APPENDIX 4: TEXT OF THE ASSISTED DYING
FOR THE TERMINALLY ILL BILL [HL]
Assisted Dying for the Terminally Ill
Bill [HL]
CONTENTS
1 Authorisation of assisted dying
2 Qualifying conditions
3 Offer of palliative care
4 Declaration made in advance
5 Further duties of attending physician
6 Revocation of declaration
7 Duties of physicians, and conscientious objection
8 Psychiatric referral
9 Notification of next of kin
10 Protection for physicians and other medical personnel
11 Offences
12 Insurance
13 Requirements as to documentation in medical records
14 Monitoring commission and reporting requirements
15 Administration of drugs to patients suffering
severe distress
16 Power to make regulations
17 Short title and extent
Schedule — Form of declaration
A
Bill
TO
Enable a competent adult who is suffering unbearably
as a result of a terminal illness to receive medical assistance
to die at his own considered and persistent request; and to make
provision for a person suffering from a terminal illness to receive
pain relief medication.
BE IT ENACTED by
the Queen's most Excellent Majesty, by and with the advice and
consent of the Lords Spiritual and Temporal, and Commons, in this
present Parliament assembled, and by the authority of the same,
as follows:—
1 Authorisation
of assisted dying
(1) Subject to the provisions of this Act, it shall
be lawful for a physician to assist a patient who is a qualifying
patient, and who has made a declaration in accordance with this
Act that is for the time being in force, to die.
(2) For the purposes of this Act—
"assisted dying" means the attending physician,
at the patient's request, either providing the patient with the
means to end the patient's life or if the patient is physically
unable to do so ending the patient's life;
"attending physician" means the physician
who has primary responsibility for the care of the patient and
the treatment of the patient's illness;
"competent" means having the capacity to
make an informed decision, and "competence" shall be
construed accordingly;
"consulting physician" means a consultant
physician practising in the National Health Service who is qualified
by speciality to make a professional diagnosis and prognosis regarding
the patient's illness and who is independent of the attending
physician;
"declaration" means a witnessed declaration
in writing made by the qualifying patient in the form set out
in the Schedule to this Act, as amended from time to time by regulations;
"incompetent" means not having the capacity
to make an informed decision, and "incompetence" shall
be construed accordingly;
"informed decision" means a decision by
a qualifying patient to request medical assistance to die, which
is based on an appreciation of the relevant facts and after being
fully informed by the attending physician, and the consulting
physician (save in respect of (c) below), of—
(a) his medical diagnosis;
(b) his prognosis;
(c) the process of being assisted to die; and
(d) the alternatives, including, but not limited
to, palliative care, care in a hospice and the control of pain;
"medical care team" means a person or persons
assisting the attending physician in the provision of medical
care to a patient, and includes but without limitation a nurse
or pharmacist;
"monitoring commission" means a commission
set up by the Secretary of State to monitor the workings of this
Act in a country or region forming a part of Great Britain;
"patient" means a person who is under the
care of a physician;
"physician" means a registered medical
practitioner;
"qualifying conditions" means those conditions
set out in sections 2, 3, 4 and 5;
"qualifying patient" means a patient who
has reached the age of majority, who has been resident in Great
Britain for not less than twelve months as at the date of the
declaration and in respect of whom all the qualifying conditions
under sections 2, 3, 4 and 5 are met;
"terminal illness" means an illness which
in the opinion of the consulting physician is inevitably progressive,
the effects of which cannot be reversed by treatment (although
treatment may be successful in relieving symptoms temporarily)
and which will be likely to result in the patient's death within
a few months at most;
"unbearable suffering" means suffering
whether by reason of pain or otherwise which the patient finds
so severe as to be unacceptable and results from the patient's
terminal illness; and "suffering unbearably" shall be
construed accordingly;
"waiting period" means that period of time
between the date on which the patient first informed the attending
physician that the patient wishes to be assisted to die in accordance
with section 2(2)(a) and the date on which the patient is assisted
to die, and such period shall not be less than 14 days in all;
and "witness" means a person who signs by way of attestation
a declaration made under section 4.
