[Euthanasia in UK #3] Details of the process from application to completion based on the contents of the UK Euthanasia Bill, and safeguards to avoid the risk of coercion

リップディー（RiP:D)
Nov 27
8 min read

[Euthanasia in UK: Details of the process from application to completion, and safeguards to avoid the risk of coercion, as seen in the UK Euthanasia Bill]

This paper focuses on the euthanasia law currently under consideration in the UK.

・"The specific process from requesting euthanasia to its completion"

- "Safety measures in place to prevent harm to patients"

--I will explain this while focusing on the above two points.

UK Parliament website: Euthanasia Bill website

https://bills.parliament.uk/bills/3774

※The actual PDF of the "Euthanasia Bill" can be found here

https://publications.parliament.uk/pa/bills/cbill/59-01/0212/240212.pdf

*For the current status of the UK Euthanasia Bill, please see this page

[Bill name]

Terminally Ill Adults (End of Life) Bill

※Japanese translation: "Terminal Adulthood (End of Life) Bill"

[Eligibility conditions]

1. Terminally ill adults (age 18 or older) with an irreversible , progressive disease that is expected to result in death within six months .

* There was a proposal to include cases of neurodegenerative diseases where death is predicted to occur within 12 months , but the current deliberation stage has changed to "within 6 months for all diseases." This is a strict life expectancy requirement, just like in the United States.

*Neurodegenerative diseases : ALS, Parkinson's disease, spinocerebellar degeneration, multiple system atrophy, multiple sclerosis, Huntington's disease, etc.

2. Having the capacity to make the decision to end one's own life.

(*Mentally stable and capable of making decisions)

3. At the time of application, you must have ordinarily resided in England or Wales for at least 12 months and be registered as a patient with a general medical practice in England or Wales.

4. A clear, firm and informed intention to end one's life.

5. It is a voluntary decision , without coercion or pressure .

remarks

*Non-terminal illnesses and mental illnesses are not covered .

No matter how much "terrible pain" you are in, no matter how unbearable "discomfort" you are feeling,

If a pet still has a lot of life left , it is not a candidate for euthanasia .

For example, even if a person has severe fibromyalgia and experiences constant pain throughout their body like an electric shock, they are not eligible for euthanasia if they still have a long way to go before they can die . Mental illnesses are also classified as non-terminal illnesses.

*On the other hand, Switzerland, the Netherlands, Belgium, Germany, Canada, Spain, and South America also cover non-terminal illnesses . The same is true of the French bill.

[Review process]

( The process from application to completion as seen in the UK Euthanasia Bill)

[Application stage]

Preliminary discussion:

Registered healthcare professionals are not obliged to raise the topic of voluntary assisted dying with patients, but may discuss it if they deem it appropriate.

A written record of the discussion will be submitted to your registered medical practitioner as soon as possible and included in your medical record.

・First Declaration:

A patient wishing to die must make an " initial declaration of intent ," which must be signed and dated by the patient in a prescribed form and must be witnessed by both the coordinating physician (the first physician) and another witness.

The declaration of intent includes the initial conditions of eligibility (over 18 years of age, residency requirement, GP registration), confirmation that preliminary discussions have taken place, consent to be assessed, an understanding that there is no coercion and that the declaration of intent can be cancelled at any time.

Patients must present two forms of identification to the coordinating physician and a witness to verify their identity.

[Evaluation stage 1] (Two doctors)

1. Initial physician evaluation (coordinating physician)

A coordinating physician (who is not a relative of the patient and is not involved in the patient's terminal illness care) assesses the patient for terminal illness, decision-making capacity, and voluntary will.

If there are doubts about decision-making capacity or if there is a lack of expertise regarding the patient's illness, a referral to a specialist (psychiatrist or specialist in the relevant illness) is required.

2. Evaluation by a second physician (independent physician)

The coordinating physician will refer the patient to an independent physician who will conduct a second evaluation as soon as possible after the seven-day reflection period from the date of the coordinating physician's report.

The independent physician must not have provided treatment or care for the patient's terminal illness, be a relative, or be a partner or colleague in the same practice or clinical team as the coordinating physician.

Following the assessment, the independent doctor will prepare a report and provide copies to the patient, the coordinating doctor and the GP practice.

[Evaluation Stage 2] (Consultation Stage: Final Review and Approval)

・Euthanasia Review Panel

If both doctors determine the patient is eligible, the case is referred to a euthanasia review panel.

The panel reviews the submitted documentation, hears from the coordinating physician, independent physicians, and, in principle, the patient. If the panel determines that the patient is eligible, it issues a certificate of eligibility .

- Review of the panel's decision

If the panel refuses to issue a certificate of competency, the patient can petition the commissioner for reconsideration on the grounds of legal error, unreasonableness, or procedural unfairness. If the commissioner grants the petition, he or she will refer the case to another panel for review.

* Panels are...

The Euthanasia Review Committee is an organization independent of the two doctors.

A review body chaired by a High Court judge or former senior judge , with participation from a variety of experts including lawyers, palliative care physicians, psychiatrists and social workers .

