Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence

Memorandum by The Association of Catholic Women


  1.  The Association of Catholic Women is an organisation of women and men "supporters"; it is listed in the Catholic Directory, but is independent as an organisation of the Catholic Bishops' Conference of England and Wales.

  2.  The membership of the Association numbers more than 1,000. The coincidence of the consultation period with the summer holiday period has made it impossible to undertake a consultation exercise amongst the membership at large. This response represents the corporate view of the Association's Steering Committee.

  3.  Many of the Association's members have experienced the work of hospices, both in the United Kingdom and abroad; through this experience we have direct knowledge of people of all faiths and none whose last weeks of life have been transformed from times of fear, anxiety and pain to peaceful and virtually pain-free acceptance.


  4.  The drive to give and to preserve life is one of the most powerful of animal instincts. Mothers of all species fight ferociously to protect the lives of their offspring. Babies born in the most adverse conditions of war, disease and famine cling to life and respond remarkably well to only minimal standards of care.

  5.  Medical practitioners accept that seriously ill and injured people often defy unfavourable prognoses through sheer determination to survive.

  6.  Our society has rightly held the conscious giving of one's own life to save that of another, or in defence of one's beliefs, to be an act of supreme heroism and sacrifice.

  7.  By contrast, when we speak of "losing the will to live", we are describing a condition of despair, a departure from the natural order. A decision to seek to end one's life, or to seek to have it ended, results from a sense of hopelessness, a belief that death must be preferable to the physical pain or loss of personal independence (both of which are recognised triggering factors in clinical depression) presently being endured.

  8.  In such circumstances, our clear duty to a fellow human being, rather than to collude with the person's despair, is to do whatever is possible to alleviate the pain, both physical and psychological, that has led him or her to seek assistance to die. This is the underlying principle of palliative care, which is the hallmark of, but is not exclusive to, the hospice movement.

  9.  The first duty of medical practitioners is to do no harm. The alleviation of pain is at the heart of medical practice; the administration of pain-relieving medication is held to be a licit and positive practice, even in circumstances in which the medication will itself shorten life.

  10.  To ask a doctor or other medical practitioner to assist a person in ending his or her life is to move beyond the aim of pain alleviation; it goes against the principle of non nocere. The compassion doctors and nurses rightly feel for the patients in their care should not be used a lever of persuasion to set aside that principle.


  11.  The intrinsic value of human life has, for many centuries, been the underlying principle of the rule of law. Crimes against the life of the person rightly attract the most severe penalties. Even in time of war, the taking of human life outside of recognised rules of engagement attracts the opprobrium of the international community and is punishable in international law as a war crime.

  12.  If enacted, the provisions of this Bill would directly contradict Section 58 of the Mental Capacity Bill. For the government to give time to a Private Member's Bill, the effect of which would be to render inoperative safeguards built into its own legislation, as recently amended, is irrational.


  13.  The dual purpose for which this Bill is proposed to be enacted is twofold: ". . . to enable a competent adult who is suffering unbearably as a result of a terminal illness to receive medical assistance to die . . . ; and to make provision for a person suffering from a terminal illness to receive pain relief medication."

  14.  The latter provision, as described in Section 15 of the Bill already exists. It is difficult to see what purpose this provision serves, either in the title of this Bill or in Section 15, other than to draw attention to the one universally acceptable proposal; this might, in fact, mislead members of Parliament and the public, who may not be aware that this is already an entitlement exercised under the oversight of doctors but, more often than not, nurse managed. To include this provision could soften opposition to the more contentious proposals in the Bill.

  15.  Sections 2 and 3 enumerate a comprehensive list of "qualifying conditions" which must be met before the patient may proceed to execute a declaration that he or she wishes to be assisted to die.

  16.  The gradual erosion of these safeguards may be envisaged. The Bill as it stands only applies to competent adults who are suffering unbearably. How soon will it be before a campaign begins to extend its provisions to relieve the unbearable suffering of terminally ill children? Obviously, minor children could not be competent to make the declaration; therefore parents or guardians would be permitted to do so on their behalf. Once the principle was conceded that a responsible adult could make the declaration on behalf of a suffering, but incompetent minor, it would be only a short step to permitting an adult child to make the declaration on behalf of an elderly, incompetent parent. It would come to be seen to be unfair for a suffering, terminally ill but incompetent person to be left unassisted for the lack of an appropriate adult relative; another competent adult could be appointed to make the declaration. Thus, carefully constructed safeguards could be set aside with relative ease, apparently for the best of motives.

  17.  Both the solicitor witness and the lay witness to the advance declaration, as provided for in Section 4, are required by sub-sections (3)(b) and (4)(b) to make an assessment as to the patient's soundness of mind, which neither is likely to be professionally competent to make. Solicitors, as far as we are aware, are not trained to assess competence in a matter of life and death.

  18.  There is an implicit assumption in the requirement in Section 7 for an attending physician or a consulting physician who has a conscientious objection to assisting a patient's death to refer the patient to another physician who has no such conscientious objection, that such a conscientious objection will be the exception, rather than the rule.

  19.  Moreover, the requirement to refer to a physician who has no such conscientious objection renders the objecting physician complicit in an outcome to which he or she has a conscientious objection.

