Hourglass' View on the End of Life Bill

Overarchingly, Hourglass has a neutral view on the proposed Terminally Ill Adults (End of Life) Bill.

We understand and support the need for older people to be able to make choices regarding their own lives and deaths and have autonomy over decision making in this sphere and any others.

However, we are concerned by elements of the Bill revolving around safeguarding, oversight and regulation, and we are anxious to ensure that older people are not at risk of coercion, abuse, and pressure to end their lives on account of the Bill.

AUTONOMY OF CHOICE

Hourglass’s commitment and call for a Safer Ageing Society by 2050, as outlined in its recent manifesto, specifically lays down an aim to “foster an environment where the safety and dignity of ageing individuals are guaranteed.” While assisted dying may seem antithetical to notions of keeping older adults safe and allowing for safer ageing, assisted dying legislation may well fit in a dignity consensus, and allow the dignity of choice for older people, especially in cases of terminal illness.

A key concept raised by those supportive of assisted dying is that it allows a person with capacity but in need of medical support, the right to choose, and the key moral autonomy to determine for themselves when and how they die, the ethical principle of a “right to die.”As a participant from a recent Health and Social Care Select Committee roundtable on the subject contended:

“As my life starts to end and the myriad increasing comorbidities multiply, I want to die while I’m able to choose and act preserving my dignity and self-respect.”

When concerning assisted dying support for terminally ill older people rather than that of “intolerable suffering”, the choice is not between living and dying, but between dying at a time and place not of one’s choosing, or dying at a time and place of one’s choosing. People already have recognised freedom to accept or decline some life ending decisions in clinical and non-clinical contexts, including the right to refuse lifesaving treatments, or to make a Do Not Resuscitate order. As such, assisted dying could be seen as an extension of these existing rights.

Even with advanced modern medicine and palliative care, pain is not extinguished from the ageing process. The provision and standard of palliative care can be variable across the UK and it must be recognised that older people should not have to make a choice between sub-optimal end of life care and assisted dying. Another prominent argument around the legislation of assisted dying is that forcing people to suffer unbearable physical and mental pain The Terminally Ill Adults (End of Life) Bill Hourglass www.wearehourglass.org and distress is contrary to modern ethics around health and wellbeing. As Shaw and Morton note, “permitting assisted dying enables consenting patients to avoid negative quality-adjusted life years (QALYs), enabling avoidance of suffering.”Hourglass argues that the choice to extinguish pain for those with terminal illnesses is one aspect of the dignity of choice and autonomy, and can fit within a safer ageing society.

View our full 'Written Evidence' document below.