Problems with the Alleged Safeguards

It is claimed that ‘safeguards’ will be put into the law, so as to give continued protections to vulnerable people. When we look at the alleged protections that have been proposed however, we see that these are vague, and that those which have been proposed and practised in other jurisdictions could not but fail to provide the rigour that would be needed to protect vulnerable constituencies of people.

The ‘safeguards’ mentioned within the proposition (relevant to the process of patients’ presenting for EAS) are that :

  • EAS should be “permitted with the direct assistance of registered medical practitioners and registered nurses only”;
  • Patient access to EAS “should be subject to a mandatory period of reflection”;
  • A “withdrawal of request should be permitted at any time;
  • EAS “should only be permitted at pre-approved locations”; and
  • EAS “should be subject to a pre-approval process which, subject to further consultation, may involve a decision made by a court or specialist tribunal”.


These proposals are too vague to tell us precisely how doctors and nurses would be involved, what the pre-approval process would be, and what the involvement of a “court or specialist tribunal” would be, either. It would surely be more responsible for the States Assembly to only agree in principle to euthanasia and assisted suicide being introduced into our law and medical practice when a clear and explicit set of proposals were presented before it for prior consideration.

It seems likely however, that the proposals eventually argued for will be very similar to the ‘Assisted Dying Bill’ (ADB) which was recently debated within the UK’s House of Lords in Westminster, and proposals by ‘My Death, My Decision’. Both these prescribe the purported safeguard of two doctors, in the ADB’s case the first a ‘registered medical practitioner from whom the person has requested assistance to end their life (“the attending doctor”)’, and the second a ‘registered medical practitioner (“the independent doctor”) who is not a relative, partner or colleague in the same practice or clinical team, of the attending doctor’, both of whom must be ‘suitably qualified’ in holding ‘such qualification or… such experience, including in respect of the diagnosis and management of terminal illness, as the Secretary of State may specify in regulations’, and must affirm that they are ‘satisfied [that the patient] is’:

  • ‘terminally ill’;
  • ‘has the capacity to make the decision to end their own life’; and
  • ‘has a clear and settled intention to end their own life which has been reached voluntarily, on an informed basis and without coercion or duress’.


Such an evaluation would come before the patient, in front of and countersigned by a witness, as well as a registered medical practitioner (who may be the “attending doctor”), signed a declaration that s/he ‘has a voluntary, clear, settled and informed wish to end his or her life’.

This largely replicates the provisions of the Oregonian Death With Dignity Act and the similar Canadian Act, in which ‘attending’ and ‘consultant’ physicians must diagnose and confirm respectively that the patient possesses a terminal illness, “and verify that the patient is capable, is acting voluntarily and has made an informed decision”. The patient then writes a written request for assisted suicide before ‘at least two individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, acting voluntarily, and is not being coerced to sign the request’.

UK proponents of assisted suicide have great confidence in these legal prophylactics. Baroness Meacher, who is the proposer of the ADB in the House of Lords, said in a speech in favour of a Bill proposing the Oregon system in 2014:

Our opponents need not fear abuse by relatives; the safeguards have been shown in Oregon to deal with this relatively small problem very well”.

Sadly, these paper regulations stand up neither in theory nor in practice. They have proved insufficient to prevent elder abuse, or protect patients whose autonomy has been compromised due to mental illness.

Nowhere do such proposals set out how either doctor might go about evaluating a patient to discern that they are not acting under any form of duress, inducement or undue influence (including that due solely to a perception or mistake on the part of the person) in relation to his or her wish to request voluntary euthanasia, nor is there any requirement that they have psychological training, but even with the stipulation of a qualified psychiatric specialist, such a question of motivation is not a medical one, but a personal, social, and domestic one, outside of the expertise of doctors and even psychologists.

Even if all this were not the case, this also relies on both doctors knowing the patient well enough, and their families, to be able to evaluate their intentions, mental capacity, and freedom from duress such as subtle pressure from relations. Given the relationship between most patients and even their General Practitioners, which is much less familiar than would be required, this is incredibly unrealistic. Not only would their time with the patient be limited, it would be very unusual for any doctor nowadays to have the kind of deep relationship with their patient that would allow them to detect undue influence, or even feeling a burden and other incentives, all of which undermine the ‘voluntary’ desire to end their own lives.

With the added work of a psychiatrist, the amount of time s/he would have to check the patient would also be limited, and given this there is no way they would be able to develop the kind of similarly long term and in-depth rapport with the patient that might, and only potentially, allow them to detect (for example) the problems mentioned above. Since this process is inherently flawed, such so-called ‘safeguards’ are effectively toothless, and lack the detail and power to protect vulnerable people.

The same problem accrues with the proposal to add further the oversight “of a court or specialist tribunal”. What would such a tribunal do? Would it interview the patient presenting for EAS? If so, then it would have no more time to know and detect pressure on the patient than two doctors or a psychiatrist, and with even less expertise. If it only means a panel of judges checking that the so-called ‘safeguard’ process has been followed, meanwhile, this is a guarantee that is meaningless if the safeguards (as we have seen) are toothless.

Suffice it to say then, the theoretical underpinnings of so-called ‘safeguards’ for assisted suicide and voluntary euthanasia are greatly lacking, and sadly, the human cost of this ill-thought practice in reality is demonstrable in places like Belgium and Holland, where involuntary euthanasia and incremental extension of application have taken place.