Response to the Clauses Committee 

Isle of Man Medical Society (IOMMS) Response to the Report of the Assisted Dying Bill 2023 Clauses Committee  

This response is endorsed by the Isle of Man Medical Society (IOMMS) Executive. The IOMMS represents all doctors on the Isle of Man.

We have thoroughly reviewed the House of Keys Committee on the Assisted Dying Bill Report​​- March 2024 and our assessment is as below:

·       We dispute the assertion in paragraph 5 “that the general policy principles of this Bill” have been agreed by the House. Eight MHKs voted against the bill at the second reading and having at least one of them on the committee would have provided more balanced input.  Furthermore, several MHKs who voted to allow it to pass the second reading stated they would not support it further unless their concerns were addressed. We do not see many of those concerns being addressed by the committee in this report. The principles behind assisted dying have certainly not been agreed by health care workers, particularly doctors, by disability groups and by faith groups of all denominations and we hope and expect this dangerous Bill to fall at its Third Reading in the House of Keys.

·       We dispute the conclusion relating to Clause 1 – Short Title. The draft Bill relates to Medically Assisted Suicide and Voluntary Euthanasia and to call the Bill anything else remains incorrect and misleading.

·       We support the requirement for an honest death certificate and the change to recommended residency status to 5 years which should reduce the risks of death tourism.

·       We support the requirement for DHSC to produce recommendations for codes of practice and guidance and the establishment of an opt-in rather than opt-out which will protect the vast majority of doctors who would not want to be involved in any aspect of assisted dying.

·       We remain very concerned that the crucial capacity assessments in Clause 4 hinge on the Capacity Act 2023, which has not yet been implemented on the IOM.

·       The IOMMS are confused by the committee’s recommendation in Clause 5 – Terminal Illness to extend the life expectancy requirements to 1 year. We referenced several pieces of evidence to inform the committee that it is impossible to accurately predict if someone has six months to live. It is even more difficult to judge that someone is in their last year of life than it is to judge they are in their last six months and no training exists in medicine to get any better at judging that. Our evidence seems to have been ignored. On the IOM each year there are around 900 deaths (867 in 2023, 918 in 2022), Therefore on any given day there will be approximately 900 people starting their last year of life. If 150 of these die as a result of a sudden unforeseen cause, the other 750 will die of the medical condition that would identify them as terminal. Since judging the last year is so difficult, really anyone in their last two years could easily be judged to be in their last year. So, if this Bill goes ahead, with a life expectancy criterion of twelve months on any given day there will be 1500 people possibly being put under pressure to ask for assisted dying.

It is generally acknowledged that what starts out a personal choice, can become a suggestion made by others, leading to an expectation that the vulnerable person will do the honourable thing and seek assisted dying. No safeguards can protect the vulnerable against coercion- deliberate, perceived, or societal. 

·       The IOMMS are disappointed that although this was our first opportunity to give input into consideration of this draft Bill and it is envisaged that doctors are the very people who would be crucially involved in the process of assisted dying and euthanasia, that most of our submission was ignored or simply paid lip service to.

·       We are concerned that there is no mandate for this Bill. The largest sampling of Isle of Man public opinion was the Assisted Dying Consultation which reported in March 2023. Despite its intrinsic biases in favour of the Bill the responses showed a majority of Island residents opposed to the legalisation of Assisted Dying. Professional medical opinion by doctors dealing with seriously ill people daily in Noble’s Hospital, in the Hospice and in General Practice is strongly against. The IOMMS is pleased to see correspondence from the GMC which cautions doctors that assisted dying remains firmly outside their ethical guidance as the profession’s regulator whether it is legalised in a jurisdiction or not. Doctors becoming involved with assisted dying especially if they do not solely practice on the IOM, risk their registration and may be subject to GMC investigation.

Conclusion:

The IOMMS concludes that the Assisted Dying Bill, which is manifestly unworkable in practice, appears to be rapidly forced through with the sole aim of being the first British Isles jurisdiction to legalise, with scant regard to the damaging effects on Manx society and despite an unwilling Manx population.

Dr Fiona Baker General Practitioner,                                 IOMMS Executive Committee Member

Dr Duncan Gerry, Consultant in older people’s medicine, IOMMS Executive Committee Member

Dr Ben Harris, Palliative and end of life care specialist,    IOMMS President

21st April 2024