Areas of Concern
88% of head & neck cancer prognoses are wrong. (1)
Nearly half of predictions in heart failure are wrong. (2)
5% of terminal diagnoses are wrong. (3)
Estimating survival is often wrong
No known methods for measuring or estimating suffering by healthcare professionals.
A person’s estimate of their own suffering is strongly affected by a wide range of treatable issues including psychosocial support,(4) loneliness and depression.(5)
Physical illness and depression commonly co-exist.(6)
Suffering cannot reliably be estimated
Assisted deaths are cheaper than two weeks in a nursing home
Over half of Oregon patients state financial burdens as a reason for requesting an assisted death.(11)
Some Canadian patients are choosing an assisted death because of a lack of available care.(7)
Will Jersey become the Vancouver Island of the UK?
Canada’s assisted deaths have risen more than 10 times in 6 years.(8)
On Vancouver Island 1 in 13 of all deaths are assisted (7.5%).(9)
Who is going to authorise assisted dying drugs?
Is the Jersey Government willing to authorise lethal ‘substances’ that have never been approved by any regulatory authority anywhere in the world?
Will Jersey doctors be willing to prescribe and pharmacists willing to prepare and dispense unapproved lethal drugs?
Will the Jersey Government provide unlimited indemnity in the event of a problem?
All assisted dying safeguards have been eroded over time
Every safeguard is attacked as being discriminatory and anti-choice.
Groups are already trying to extend the 6m prognosis limit and in Scotland a petition has been submitted to include mental health problems.
Any safeguard is easily challenged in court.
Should assisted dying become a legal right, when palliative care is not a legal right?
The service will be free, unlike GPs and investigations. Many palliative care services will continue to be charity-funded.
The cost of an assisted death on Canada equates to 2 weeks care home care.(10)
The number of patients giving a financial burden as a reason for an assisted death has risen steadily in Oregon, reaching 8.4% in 2021.(11)
Doctors are the weak link. They often miss treatable problems
Doctors often miss depression,(12) and loneliness.(5)
Doctors are not trained to detect coercion, while the doctor’s compassion will risks missing manipulation.
Three-quarters of those with a wish to die report being lonely and 60% have a clinical depression.(6)
Additional assessments will only be requested if the co-ordinating doctor (likely to be a non- specialist) is aware of the need.
Assessing capacity appears superficially straightforward under capacity legislation. In reality implementation of such legislation has been patchy.(13)
Independence may be impossible in a small medical community
All the issues with the co-ordinating doctor apply to this second doctor
In Oregon and Canada, only 2% of doctors prescribe assisted dying drugs.
Are there sufficient resources to support professionals and fill gaps?
Participating in assisted deaths has a psychological impact on up to half of doctors that persists in 20%.(14)
Factors contributing to the emotional burden of participating in an assisted death include discomfort with being involved in the process, assessing a patient’s capacity to decide, and having to judge if the patient fits the criteria for an assisted death.(14)
Canadian physicians’ refusal to participate in assisted deaths was not based on religious or moral grounds, but because of the emotional burden and fear of psychological repercussions.(15)
Doctors in Victoria, Australia, are struggling to do eligibility assessments, know the patient or reconcile their role in assisted deaths.(16)
Monitoring of ‘Route 1’ patients happens after death. That is too late to check for problems
Monitoring in other legislations is poor.(17, 18, 19)
Oregon is the only legislation to produce detailed information and yet much information is missing.
No information is given on what the annual report will contain apart from ‘number of assisted deaths and requests.’
No assisted dying legislature monitors decisions prospectively, relying on the evidence from the doctor who administered the drugs.
