Thank you Mr Speaker
The private Member’s Bill being promoted by the Hon Member for Ramsey, Dr Allinson is a modest Bill with only 14 Clauses, but it is one that needs to be very carefully thought through.
We know that England and Wales, Scotland and the Channel Islands are all looking at introducing legislation on Assisted Dying, and most of them are still at a very early stage, other than our colleagues in Jersey who in November 2021 became the first Parliament in the British Isles to decide in principle that assisted dying should be allowed.
The amount of work and early engagement that the Government of Jersey had with all stakeholders in respect of their Assisted Dying legislation should be applauded, and that is even before they consider drafting legislation.
In fact the actual the process in Jersey was started by an e-petition in 2018, and this was followed by a “Citizens’ Jury” that was set up by the Government of Jersey to look at Assisted Dying, which then took a considerable amount of evidence before publishing its recommendations for consideration.
If Members are not familiar with the work undertaken in Jersey it is well worth looking at before the Clauses stage of this draft legislation, because it does give some alternative views in respect of what future legislation on Assisted Dying might look like…
In respect of the Isle of Man draft legislation on Assisted Dying, as elected Members I think we all understand that there are people within our own communities who desperately want to see this very important piece of legislation receive Royal Assent as quickly as possible…
…but if the Isle of Man is to introduce legislation on Assisted Dying then it has to be right, and it must have the right level of safeguarding in place for our medical professionals and for the wider Manx Community, especially for the most vulnerable in society.
We also have to carefully consider the current position of Manx Care who are already under immense financial and operational pressure, with high vacancy rates and costs running over budget.
Mr Speaker
When I was researching this topic, I noted that Baroness Meacher had brought forward a private member’s bill on “Assisted Dying” before the House of Lords in 2021, which did receive its second reading, but failed to progress before the end of the Parliamentary session.
I am extremely grateful to the Hon Member for Ramsey for bringing this private member’s Bill on Assist Dying for our discussion on behalf of our own Community here on the Isle of Man.
Having canvassed and spoken to so many of my own Constituents in Onchan who are either in favour or against this legislation, it is clear that the debate on assisted dying understandably raises some very passionate views, and many different and equally valid perspectives.
In fact, I received around 370 messages and correspondence on the topic, and I’m extremely grateful to each and every one of those people who took the time to share their own personal views.
Many of them shared their own experience in which they witnessed a loved one suffering a traumatic, unbearable and painful end of life…
Baroness Meacher outlined in her opening remarks in the House of Lords in 2021 that often the loved ones of these people go through years and years of nightmares and panic attacks, thinking back and remembering the pain and suffering that their nearest and dearest went through.
There is also a huge library of material and literature that has been published on the topic, which outlines the key arguments for those that support or oppose Assisted Dying.
The British Medical Association published an article a few years ago, in which they put forward the arguments for, against and from a neutral position towards Assisted Dying, but I feel the opposing view published by the BMA mirrored some of those concerns being raised by own Constituents in Onchan.
These included: social attitudes changing towards certain members of our Community in the future; safeguarding issues; that the legislation could be widened once Assisted Dying becomes normalised; and the fact that Doctors in the current world know very little about their patients beyond their consulting room or hospital ward.
The BMA also said that Assisted Dying is not a role for hard pressed Doctors, and that is something that we will need to fully review and understand as this important legislation progresses.
In the middle of all of this are the publicly elected Parliamentarians who have to find a way though the many ethical, moral and social issues associated with Assisted Dying…
…but at the same time we also have a duty to listen very carefully to public opinion.
Over 3,316 responses were received in respect of the Public Consultation held on the island between December 2022 and January 2023, and question 8 of that consultation asked the main question “in principle, do you agree or disagree that assisted dying should be permitted for terminally ill adults on the Isle of Man?”
49.1% were in favour and 49.6% were against.
However, back in May 2021 Island Global Research undertook a survey on behalf of Dignity in Dying and 65% of the respondents supported legislation in respect of Assisted Dying…
…and in a more recent survey this year it was found that around 53% of respondents were in favour of a change in law…
So you can see why there are so many different views on Assisted Dying at the moment.
I don’t believe this very important Public Consultation on Assisted Dying should have been held over the Christmas period, because based on the weight of correspondence and comments received there is a very clear high percentage of Isle of Man residents that actually do support some form of legislation being introduced on the island in respect of Assisted Dying…
….and that view is also shared in England and Wales, Scotland and the Channel Islands by a very high percentage of their own population.
Mr Speaker
I mentioned the House of Lords and the private member’s Bill moved by Baroness Meacher in 2021, because it is almost identical to the draft legislation being moved by the Hon Member for Ramsey.
