The Royal College of Psychiatrists’ lead on assisted dying has told Sky News she is approaching Friday’s vote by MPs “with professional trepidation”.
The medical organisation said the Terminally Ill Adults (End of Life) Bill in its current form did “not meet the needs of patients”.
It has also expressed concern over the shortage of qualified psychiatrists to take part in assisted dying panels, concerns around capacity assessment, and whether or not assisted dying will be interpreted as a treatment – because that would have a profound impact on the psychiatrist’s decision-making process.
Friday will be the first time the bill has been voted on in its entirety since last year’s yes vote, when MPs supported the principle of assisted dying for England and Wales by a majority of 55. MPs are allowed to have a free vote on the bill, meaning they can decide based on their conscience instead of following party lines.
The bill’s supporters have said it is coming back to the Commons with better safeguards after more than 90 hours of parliamentary time spent on it to date. But opponents claim the process has been rushed and that changes to the bill mean it is weaker than when it was first introduced.
The proposed legislation would allow terminally ill adults, with fewer than six months to live, to apply for an assisted death, subject to approval by two doctors and a panel featuring a social worker, senior legal figure and psychiatrist.
Read more: What is in the legislation?
Dr Annabel Price, the lead for the Terminally Ill Adults (End of Life) Bill at the Royal College of Psychiatrists ( RCPsych), said: “We know that there is a strong association between a wish to hasten death and depression, and that there isn’t adequate opportunity within the bill to assess somebody’s needs and also to make sure that those needs are met, which might have an impact on their continued wish to want to end their life.”
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The RCPsych was one of the first royal colleges to voice concerns about the bill in its current form. These fears have since been echoed by two more royal colleges, physicians and pathologists.
It has provided written evidence to the bill’s scrutiny committee, while Dr Price has provided oral evidence. She said the organisation had “actively engaged with parliamentarians throughout the process” and expressed concerns in two public statements.
But despite all of this, the concerns raised have not been addressed, it is claimed.
This has prompted worries because, under the bill, psychiatrists would have a leading role in assessing a patient’s mental capacity when an assisted death has been requested.
They would be on a panel alongside doctors, social workers, and a legal expert. The panel would not be expected to meet the patient during the process.
Panel role ‘doesn’t map on to job of psychiatrist’
Dr Price said the idea of making a clinical assessment of a patient’s mental health ran contrary to everything a psychiatrist had been trained to do.
She said: “The panel role doesn’t really map on to the professional job and training of a psychiatrist. What psychiatrists are trained to do is the assessment and treatment of mental illness.
“The panel role is really to check what the two other doctors have done and whether that patient meets the eligibility criteria.
“And if they do, then they must be granted assisted dying. That doesn’t really give room to identify meeting an unmet need, like depression for example, but there are lots of things that may be unmet, social difficulties, untreated pain and other physical symptoms, where that person might no longer want to die.
“And it doesn’t really give room for a psychiatrist to do what they’re trained to do and where their expertise lies, which would be essentially a checking role.”
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Clarification call
Dr Price said other areas of the bill also needed urgent clarification.
She said: “When somebody has a mental illness, our job is to see if we can treat that mental illness. The other area in the bill that hasn’t really been addressed is the psychiatrist’s responsibility around suicide prevention.
“When we meet somebody who wants to end their life, we have a duty to that patient and that duty may involve assessing that patient under the Mental Health Act to try to manage the mental health aspects that may be making them want to die. And there really isn’t enough detail as to how we do that, how we square those two roles and duties. That needs more attention.”
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Dr Price added: “The Mental Capacity Act was designed to support people who can’t make decisions for themselves to be able to have decisions made in their best interest for them.
“There is nothing in the provision of the Mental Capacity Act that talks about a decision to end one’s own life, so this is a new decision.
“We don’t currently have anything that maps on to that clinically and so the Mental Capacity Act, we have stated very clearly, is not sufficient to be a sufficient safeguard in assisted dying and that we need to rethink how capacity is assessed.”