Appendix
1 Hoesseini A et al. Physicians’ clinical prediction of survival in head and neck cancer patients in the palliative phase. BMC Palliative Care, 2020; 19: 176-85. https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-020-00682-2
2 Warriach HJ et al. Accuracy of physician prognosis in heart failure and lung cancer: comparison between physician estimates and model predicted survival. Palliative Medicine, 2016; 30(7): 684-9.https://journals.sagepub.com/doi/abs/10.1177/0269216315626048
3 House of Lords Report 86-II (Session 2004-05), p730.
https://publications.parliament.uk/pa/ld200405/ldselect/ldasdy/86/8602.htm
4 Neimeyer RA et al. Confronting suffering and death at the end of life: the impact and religiosity, psychosocial factors, and life regret among hospice patients. 2011; 35(9): 770-80. https://www.tandfonline.com/doi/abs/10.1080/07481187.2011.583200
5 Lee SL et al. The association between loneliness and depressive symptoms among adults aged 50 years and older: a 12-year population-based cohort study. Lancet Psychiatry, 2021; 8: 48-57. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30383-7/fulltext
6 Hartog ID, Zomers ML, van Thiel GJ, Leget C et al. Prevalence and characteristics of older adults with a persistent death wish without severe illness: a large cross-sectional survey. BMC Geriatrics, 2020; 20: 342- 356. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01735-0
7 Ontario man applying for medically-assisted death as alternative to being homeless - https://toronto.citynews.ca/2022/10/13/medical-assistance-death-maid-canada/
8 Second annual report in Medical Assistance in Dying in Canada 2020. https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2020.html
9 A rare look at Canada’s growing demand for medical assistance in dying. https://www.ctvnews.ca/w5/a- rare-look-at-canada-s-growing-demand-for-medical-assistance-in-dying-1.5854612
10 Cost estimate for bill C-7 “Medical Assistance in Dying”. Ottawa: Parliamentary Budget Officer. Oct 20, 2020. See: http://www.pbo-dpb.gc.ca/en/blog/news/RP-2021-025-M--cost-estimate-bill-c-7-medical- assistance-in-dying--estimation-couts-projet-loi-c-7-aide-medicale-mourir
11 Oregon Health Authority: Annual Reports.
12 Shastri A et al Recognition and treatment of depression in older adults admitted to acute hospital in England. Clinical Medicine 2019; 19(2): 114-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454375/
13 Select Committee on Mental Capacity Act 2005- Report of session 2013-14.
https://publications.parliament.uk/pa/ld201314/ldselect/ldmentalcap/139/13902.htm
14 Kelly B et al. “An indelible mark” the response to participation in euthanasia and physician-assisted suicide among doctors: a review of research findings. Palliative and Supportive Care, 2019; 18(1): 82-8. https://www.cambridge.org/core/journals/palliative-and-supportive-care/article/abs/an-indelible-mark-the-response-to-participation-in-euthanasia-and-physicianassisted-suicide-among-doctors-a-review-of-research-findings/38E83F6E75B2F3A671CF48205612498A
15 Bouthillier M-E, Opatrny L. A qualitative study of physician’s conscientious objections to medical aid in dying. Palliative Medicine, 2019; 33(9): 1212-20. https://journals.sagepub.com/doi/abs/10.1177/0269216319861921
16 Rutherford J et al. What would the doctor prescribe: physician experiences of providing voluntary assisted dying in Australia. Omega- Journal of Death and Dying, 2021; July 20. https://journals.sagepub.com/doi/10.1177/00302228211033109
17 Smets T et al. Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis or reported and unreported cases. BMJ, 2010; 341: c5174. https://www.bmj.com/content/341/bmj.c5174.short
18 Raus K et al.. Euyhanasia in Belgium: shortcomings of the law and its application and of the monitoring of practice. Journal of Medicine and Philosophy 2021; 46: 80-107. https://academic.oup.com/jmp/article-abstract/46/1/80/6118631
19 Kotalik J. Medical assistance in dying: challenges of monitoring the Canadian program. Canadian Journal of Bioethics, 2020; 3(3): 202-9. https://www.erudit.org/en/journals/bioethics/1900-v1-n1-bioethics05693/1073799ar/abstract/