Source · Select Committees · Health and Social Care Committee
Second Report - Assisted Dying/Assisted Suicide
Health and Social Care Committee
HC 321
Published 29 February 2024
Recommendations
6
Accepted
Require UK Government to prepare for legislative divergence on assisted dying in UK jurisdictions.
Recommendation
The UK Government must consider how to respond to another jurisdiction in the UK, or the Crown Dependencies, legislating to allow AD/AS, and how it may impact jurisdictions which do not allow it. Following the recommendation by the Jersey Citizens’ …
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Government Response Summary
The government confirms it will discuss with devolved administrations and Crown Dependencies the practical and constitutional implications for England and Wales should any assisted dying/suicide legislation be enacted elsewhere.
Department of Health and Social Care
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13
Accepted
Para 278
Ensure universal coverage of palliative and end of life care services, including hospice care at home.
Recommendation
The UK has long been a world leader in palliative and end of life care, but access to and provision of palliative and end of life care is patchy. The Government must ensure universal coverage of palliative and end of …
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Government Response Summary
The government highlights that palliative care is now a mandated commission for ICBs, supported by statutory guidance. NHS England is further ensuring consistency by including palliative care in performance discussions from April 2024 and developing an all-age palliative and end-of-life care dashboard.
Department of Health and Social Care
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14
Accepted
Para 279
Integrated Care Boards need better population data to understand and support service provision.
Recommendation
As identified in the report of the HSIB (now the Health Services Safety Investigations Body (HSSIB)) on variations in palliative care services to adults, we agree that better data on the population within an ICB catchment area needs to be …
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Government Response Summary
The government states the NHS is already required to commission appropriate palliative and end-of-life care services. Palliative care services were added to the list of services an integrated care board (ICB) must commission, promoting a more consistent national approach and supporting commissioners in prioritising palliative and end-of-life care and that NHS England has published statutory guidance and service specifications to support ICBs in this duty, further work is ongoing including NHS England including palliative and end-of-life care in the list of topics for its regular performance discussions between national and regional leads, and NHS England commissioning the development of an all-age palliative and end of life care dashboard, which brings together relevant local data in one place.
Department of Health and Social Care
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15
Accepted in Part
Para 280
Commit to an uplift of funding to guarantee support for hospices requiring financial assistance.
Recommendation
We understand that the flexible nature of the current funding model for hospices is valued by some hospice leaders, and rather than suggesting that the Government funds 100% of hospice operations, we call on the Government to commit to an …
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Government Response Summary
The government explains the current funding model for hospices and does not commit to a general uplift for all hospices requiring assistance. However, it details significant increases and renewals of funding specifically for children's hospices, including £25 million allocated for 2023/24 and renewed for 2024/25.
Department of Health and Social Care
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19
Accepted
Para 307
Commission research into providing better mental health support and guidance for terminally ill people.
Recommendation
There is a pressing need to understand how to better provide mental health support, and guidance, for people who are living with a terminal diagnosis. We therefore recommend that the Government commission such research and report back to Parliament.
Government Response Summary
The government has accepted the recommendation by investing £3 million through the National Institute for Health and Care Research into a new Palliative and End Of Life Care Policy Research Unit to build the evidence base. It also highlights existing NHS Talking Therapies and a priority for integrating mental and physical health services for those with long-term conditions.
Department of Health and Social Care
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20
Rejected
Establish a national strategy for death literacy and support following a terminal diagnosis.
Recommendation
The Government must establish a national strategy for death literacy and support following a terminal diagnosis. This strategy will help healthcare professionals to better support someone and their loved ones, from the moment of a terminal diagnosis. (Paragraph 308) 98 …
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Government Response Summary
The government explicitly states it does not plan to establish a national strategy for death literacy. Instead, it will address related issues through the inclusion of palliative care in wider strategies, existing training for professionals, and ongoing research by the new Policy Research Unit.
Department of Health and Social Care
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Conclusions (14)
1
Conclusion
Deferred
Para 11
Our aim for this report is for it to serve as a basis for discussion and debate in future Parliaments. We have therefore endeavoured to bring together a comprehensive and up-to-date body of evidence relating to this difficult, sensitive, and yet, crucial subject. The debate on AD/AS is not new, …
Government Response Summary
The government states that should Assisted Dying/Assisted Suicide legislation be enacted, it will discuss its practical and constitutional implications for England and Wales with the devolved administrations and Crown Dependencies.
2
Conclusion
Accepted
Throughout our inquiry, a common theme across the evidence was the pursuit of the very best end of life care, and what many witnesses called “a good death”, where the person dying was cared for with compassion and high-quality care and provided with as much agency and choice as possible. …
Government Response Summary
The government details ongoing work and existing policies aimed at improving end-of-life care, including mandatory commissioning for Integrated Care Boards, statutory guidance from NHS England, the development of a palliative care dashboard, and recognition of personalised care in the Major Conditions Strategy.