It is a safeguarding body made up of interdisciplinary experts and is a "major feature" of the UK euthanasia bill, which is said to have strict scrutiny unlike other countries where euthanasia is legal.

[Implementation stage] (final confirmation of intent and execution)

Confirmation of the request (Second Declaration):

After the certificate of competency has been issued and the 14-day reflection period has expired (which can be shortened if the coordinating physician reasonably determines that death is imminent), the patient will make a "second declaration of intent" indicating their desire for euthanasia.

This declaration is voluntary, unforced and confirms that it has not been cancelled.

The coordinating physician will confirm that the patient is terminally ill, has decision-making capacity, and has clear, firm and voluntary intentions at the time of will expression, and will prepare a statement to that effect .

・Cancellation of declaration of intention:

You may revoke your First or Second Statement of Intent at any time by notifying your Coordinating Doctor or a healthcare professional at your GP practice, either verbally or in writing. The revocation will be recorded in your medical record.

・Providing euthanasia:

Euthanasia will be carried out once a certificate of competency has been issued, the second period of consideration has expired, the second declaration of intent has been submitted and not cancelled, and a statement from the coordinating physician has been made.

At the time of providing the approved substance, the coordinating physician must ensure that the patient has decision-making capacity, has a clear and firm will, and is voluntarily seeking assistance.

The coordinating physician can prepare the substance so that the patient can self-administer it and assist with the administration, but the final act of self-administration must be performed by the patient themselves ( doctors are not allowed to administer injections, etc. ).

The coordinating physician must remain with the patient until the patient self-administers the substance and dies, or until the procedure fails or the patient decides not to self-administer.

Death registration and reporting:

In the event of death by euthanasia, the coordinating physician will prepare a "final statement" and send a copy to the Commissioner, which will be recorded in the medical record.

The Registrar General of England and Wales provides Parliament with a report each year analysing statistics on deaths by euthanasia, with the cause of death recorded as " assisted death " along with terminal illness.

[UK Euthanasia Process] (Simplified image)

① Request a coordinating doctor (a doctor who can handle euthanasia) (first check)

⇩

② Euthanasia requested by an independent doctor (a completely different doctor) (second check)

⇩

3) Review by a panel (review by high judges and various experts) (third check)

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④ After the coordinating doctor performs euthanasia, he/she reports to the administrative agency.

[Protective measures (safety guards) etc.]

・Initial Doctor Evaluation (Coordinating Doctor):

The coordinating physician must meet certain requirements, not be a relative of the patient, and have no conflicts of interest .

・Second Doctor Evaluation (Independent Doctor):

It is carried out by a physician independent of the coordinating physician (one who has not been involved in the treatment or care of the patient's terminal illness and is not a relative of the patient or a colleague of the coordinating physician).

• Approval and final review

Assisted Dying Review Panel :

The evaluation reports of the first and second doctors will be reviewed, and interviews will be conducted with the doctors and the patient themselves.

If the patient is physically unable to self-administer, it may be administered by an authorized healthcare professional .

This requires patient consent and specific training and qualifications, including training on coercive control and financial abuse.

Law enforcement and immunity

Any person who assists or practices euthanasia in good faith in accordance with this Act shall be immune from civil or criminal liability and professional disciplinary action.

Inducing a request for euthanasia by fraud, coercion or pressure, or preventing a request from being withdrawn, is punishable by up to 14 years in prison .

Inducing self-administration of a euthanasia substance by fraud, force or pressure is punishable by life imprisonment .

Creating false documents, forging or destroying documents is also a crime.

• Monitoring and review

Voluntary Assisted Dying Commissioner:

▪ Experienced judges appointed by the Prime Minister.

▪ Monitor the implementation of the law, conduct investigations and submit annual reports.

▪ Appointing a Disability Advisory Committee on the implementation and impact of the Act on persons with disabilities.

- Review the law every five years to assess the current status of euthanasia, the availability of palliative care, and the impact on people with disabilities.

A code of practice and guidance will be developed to provide guidance on assessing decision-making capacity, the impact of mental illness, providing information and ensuring communication.

remarks

I feel that the set of requirements is a little too strict .

The overall system is not significantly different from that of other countries that allow euthanasia.

However, the establishment of a review board that includes high judges, experts, the two doctors involved, and the patient himself is an extremely careful and multi-layered structure , and is expected to impose a considerable burden on the operation.

In particular, there are concerns about whether such a complex screening process can be completed smoothly within the time constraint of "within six months of life expectancy." It is easy to understand why the current situation is described as "the strictest screening standards in the world."

However, it is natural that caution is required in the establishment stage of the system , and it is reasonable to adopt a strict framework in the initial operation. In the future, as the operation becomes stable and practical issues are sorted out, it is possible that some relaxation of the standards will be considered.

Regarding the severity of the penal provisions, we believe that they can be appreciated from the perspective of ensuring the reliability of the system, and that they may even be strengthened.

We are considering institutional design and policy influenced by Dutch euthanasia .

I hope you will compare it with the UK and gain a deeper understanding of the situation.