However, there are also some very significant changes or omissions in this piece of legislation being moved by the Hon Member for Ramsey, and those changes have to be fully explained by the mover of this Bill.
As I have already mentioned, if the Isle of Man is to introduce any legislation on Assisted Dying, then it has to be wrapped around a very rigorous safeguarding system.
Unfortunately, we are unable to test the draft legislation in practice or even get a proper overview of the proposal, because it would appear that the Secondary Legislation that is so important to this particular Bill will not be available until after the Bill gains Royal Assent – and that is a deep concern for me.
Maybe we should be following the lead taken by our colleagues in Jersey by asking the Department of Health and Social Care to take this legislation forward on behalf of the Manx Government, and for the Department to work closely with Manx Care to put together the Secondary Legislation that is a critical part of this Bill.
We also need to ensure that Manx Care has the resources, funding and the working groups to seriously look at Assisted Dying being introduced on the island.
Just looking at the draft Bill that went before the House of Lords in 2021…
…a terminally ill person with a life expectancy of less than six months, aged 18 or over who wants assisted dying would need to make an application to the High Court (Family Division) by way of a Declaration.
This Declaration would be their voluntary, settled, and informed wish to end their own life.
However, the draft Bill being moved by the Hon Member for Ramsey has removed any reference to or involvement by the Isle of Man High Court in his private member’s Bill on Assisted Dying, and that needs to be fully explained.
Instead we appear to be putting all of the responsibility on the shoulders of the attending Doctor who will be making the declaration, along with the Medical Practitioner as the Independent Doctor.
On that particular point, we should also be fully aware that there are various articles online which show that only around 50% to 57% of doctors are in favour of legislation to allow Assisted Dying for terminally ill patients providing there were stringent safeguards and guidelines in place….
….and around 21% of Doctors are actually against such legislation and the remaining 22% are unsure.
More concerning is the correspondence that Hon Members received from the Isle of Man Medical Society who said that 74% of the respondents to their recent survey were against Assisted Dying – that is something we cannot ignore as Members of this House.
Although the BMA has taken a neutral position in respect of Assisted Dying they have made it very clear that the role of a Doctor is to support patients to live well, and as comfortably as possible until they die, and not to deliberately bring about their death.
That is a really a strong statement and it really does raise some very powerful ethical and moral questions that our medical professionals on the island must overcome…
…and if the Isle of Man High Court or Appeals Court does not form part of the Isle of Man Assisted Dying legislation, then we really do need to ensure that our Medical Practitioners, our valuable Doctors and Nurses have those rigorous safeguarding measures installed, not only to protect them, but also our Community.
Although our medical staff are extremely professional and well trained, we also have to ensure that any Medical Practitioner, Doctor or Nurse that chooses to participate in the assisted dying of another person…
Then they must have access to the very best possible support services and training, in order to help them process and reflect on the emotions that will be associated with assisting someone else to die.
From reviewing both pieces of draft legislation, it could be argued very strongly that the Isle of Man draft legislation on Assisted Dying being moved by the Hon Member for Ramsey is actually proposing to remove a vital part of safeguarding in my opinion….
…and I would certainly welcome Dr. Allinson’s reasons as to why he feels it necessary to remove any mention of the Isle of Man High Court’s involvement in this draft legislation…
…because it would be the Court’s responsibility to ensure that the person who wishes to end his or her own life was voluntary, a correct declaration has been made and that they are over the age of 18…but more importantly that the person has the capacity to make that decision to end his or her own life.
Even in the proposals being considered by the Government of Jersey they have included an appeals process in which an application can be made to the Appeal Court by the person who has requested an assisted death or by a family member.
We really do need to look at this particular point very carefully.
I also have some concerns around the short title of this particular Bill, which is the “Assisted Dying Act 2023”, and I will explain those concerns in a few moments.
In respect of Clause 4 – “Assisted Dying”, I am concerned around the residency period of not less than one year.
Although it is identical to the draft legislation considered by the House of Lords in 2021 and our colleagues in Jersey, I am concerned that the Isle of Man will start to see people moving to the island in the last two, three or four years of their lives, in order to take full advantage of this particular Bill, especially if the Isle of Man was to introduce this legislation ahead of England and Wales.
That will certainly put significant strain on the Isle of Man Health and Social Care services.
…and therefore I feel one of two things must happen.
Either we table an amendment to this draft legislation, which changes the residency period of “not less than one year” to a residency period of “not less than five years”, in order to ensure that any legislation around Assisted Dying is for Isle of Man residents only, and to ensure that our island is not labelled as a “Death Tourism” location in the future.