2 Qualifying
conditions
(1) Before the attending physician can assist a qualifying
patient to die the conditions specified in this section and sections
3, 4 and 5 must be satisfied.
(2) The attending physician shall have—
(a) been informed by the patient that the patient
wishes to be assisted to die;
(b) examined the patient and the patient's medical
records and have no reason to believe the patient is incompetent;
(c) made a determination that the patient has a terminal
illness;
(d) concluded that the patient is suffering unbearably
as a result of that terminal illness;
(e) informed the patient of—
(i) his medical diagnosis;
(ii) his prognosis;
(iii) the process of being assisted to die;
(iv) the alternatives, including, but not limited
to, palliative care, care in a hospice and the control of pain;
(f) if the patient persists with his request to be
assisted to die, satisfied himself that the request is made voluntarily
and that the patient has made an informed decision; and
(g) referred the patient to a consulting physician.
(3) The consulting physician shall have—
(a) been informed by the patient that the patient
wishes to be assisted to die;
(b) examined the patient and the patient's medical
records and satisfied himself that the patient is competent;
(c) confirmed the diagnosis and prognosis made by
the attending physician;
(d) concluded that the patient is suffering unbearably
as a result of the terminal illness;
(e) informed the patient of the alternatives including,
but not limited to, palliative care, care in a hospice and the
control of pain;
(f) if the patient still persists with his request
to be assisted to die, satisfied himself that the request is made
voluntarily and that the patient has made an informed decision;
and
(g) advised the patient that prior to such assistance
the patient will be required to complete a declaration which the
patient can revoke.
3 Offer of
palliative care
(1) The attending physician shall ensure that a specialist
in palliative care who shall be a physician or nurse has attended
the patient to discuss the option of palliative care.
(2) Only once the requirements of sections 2(2),
2(3) and 3(1) have been satisfied may the patient make the declaration
in the form set out in the Schedule.
4 Declaration
made in advance
(1) When the conditions set out in sections 2 and
3 have been met, a patient who wishes to be assisted to die must
make a declaration in the form set out in the Schedule.
(2) The declaration must be witnessed by two individuals
one of whom shall be a solicitor who holds a current practising
certificate.
(3) The solicitor may only witness the declaration
if—
(a) the patient is personally known to the solicitor
or has proved his identity to the solicitor;
(b) it appears to the solicitor that the patient
is of sound mind and has made the declaration voluntarily; and
(c) the solicitor is satisfied that the patient understands
the effect of the declaration.
(4) The other witness may only witness the declaration
if—
(a) the patient is personally known to that witness
or has proved his identity to that witness; and
(b) it appears to that witness that the patient is
of sound mind and has made the declaration voluntarily.
(5) The patient and witnesses shall sign and witness
the declaration respectively at the same time and each in the
presence of the others.
(6) The attending or consulting physician, psychiatrist
or member of the medical care team, or a relative or partner (by
blood, marriage or adoption) of the qualifying patient signing
this request may not witness the declaration.
(7) No person who owns, operates or is employed at
a health care establishment where the person is a patient or resident
may witness the declaration.
(8) The declaration shall come into force after the
requisite waiting period has elapsed and shall remain in force
(unless revoked) for six months.
5 Further
duties of attending physician
Before taking any step to assist the patient to die
the attending physician shall have—
(a) informed the patient of his right to revoke the
declaration;
(b) verified immediately before assisting the patient
to die that the declaration is in force and that it has not been
revoked by the patient; and
(c) asked the patient immediately before assisting
him to die whether he wishes to revoke the declaration.
6 Revocation
of declaration
(1) A patient may revoke his declaration whether
orally or in any other manner without regard to his physical or
mental state.
(2) In the event of a declaration being revoked,
the attending physician shall ensure that a note recording its
revocation is made on the patient's file and that the declaration
is removed from the patient's medical file and destroyed.