3
Conclusion
Deferred
Para 38
A view put forward by some who have provided evidence to us was that the current state of the law is unclear.
Government Response Summary
The government's response details funding for hospices, including £25 million for children's hospices in 2024/25, and discusses disparities in hospice access, completely sidestepping the recommendation regarding the clarity of the law on Assisted Dying/Assisted Suicide.
4
Conclusion
Accepted
Para 39
During our inquiry we have heard statements from people who have been involved in assisting a loved one to pursue AD/AS abroad.
Government Response Summary
The government is investing £3 million in a new Palliative and End of Life Care Policy Research Unit to build the evidence base for all-age palliative and end-of-life care, and highlights existing NHS Talking Therapies services for mental health support.
5
Conclusion
Deferred
Para 40
We also heard about the documentation which has had to be secured as part of the application, including a medical report for the person applying. We note that the General Medical Council’s guidance for Investigation Committees assessing a doctor’s fitness to practice following an allegation of a doctor’s encouragement or …
Government Response Summary
The government states it does not plan to establish a national strategy for death literacy and outlines existing palliative and end-of-life care strategies and training, but does not address the recommendation for revised guidance from the GMC and BMA on doctors assisting with medical reports for assisted suicide abroad.
7
Conclusion
Deferred
Para 142
In the evidence we received we did not see any indications of palliative and end- of-life care deteriorating in quality or provision following the introduction of AD/ AS; indeed the introduction of AD/AS has been linked with an improvement in palliative care in several jurisdictions. We also conclude that jurisdictions …
Government Response Summary
The government redirects responsibility for any change to the law regarding Assisted Dying/Assisted Suicide to Parliament, stating it is a matter of conscience for individual parliamentarians rather than a government policy matter.
8
Conclusion
Deferred
Para 143
When we undertook this inquiry, we were keen to learn as much as we could from international examples and we hope that by putting the evidence we have gathered into the public domain, we can help to further inform the debate on AD/AS in the UK. The fact that people …
Government Response Summary
The government redirects responsibility for any change to the law regarding Assisted Dying/Assisted Suicide to Parliament, stating it is a matter of conscience for individual parliamentarians rather than a government policy matter.
9
Conclusion
Deferred
There are as many ways to operate AD/AS as there are jurisdictions which have legalised it, but there are two distinct models: one limiting its availability to those with a terminal illness and the other adding provision for unbearable suffering. What has become clear to us is that better data …
Government Response Summary
The government redirects responsibility for any change to the law regarding Assisted Dying/Assisted Suicide to Parliament, stating it is a matter of conscience for individual parliamentarians rather than a government policy matter.
10
Conclusion
Deferred
Para 189
Medical professionals would have an important role in any system of AD/AS, although the details are for Parliament to determine should it move to legalise AD/ AS. During our inquiry we have heard from healthcare professionals who were content to be involved, from others who were supportive of the practice …
Government Response Summary
The government redirects responsibility for any change to the law regarding Assisted Dying/Assisted Suicide to Parliament, stating it is a matter of conscience for individual parliamentarians rather than a government policy matter.
11
Conclusion
Deferred
Para 210
Practice across the world where AD/AS is legal is varied in the respect of capacity assessments for AD/AS. We heard that any such assessment should be undertaken by professionals who have undertaken necessary training on capacity assessments, particularly in relation to vulnerable groups.
Government Response Summary
The government redirects responsibility for any change to the law regarding Assisted Dying/Assisted Suicide to Parliament, stating it is a matter of conscience for individual parliamentarians rather than a government policy matter.
12
Conclusion
Deferred
Throughout our inquiry into AD/AS, the importance of safeguards and protections, and the question of whether they can be sufficient, has been a central feature, as has the related question of assessing capacity. Hearing from various representatives of healthcare professionals, as well as from healthcare professionals directly, it is clear …
Government Response Summary
The government redirects responsibility for any change to the law regarding Assisted Dying/Assisted Suicide to Parliament, stating it is a matter of conscience for individual parliamentarians rather than a government policy matter.
16
Conclusion
Para 304
We were extremely saddened to read and hear about the experiences of people who had experienced a loved one taking their own life, and our thoughts and deepest sympathies remain with them.
17
Conclusion
Para 305
We are pleased that the ONS in now attempting to monitor the rates of suicide for people with a terminal diagnosis, as this will facilitate scrutiny in the future. The existing data already serves as a sobering reminder that the support and care around people who are managing a terminal …
18
Conclusion
Para 306
We have heard a lot of evidence around the importance of a “good death” for both the person managing their terminal diagnosis, and their loved ones. Suffering, pain and managing a terminal diagnosis will be a subjective experience, unique to the person experiencing them, and although there may be in …