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End of Life Issues. What can we expect in 2017?

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Things have been quieter than usual on the end of life front in the UK since the overwhelming defeat of Rob Marris’s and Patrick Harvie’s assisted suicide bills in 2015 in the Westminster and Scottish Parliament’s respectively. But there is new activity in the UK and plenty happening abroad. What can we expect this year?

High Court

Noel Conway, a 67 year old lecturer from Shrewsbury, is to seek a judicial review ‘on the grounds that the current laws contained in the Suicide Act 1961 are incompatible with Noel’s basic rights’. The case differs from the well-known cases of Nicklinson and Lamb in that Mr Conway’s illness – Motor Neurone Disease – is terminal, and he is reported to have a life expectancy of 12 months – although the legal principles being addressed are the same.

Motor Neurone Disease, ‘a progressive neurodegenerative disease that… leads to weakness and wasting of muscles‘, must not be misunderstood as a simple disease with all diagnoses being linked to similar prognoses: although the average life expectancy is 18 months, some patients can live for several years, depending on the variant and – significantly – the support given. Given that Parliament heeded the Supreme Court’s ruling, debated assisted suicide and rejected it by a 3-1 majority in 2015, it is important that this new case reflect legal and legislative precedent.

Scotland

It is almost two years since the Scottish Parliament rejected the Assisted Suicide (Scotland) Bill, 82 votes to 36. At the time, some MSPs warned that, while they couldn’t support the bill drafted by and for the late Margo MacDonald and taken up by Patrick Harvie, they were open to the principle. George Adam MSP is in the process of registering a new ‘Cross-Party Group on End of Life Choices’, and we can expect a new bill in what is, since the last vote, a new Scottish Parliament, within months.

California

Just as British MPs were rejecting assisted suicide in September 2015, legislators in California were endorsing Oregon-style legislation which took effect last June. We have now many years of assisted suicide statistics from Oregon (population 4m) and Washington (7.3m); we are yet to see statistics from Vermont (624,000); and the legislation in Colorado (5.5m) and the District of Columbia (681,000) was passed only three months ago.

The great west coast state of California can be expected to give some first report this year, however, and with a population of 39.2m, the figures will be of quite a different order to those we have seen before. We always hope that the number of those who accept the counsel of despair will be low, but experience tells us that California may yet before too long proffer the greatest yet cautionary tale.

It took mere months for health providers in California to go the way of Oregon, in telling patients that costly treatments previously available were not now to be covered – but assisted suicide would be. What more will we learn from California this year?

Foreign news

Episodes which throw euthanasia and assisted suicide into a less than helpful (for advocates) light are likely to continue to emerge. We’ve already mentioned US patients being denied expensive treatments once assisted suicide becomes an option; and euthanasia in cases of old age, failed gender reassignment, anorexia nervosa, blindness, psychological strain as a legacy of sexual abuse are both well documented and only a drop in the ocean.

In January, a court in the Netherlands, following the lead of the regulatory commission, cleared a doctor of wrongdoing after she drugged a patient with dementia and asked her family to hold her down while she administered the lethal injection – the woman, who in previous days had repeatedly expressed a wish not to die, having woken and fought the doctor. Such instances must not go unreported. Expect to see the boundaries pushed further this year in countries which have legalised assisted suicide, euthanasia or both: Netherlands, Belgium, Luxembourg and Canada. Expect also to see pressure to change the law in other countries, especially Australia.

NHS funding

Political debate on funding for the National Health Service has been a constant since its inception, recently characterised by industrial disputes and reports of unfilled positions across the country. Less visible are the ongoing postcode lotteries and rationing based on age, lifestyle and diagnosis; and inefficient spending, including where the failure to support appropriate out of hours services for terminally ill patients creates a disproportionate, extra burden on acute care services. The UK has the ability to deliver world-leading palliative care, but this is too often not available to patients, fuelling fear and despair. How will this situation develop in 2017?

Daniel Cuffe is Campaign Manager for Care Not Killing

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