end their life in Switzerland – this is double what the number was five years ago. 

There is a better way forward. New evidence from countries, including Canada, demonstrates that a balance between respecting autonomy and robust safeguards can be achieved. We urge all doctors who believe in reason, compassion, and empathy to support a change in the law.’

NOTES

For further comment or information or requests for interviews, please contact My Death, My Decision Campaigns and Communications Manager Keiron McCabe at keiron.mccabe@mydeath-mydecision.org.uk or phone 020 7324 3001. 

More about the BMA’s consultation

The BMA is a trade union representing and negotiating on behalf of 160,000 doctors in the UK. In 2019, at the BMA’s main policymaking meeting members voted for a motion to poll members on whether the association should adopt a neutral position on assisted dying. 

The BMA’s consultation will run from 06 February until 27 February and is being organised by the independent organisation Kantar. 

Members will be asked whether they believe the BMA should actively support, actively oppose, or neither actively support nor actively oppose (take a neutral stance on) a change in the law to permit doctors to prescribe drugs for eligible patients to self-administer to end their own life. They will also be asked whether the BMA should actively support, actively oppose, or neither actively support nor actively oppose (take a neutral stance on) a change in the law to permit doctors to administer drugs with the intention of ending an eligible patient’s life.

Results from the survey will be published ahead of the ARM, which takes place in Edinburgh from 21 to 25 June.

2019 Motion

That this meeting notes the recent decision by the Royal College of Physicians to adopt a neutral position on assisted dying after surveying the views of its members, and:
i)   supports patient autonomy and good quality end of life care for all patients;
ii)  recognises that not all patient suffering can be alleviated;
iii) calls on the BMA to carry out a poll of its members to ascertain their views on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying.

The law on assisted dying in the UK

Under section 2(1) and 2(2A) of the 1961 Suicide Act, it is unlawful in England and Wales to encourage or assist someone to end their life. Anyone found guilty of an act ‘capable of encouraging or assisting the suicide or attempted suicide of another’ can face up to 14 years’ imprisonment. 

Recent updates 

Assisted dying is now permitted for terminally ill and incurably suffering people in Canada, Belgium, Italy, Luxembourg, and the Netherlands. It is also permitted specifically for terminally ill people in Colombia, ten US jurisdictions, and the Australian states of Western Australia Victoria.

In January 2019, MPs debated in a Westminster Hall debate proposals for an independent call for evidence into assisted dying. MPs from all major political parties called for the Secretary of State for Justice, Robert Buckland QC MP, to initiate a formal call for evidence on the impact of the UK’s existing law. 

Last year two members of My Death, My Decision living different conditions that mean they are facing incurable suffering separately applied for permission to judicially review the law on assisted dying in England and Wales. Paul Lamb, who is paralysed from the neck down, was refused permission from the High Court in December 2019; Phil Newby, who suffers from motor neurone disease, was denied permission from the Court of Appeal in January.

About My Death, My Decision

My Death, My Decision is a grassroots not-for-profit organisation that campaigns for a compassionate and balanced approach to assisted dying in the UK. As a growing movement we are at the forefront of social change: nearly 90% of the public now favours a change in the law to allow adults of sound mind, who are either terminally ill or facing incurable suffering, the option of a peaceful, painless, and dignified death.

Unlike some right-to-die organisations, My Death, My Decision does not believe that assisted dying should be restricted to only those who are terminally ill with a prognosis of six or fewer months left to live. Just as compassion for others motivates people to support assisted dying for those who are terminally ill, we believe it should also underscore support for those facing incurable suffering, as were the late Tony Nicklinson and Debbie Purdy, and now Paul Lamb and Phil Newby. 

Read more about how nearly 90% of the public support an inclusive change in the law. 

Read more about research which found that more than one British citizen a week now ends their life in Switzerland. 

Read more about My Death, My Decision’s campaign for an inclusive change in the law:

http://www.mydeath-mydecision.org.uk/

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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.