  20.  The provisions of Section 7(1) and of Section 10(1-3) relating to protection for physicians and other medical personnel are silent with regard to discrimination in career progression.

  21.  The establishment of various monitoring commissions, to cover either countries or regions at the discretion of the Secretary of State, is a potential cause for concern about lack of consistency of application; there is scope for considerable variation between commissions in the application of the qualifying conditions for making an advance declaration.

  22.  The requirement for the attending physician to send the file of documentation to the monitoring commission only after the assisted death (or attempted assisted death) has taken place, and for the monitoring commission to determine at that stage whether the qualifying conditions have been met is hard to understand. A determination that the qualifying conditions have not been met can no longer protect the patient.

  23.  On every day in the year, throughout the United Kingdom, in hospitals, hospices, care homes and in their own homes, terminally ill patients request and receive medication for the relief of pain and distress, as described in Section 15. At least one member of this Steering Committee has direct personal experience of the administration of such palliative treatment to a close family member in hospital. There is no need, legal or ethical, for this Bill to be enacted to guarantee this entitlement.

  24.  The power given to the Secretary of State in Section 16, to make regulations by statutory instrument, gives him or her power to go beyond the intentions of Parliament; the requirement for such statutory instruments to be approved by resolutions of both Houses of Parliament is not a realistic safeguard (as the examples in paragraph 16 illustrate).

  25.  None of the safeguards in the Bill will (or, indeed, could) protect the patient from psychological pressure (perhaps self-imposed) to decline palliative care in favour of assisted suicide, in order to avoid being a burden to family or medical staff, to free up resources of staff, beds or medication. The Bill, if enacted, could in fact exacerbate a desire for self-harm in vulnerable people. It is possible to envisage hard-pressed medical staff not seeking to deter such patients.


  26.  There is a well-established and commonly understood principle that "hard cases make bad law". There can be few "harder cases" than the prospect of terminally ill patients suffering pain and distress that is capable of relief, and the compassionate desire to relieve that suffering is laudable.

  27.  We believe that the capabilities of modern medicine render the ending of life to prevent such suffering unnecessary. Good nursing care provides the opportunity for the patient to live the final stages of his or her life, initially approached with dread and fear, as a time for reconciliation, final family contacts and peace.

  28.  We believe that there is intrinsic value in all human life, at whatever stage. Respect for human life is not, however, an exclusively Catholic, Christian or even religious concept. We have sought to demonstrate that respect for life is enshrined in both the natural order and the British legal system.

  29.  This Bill would, if enacted, remove a vital safeguard only recently inserted by amendment to the government's own legislation, and is therefore misconceived. We are convinced that is also represents a significant departure from an underlying principle of British law and would be the likely precursor of legislation to permit the wider use of euthanasia.

  30.  The Association of Catholic Women strongly urges members of this Select Committee to recommend that this Bill should not proceed.



    —  The Association of Catholic Women, listed in the Catholic Directory but independent of the Bishops' Conference of England and Wales, is an organisation of more than 1,000 women and men "supporters", many of whom have direct experience of the work of hospices at home and abroad.

    —  This response, from the Association's Steering Committee, is informed by this experience.


    —  The drive to give, preserve and cling to life is powerful; examples abound of the expectations of both medical science and common sense being defied.

    —  The desire to choose death is an aberration, motivated by despair, the response to which should be to seek to alleviate the pain (physical or psychological) which gives rise to it.

    —  To ask doctors or nurses to comply with a patient's wish to end his or her life is to ask them to deny their principal duty to the patient and to collude with the patient's despair, rather than try to treat the symptoms giving rise to it.


    —  The intrinsic value of human life has been the underlying principle of the rule of law since earliest times.

    —  The provisions of this Bill contravene this principle and contradict provisions recently inserted into the government's own legislation.


    —  The provision in the title of the Bill and in Section 15, to enable a person suffering from terminal illness to receive pain relief medication, is unnecessary, in that such medication is already routinely administered to terminally ill patients whether in hospital or not.

    —  The "qualifying conditions" outlined in the Bill, while apparently tightly drawn, are vulnerable to gradual erosion over time, especially in view of the provision to give power to the Secretary of State to make regulations by statutory instrument.

    —  There is an inherent assumption in the qualifying conditions that doctors who hold a conscientious objection to assisting a patient's death will be few in number, and the requirement that they refer to another doctor who does not object makes them complicit in the action to which they hold a conscientious objection.

    —  The patient is not protected by the proposed monitoring arrangements; neither is the patient protected from psychological pressure to cease being a burden and to release medical and care resources.


    —  The desire to alleviate the pain and suffering of terminally ill patients is laudable.

    —  The capabilities of modern medicine render the taking of life to prevent such suffering unnecessary; skilled nursing and palliative care can enable patients and their families to experience their final days and weeks as a positive and peaceful ending.

    —  The Bill represents a significant departure from an underlying principle of British law and medical ethics, and is misconceived in that it would remove a vital safeguard recently inserted by amendment to the government's own legislation.

    —  The Association of Catholic Women strongly urges members of this Select Committee to recommend that this Bill should not proceed.

23 August 2004

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