Now, the 5 person committee in the House of Keys — Legislature of the Isle of Man — has released their report on the proposed Assisted Suicide/Voluntary Euthanasia Bill. (Previously reported on in CA.)
Obviously, there is NO COLLUSION WHATSOEVER between Mann, Jersey, Scotland and Ireland though the 4 reports & Bills are dropping within days of Easter and of each other!
The Joint Committee on Assisted Dying in Ireland reported on March 19#;
The State of Jersey released their “Proposition” on 22 March;
Tynwald — legislature in Mann — released the 5-person report today;
Liam McArthur announced that he will drop his Bill in ‘Holyrood’ — the Scottish Parliament — tomorrow.
The 5-person committee are all Members of the House of Keys [MHK]:
D J Ashford MBE (Chair);
Hon Dr A J Allinson
R E Callister
Dr M E K Haywood
Hon L L Hooper
I have limited time to review the 214-page document properly, so for today, here is the
CONSOLIDATED LIST OF CONCLUSIONS:
CONCLUSION 1
The Committee – noting the exception of Mr Callister MHK – concludes that Clause 1 (Short Title) should remain unchanged, as the Assisted Dying Bill 2023. The Committee notes the arguments suggested for retitling the Bill, including the suggested use of “Euthanasia”, and those against.
The Committee’s rationale for concluding it remain as currently titled includes the fact that ‘Assisted Dying’ is a term that generally appears widely understood, aided by increased public discourse around the topic more broadly.
CONCLUSION 2
The Committee concludes that Clause 2 (Commencement) does not require amendment. This Clause deals with the routine commencement of the legislation.
CONCLUSION 3
The Committee concludes that Clause 3 be considered for amendment. In particular at Page 6, lines 15 to 22, the Committee considers the definition of ‘relative’ to be too narrow. The Committee finds merit in potentially expanding the definition for clarity and completeness, so as to include a more representative understanding of what comprises a ‘relative’ in the context of modern family life, e.g. step-children and those living together as if spouses or civil partners.
CONCLUSION 4
The Committee concludes that Clause 4 be considered for amendment.
(i) Residency period:
The Committee concludes that the requirement for a patient to be ‘ordinarily resident in the Island for not less than one year’ is insufficient, and support the bringing forward of an amendment to extend this to five years.
In their deliberations, the Committee also considered the following two points:
(ii) ‘Clear and settled Intention’:
The Committee concludes that the term ‘clear and settled intention’ is an important one. The Committee notes the definition of what constitutes this would likely be set out in a Code (or Codes) of Practice issued by the Department of Health and Social Care (Clause 12, 1a) and before issuing a Code, the Department shall consult ‘such persons as it considers appropriate’ (Clause 12, 2).
The Committee would expect that any consultation would be comprehensive, and evidence the input of professional bodies and representative stakeholders.
The Committee would also expect that there be sufficient appropriate medical training for professionals.
(iii) Clarification on capacity:
The Committee concludes that there could be scope for additional clarity and context around capacity. With the successful passage of the Capacity Act 2023, we note that the Department of Health and Social Care are presently engaged in considering regulations, guidance and training; together with a Code of Practice informed by stakeholder engagement.
Once these aspects are in place, it is expected that additional clarity would be forthcoming.
CONCLUSION 5
The Committee concludes that Clause 5 be considered for amendment with respect to life expectancy criterion.
The Committee supports amending the life expectancy criterion from six months to twelve months.
The Committee considers that medical practitioners already determine life expectancy – albeit not for the purposes of assisted dying. Consequently, the Committee considers there ought to be sufficient training and support made available to those medical practitioners who have indicated they are content to participate in an assisted dying pathway.
CONCLUSION 6
The Committee concludes that Clause 6 be considered for amendment. In particular at subsection 13, line 2, where it currently states ‘the Department may specify in regulations’ – the Committee support a change to substitute ‘must’ instead of ‘may’. We consider this provides more certainty, and is more definite.
CONCLUSION 7
The Committee concludes it is supportive of two technical amendments to Clause 7. Firstly, at page 9, at lines 8 and 16, for “delivered” substitute “dispensed and delivered”. The Committee considers this terminology is more appropriate. Secondly, at page 9, at subsection 10, the Committee supports substituting ‘may’ for ‘must’ which it considers places a stronger obligation on the Department of Health and Social Care to specify the appropriate regulations.
The Committee is supportive of amending Clauses 7(5) and 7(7) to address an inconsistency when referring to an ‘assisting health professional’ and ‘assisting health practitioner’.
The Committee is supportive of amending Clause 7(8) to take account of a potential situation whereby medication fails to cause death. At 7(8) where it states that: ‘…the assisting health professional must remain with the person until the person has died’, the Committee is supportive of the insertion of additional words for clarity, such as: ‘….or it is determined by the assisting health professional that the procedure has failed’.
CONCLUSION 8
The Committee concludes that in addition to conscientious objection ‘opt-outs’, there should also be an ‘opt-in’ provision, and the Committee would be supportive of any amendment around this. On the matter of ‘safe access zones’ the Committee notes that Leave to Introduce has been given to a Private Member’s Bill98 on this subject.
CONCLUSION 9
The Committee is supportive of the Royal College of Nursing’s commentary around the need for guidance around initiating conversations.
The Committee concludes that Clause 9 be redrafted.
CONCLUSION 10
The Committee notes the Isle of Man Medical Society and the General Pharmaceutical Council observations that under current guidance, assisted dying would constitute a criminal offence. However, should this Bill become law, then the Committee would anticipate that the Department of Health and Social Care would engage with professional regulators to advise them of any change, and engage with
them appropriately.
CONCLUSION 11
The Committee concludes that the cause of death should be recorded as “assisted dying” itself, with a subsequent recording of the underlying terminal illness as a secondary factor. This offers more clarity and certainly, and assists with accurate monitoring.
The Committee also suggests that on line 12 “may” is changed to “must” and that there is also a reference for the drafting of Rules of Court, to allow these to be prepared to assist the Courts with procedurally dealing with the legislation in practice.
Based on the information received from various insurance agencies and HM Attorney General’s Chambers, we consider that the perceived risks around insurance have been addressed. However, any patient contemplating an assisted dying pathway, should be encouraged to seek complete and comprehensive advice and guidance highlighting possible financial and estate planning implications for themselves, and their families, so that they are informed and signposted towards considering the right arrangement for their individual circumstances.
Individuals might also wish to seek the advice of a reputable independent financial adviser and legal practitioner.
CONCLUSION 12
The Committee concludes that Clause 12 appears in order, and express the view that Codes of Practice should be robust and include consultation with all relevant stakeholders for completeness and comprehensiveness.
CONCLUSION 13
The Committee concludes that it supports the view that any monitoring and reporting should be accurate, regular and transparent; particularly if it is to be useful in reflecting and reviewing an assisted dying pathway.
CONCLUSION 14
The Committee concludes that Clause 14 might benefit from amendment to strengthen the wording around offences. The Committee notes the House might wish to consider specifying that it be an offence to wilfully ignore a revoked declaration, and that it be an offence for any person coercing or exerting undue influence on a patient.
OPINION
I am sure you will have your own ideas about the timing of this report; the favourable conclusions / minor changes which patently support the introduction of AS/VE and the lack of proper response to Mr. Thomas (below.)
The committee has evidently ignored some questions put to it by Chris Thomas MHK. (See Appendix 18 of the report.)
Hopefully I will review this document in more detail, after I report on the Scottish Bill tomorrow.
Kevin Hay
(You can follow Kevin on 𝕏 @ kevinhay77)