That is my preferred option Mr. Speaker…
Alternatively, we could make it absolutely clear within the Act that the date of operation does not come into force until England and Wales have passed the same legislation on assisted dying – therefore both coming into force and operation on the same day…
With regards to Clause 5 – “Terminal Illness” there has been a lot discussed around the 6 month period, but the mover of the Bill is correct by adding in the words “reasonably expected” because Doctors cannot be exact when predicting life expectancy.
I think there is also a discussion to be had around “unbearable suffering”.
In May 2022 the Hon Member for Ramsey Dr. Allinson mentioned that “Assisted Dying allows a dying person the support and choice to have control over their own death if they decide that their suffering is unbearable”.
It was also covered under question of the 10 of the Consultation, and 47% of the respondents supported the provision of assisted dying for someone who has a condition, which causes unbearable suffering, but there is no mention of it within the draft Bill before the House.
I would welcome some input on this particular point by the mover of the Bill.
In respect of Clause 6 – “Declaration”, the mover of the Bill has added a clause “where a person who is unable to sign the declaration required, then another person may sign it on their behalf” – and again I have concerns from a safeguarding position even if the individual was present….
…especially when this draft legislation has no mention of the additional safeguarding measures which could be undertaken by the High Court or the Appeals Court on the island…
…The actual draft bill that went before the House of Lords in 2021 made it very clear that it would be the Court’s responsibility to ensure that any Declaration signed is the person’s voluntary, settled, and an informed wish to end their own life.
Again, I feel Dr. Allinson needs to fully explain the reason for adding this particular section to the draft legislation.
In respect of Clause 7 – “Assistance in Dying” the wording again between the House of Lords draft Bill and the Bill being moved by Dr. Allinson is almost identical, but again there are some vital changes.
Under the Bill moved in the House of Lords it says that prescribed medicine to enable a person to end their own life may only be delivered to the person for whom they are prescribed, and that includes:
- By the attending Doctor or
- by another registered medical practitioner
- or registered nurse
…but under this draft legislation being moved by the Hon Member for Ramsey he has added in “a registered pharmacist”, which extends that list considerably.
Under the Jersey proposal, it is very clear that only the Jersey General Hospital Pharmacy will dispense medication used for assisted dying, no other pharmacy will do so….
I think we need to be very clear in the draft legislation, are we proposing a single pharmacy possibly at Nobles Hospital or multiple pharmacies across the island.
Mr Speaker
Unfortunately, that is not my main concern in respect of clause 7, because it does appear that this section of the Bill goes beyond the short title, which is the “Assisted Dying Bill 2023”.
Looking through Dr. Allinson’s speech in this House on 24th May 2022, the Consultation document and other research material, it is very clear that “Assisted Dying” is prescribing life ending drugs for terminally ill adults to administer themselves….
…and Voluntary Euthanasia is a doctor directly administering life ending drugs to a patient who has given their consent.
The draft “Assisted Dying” Bill that Baroness Meacher brought forward before the House of Lords in 2021 was very clear when it said that “health professionals may prepare medicine for self-administration by that person, but the health professional is not authorised to administer the medicine to another person with the intention of causing that person’s death”
That is clearly a fair description of what “Assisted Dying” is.
However, the draft bill being moved by the Hon Member for Ramsey under Clause 7 gives the individual a very clear choice whether to “self-administer the medicine themselves or to request a health professional to administer the medicine to them on their behalf”
Based on Dr. Allinson’s own description, the draft legislation before this House is a mixture of “Assisted Dying and Voluntary Euthanasia”, and therefore the short title of the Bill should reflect that.
Now I am not against Clause 7 as written in the draft Bill, especially when 46% of the respondents in the consultation supported a “health professional being permitted to administer medicine on their behalf”, but the title of the Bill needs to reflect the contents of the draft legislation.
Mr Speaker
As I mentioned in my opening remarks, I am extremely grateful to the Hon Member for Ramsey for bringing this private member’s Bill on Assisted Dying, and there is a lot of support from the Manx Community to move the legislation on, but we do have to ensure that any legislation on Assisted Dying is right…
….and it is wrapped around a very rigorous safeguarding system.
Our colleagues in Jersey will be looking to draft legislation in March 2024 with an aim of introducing a law towards the end of 2025, a House of Commons Committee has just started to take evidence on Assisted Dying and in Scotland a Member’s Bill has just gone through a Consultation.
So we do have the time to ensure that the Isle of Man draft legislation on Assisted Dying is right….
I will of course support the Second Reading at this stage, but I will be moving a very important Motion shortly for a Committee of five Members to look at the Clauses of the draft Bill before the House.
Thank you Mr Speaker.