7 Duties
of physicians, and conscientious objection
(1) No person shall be under any duty, whether by
contract or by any statutory or other legal requirement, to participate
in any diagnosis, treatment or other action authorised by this
Act to which he has a conscientious objection.
(2) If an attending physician whose patient makes
a request to be assisted to die in accordance with this Act or
to receive pain relief under section 15 has a conscientious objection
as provided in subsection (1), he shall take appropriate steps
to ensure that the patient is referred without delay to an attending
physician who does not have such a conscientious objection.
(3) If a consulting physician to whom a patient has
been referred in accordance with section 2(2)(g) has a conscientious
objection as provided in subsection (1), he shall take appropriate
steps to ensure that the patient is referred without delay to
a consulting physician who does not have such a conscientious
objection.
8 Psychiatric
referral
(1) If in the opinion of either the attending or
the consulting physician a patient who wishes to make or has made
a declaration may not be competent, the attending physician shall
refer the patient to a psychiatrist for a psychiatric opinion.
(2) No assistance to end that patient's life may
be given unless the psychiatrist has determined that the patient
is not suffering from a psychiatric or psychological disorder
causing impaired judgement, and that the patient is competent.
9 Notification
of next of kin
The attending physician shall recommend to the patient
that the patient notifies his next of kin of his request for assistance
to die.
10 Protection
for physicians and other medical personnel
(1) A physician, acting in good faith, who assists
a qualifying patient to die, or attempts to do so, in accordance
with the requirements of this Act, shall not be guilty of an offence.
(2) A member of a medical care team, acting in good
faith, who helps a physician to assist a qualifying patient to
die, or to attempt to do so, in accordance with what he reasonably
believes to be the requirements of this Act, shall not be guilty
of an offence.
(3) A physician to whom subsection (1) applies or,
as the case may be, a member of a medical care team to whom subsection
(2) applies, shall be deemed not to be in breach of any professional
oath or affirmation.
(4) No physician, psychiatrist or member of a medical
care team may take any part whatsoever in assisting a qualifying
patient to die, or in giving an opinion in respect of such a patient,
nor may any person act as a witness, if he has grounds for believing
that he will benefit financially or in any other way as the result
of the death of that patient.
11 Offences
(1) A person commits an offence if he wilfully falsifies
or forges a declaration made under section 4 with the intent or
effect of causing the patient's death. A person guilty of an offence
under this subsection shall be liable, on conviction on indictment,
to imprisonment for life or for any shorter term.
(2) A witness commits an offence if he wilfully puts
his name to a statement he knows to be false. A person guilty
of an offence under this subsection shall be liable on conviction
to imprisonment for a term not exceeding five years.
(3) A person commits an offence if he wilfully conceals
or destroys a declaration made under section 4. A person guilty
of an offence under this subsection shall be liable on conviction
to imprisonment for a term not exceeding five years.
(4) A physician, psychiatrist, member of a medical
care team or witness commits an offence if he contravenes the
requirements of section 10(4). A person guilty of an offence under
this subsection shall be liable on conviction to imprisonment
for a term not exceeding five years.
(5) No provision of this Act shall be taken to affect
a person's liability on conviction to criminal penalties for conduct
which is inconsistent with the provisions of this Act.
12 Insurance
No policy of insurance which has been in force for
12 months as at the date of the patient's death shall be invalidated
by reason of a doctor having assisted a qualifying patient to
die in accordance with this Act.
13 Requirements
as to documentation in medical records
(1) The attending physician shall ensure that the
following are documented and filed in the patient's medical records—
(a) all evidence, data and records which demonstrate
that the qualifying conditions required under sections 2, 3, 4
and 5 have been met;
(b) any oral or written requests by the patient for
assistance to end his life;
(c) the declaration; and
(d) a note by the attending physician stating that
he was satisfied, at the date and time of his having assisted
the patient to die, that all requirements under this Act had been
met and indicating the steps taken to carry out the declaration
including the description and quantity of the medication prescribed.
(2) The attending physician shall send a full copy
of the file to the monitoring commission for the country or region
concerned within seven days of the qualifying patient having been
assisted to die or of an attempt so to assist having been made.
