Medical and academic experts on physician-assisted death in different countries gave testimony in Parliament Tuesday to a Commons committee. The testimonies will inform the Government as it considers whether the UK should change its laws regarding assisted death.
The Canadian experience of legislating to permit assisted dying and assisted suicide should present a "warning sign" for other countries considering a similar move, the Commons Health and Social Care Committee was told.
Canada's Parliament passed federal legislation in 2016 to allow Canadian adults to request medical assistance in dying. The medical assistance in dying (MAID) law was subsequently amended to permit assisted euthanasia in additional situations, including for people with disabilities and chronic diseases.
A 'Disturbing Societal Norm'
Dr Scott Kim, a professor of psychiatry at the University of Michigan, characterised the Canadian system as "the most extreme form of medicalised assisted dying" because "the person requesting it can refuse an effective treatment, or lack access to standard treatment, and still be legally eligible".
Dr Kim, who also holds the post of senior investigator at the department of bioethics at the National Institutes of Health in the US, explained : "The law itself says this doesn't have to be last resort, which means that a person could genuinely lack access to disability services, to outpatient psychiatric treatment, which is common in Canada. Those people would still qualify, and I think that's a very disturbing societal norm that's being practised." It could also put the healthcare profession in the position of effectively saying to some patients that ending life was "another treatment alternative we can offer you", he added.
Trudo Lemmens, a professor in health law and policy at the University of Toronto, who initially supported his country's legislation, said Canada should serve as a "warning sign" for those contemplating legalising medically assisted dying. Canada started in response to the "more exceptional cases of suffering", such as people with degenerative diseases, but "rapidly expanded" to a system where it is accessible "largely on demand in very broad circumstances". As such, it had "in some way, become a first-line therapy", he suggested.
However, James Downar, a professor in the division of palliative care at the University of Ottawa, said it was a "misconception" that MAID was often taken up by patients as a first resort . "I would simply state that what we know of the individuals who are receiving MAID, that 96% received or had good access to disability support and 98% received or had access to palliative care support," he said, adding that this was "corroborated by coroner's reports in Ontario", covering thousands of cases.
According to Professor Downar, "many countries are in a position to legalise, safely, medical assistance in dying for people with serious and incurable illness, who have intolerable suffering", and that "a number of jurisdictions have shown that this can be safely implemented as part of a comprehensive suite of end-of-life care".
Legislation Needs Checks and Balances
Tuesday's committee session also heard from expert witnesses in the Netherlands, which legislated for euthanasia and physician-assisted suicide in 2001 and from Belgium, which passed its Euthanasia Act in 2002 .
Rutger Jan van der Gaag, professor of psychosomatic medicine and psychotherapy, and former president of the Royal Dutch Medical Association, told MPs that 170,000 people died in his country in 2022, of whom 8720 died with assistance under the euthanasia law. However, 44,000 of the deaths were from palliative sedation at home, whilst the numbers who died in hospitals and nursing homes by this means were unknown.
Perofessor van der Gaag said: "I do not know if the 44,000 people who died from palliative terminal sedation last year in our country did so because they wanted it or that other pressures pushed the doctors to terminate their life; and that is the reason why I strongly advocate having a law." He held the view that "self-determination and autonomy" of people was "crucial" but that it was also "crucial that citizens have safeguards, that there are checks and balances".
Jan L Bernheim, an oncologist and emeritus professor of medicine and medical ethics at Vrije Universiteit Brussel , said both palliative care and physician-assisted dying had increased in parallel in Belgium since the law was changed. They were "you might say, bedfellows", he suggested. Since the legislation passed, "scrutiny of end of life has much, much, much improved", he told MPs, so that "the number of unrequested endings of life has become very, very small".
Professor Bernheim stressed that scrutiny, in particular from peers, was a vital component of safeguards against abuse of the law.
Earlier this year, the committee heard from peers who had attempted to introduce legislation on physician-assisted dying in the House of Lords, as well as those opposed to such a measure. MPs also considered expert evidence on the impact that such a law change might have on healthcare professionals and their families. They will also take into account whether there have been any new developments since the House of Commons last considered legislation on the subject in 2015 .
The Committee will publish a report on its findings for the Government to consider, although ministers have stated previously that it would be for Parliament to decide on whether to pass legislation permitting physician-assisted dying.
It is currently an offence in England and Wales to assist or encourage another person's suicide under section 2(1) of the Suicide Act 1961, whilst euthanasia is illegal across the UK under the Homicide Act 1957 and could be prosecuted as murder or manslaughter.