14 Monitoring
commission and reporting requirements
(1) There shall be established such number of monitoring
commissions covering countries or regions forming part of Great
Britain as the Secretary of State may determine, to review the
operation of this Act and to hold and monitor records maintained
pursuant to this Act.
(2) A monitoring commission shall consist of three
members appointed by the Secretary of State, of whom—
(a) one shall be a registered medical practitioner;
(b) one shall be a legal practitioner; and
(c) one shall be a lay person having first hand knowledge
or experience in caring for a person with a terminal illness.
(3) If, in relation to a file sent to a monitoring
commission in accordance with section 13(2), two of its members
consider that the qualifying conditions have not been met, they
shall refer the matter to the district coroner or in Scotland
to the procurator fiscal for further investigation.
(4) A monitoring commission to which a file has been
sent in accordance with section 13(2) shall confirm to the attending
physician concerned whether the qualifying conditions have been
met as soon as reasonably possible after the date of receiving
such notification of the patient having been assisted to die whether
or not such assistance led to the patient's death.
(5) The Secretary of State shall publish an annual
statistical report of information collected under this section.
15 Administration
of drugs to patients suffering severe distress
A patient suffering from a terminal illness shall
be entitled to request and receive such medication as may be necessary
to keep him free as far as possible from pain and distress.
16 Power
to make regulations
(1) The Secretary of State may make regulations under
this Act—
(a) to ensure the intent of this Act is carried out;
(b) determining classes of persons who may or may
not witness a declaration made under section 4;
(c) regulating the custody of records and the collection
of information regarding the operation of this Act; and
(d) making provision about appointments to and the
operation of the monitoring commissions.
(2) The power to make regulations under this Act
is exercisable by statutory instrument.
(3) No statutory instrument may be made under this
Act unless a draft of the instrument has been laid before, and
approved by a resolution of, each House of Parliament.
17 Short
title and extent
(1) This Act may be cited as the Assisted Dying for
the Terminally Ill Act 2004.
(2) This Act does not extend to Northern Ireland.
SCHEDULE
Section 1
FORM OF DECLARATION
Declaration made ___________ 20__
by [____________________]
of [____________________]
I, ____________________, am an adult of sound mind
who has been resident in Great Britain for at least twelve months
as at the date of this declaration.
I am suffering from ____________________, which my
attending physician, Dr ____________________, has determined is
a terminal illness and which has been confirmed by a consulting
physician, Dr ____________________.
I have been fully informed of my diagnosis, prognosis,
the process of being assisted to die, and the alternatives, including
palliative care, care in a hospice and the control of pain.
I request that my attending physician assist me to
die.
I make this request voluntarily and without reservation.
Please delete as appropriate:
I have decided to inform / not to inform my family
of my decision.
I understand that I have the right to revoke this
declaration.
Signed: ____________________
Date: ______________________
DECLARATION
OF WITNESSES
I declare that I am a solicitor with a current practising
certificate and that the patient signing this request:
(a) is personally known to me or has proved his identity
to me;
(b) signed or made his mark confirming that this
was his request in my presence;
(c) appears to be of sound mind and to have made
the declaration voluntarily; and
(d) appears to understand the effect of the declaration.
_________________________ Witness 1
Date
I declare that the person signing this request:
(a) is personally known to me or has proved his identity
to me;
(b) signed or made his mark confirming that this
was his request in my presence; and
(c) appears to be of sound mind and to have made
the declaration voluntarily.
_________________________ Witness 2
Date
Notes
1. One of the witnesses must be a solicitor with
a current practising certificate who has satisfied himself that
the patient understands the effect of the declaration.
2. The patient and witnesses shall sign and witness
the declaration respectively at the same time and each in the
presence of the others.
3. The attending or consulting physician, psychiatrist
or member of the medical care team, or a relative or partner (by
blood, marriage or adoption) of the qualifying patient signing
this request may not be a witness.
4. No person who owns, operates or is employed at
a health care establishment where the person is a patient or resident
may be a witness.
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