Course: Summer school – Doctors and lawyers dealing with death and dying

31 March 2017

 

Medical, legal and ethical challenges in end-of-life decision making. 3-7 July 2017

Preliminary Program Summer School

The Erasmus School of Law in collaboration with the department of Public Health of the Erasmus Medical Center (Erasmus MC) will host the international summer school ‘’Doctors and lawyers dealing with death and dying’’ in the first week of July 2017 in Rotterdam.

Many countries are currently engaged in a societal debate about the question whether to decriminalize or legalize some form of assistance in dying. In this multi-disciplinary one-week course, students will be introduced to the Dutch situation regarding Termination of Life on Request and Assisted Suicide (Review Procedures) Act of 2002, the practice of medical decision making at the end of life, and current ethical, legal and medical challenges in comparative perspective with other European countries.

The aim of this course is to expand the knowledge of participants on medical, legal, and ethical issues at the end of life, and to reflect on these issues based on the facts and figures. The summer school is part of a broader Research Excellence Initiative (REI) ‘’Doctors and lawyers dealing with death and dying’’.

 


Conference: ‘A Right to Die?’ – Socio-legal perspectives at Keele University

6 March 2017

18th July 2017

School of Law, Keele University

Register here

Programme

10.00 Registration & Coffee

10.30 Welcome from Professor Alison Brammer, Head of Keele Law School

10:35 Introduction by Chair, Dr Sue Westwood

10.40 Keynote speaker: Professor Penney Lewis, Dickson Poon School of Law, King’s College London (‘Assisted Dying and Legal Change’)

11.10 Q&A

11.20 – 12.30 Panel 1: Assisted Dying & Euthanasia – Current Debates. Chair: Dr Anthony Wrigley

Speaker (1) Dr Iain Brassington, University of Manchester (‘Overview of Debates’)

Speaker (2) Professor Richard Huxtable, University of Bristol (‘Euthanasia, Ethics and the Law’)

Speaker (3) Professor Alison Brammer, Keele University (‘Safeguarding Issues’)

12.20 Q&A

12.30 – 1.15 Lunch

1.15 – 2.40 Panel 2: Assisted Dying & Euthanasia – Views. Chair: Professor Marie-Andre Jacob

Speaker (1) Professor Clare Wilkinson, Bangor University (‘Why do we want the right to die?)

Speaker (2) Dr Glenys Caswell, University of Nottingham (‘Agency, death and dying in the UK’)

Speaker (3) Davina Hehir, Director of Legal Strategy and Policy, Dignity in Dying (‘Choice, control and access to services at the end of life: Advocating for the right to die’)

2.30 Q&A

2.40 – 3.00 Tea Break

3.00 – 4.10 Panel 3: Assisted Dying & Euthanasia – Subjectivities Chair: Dr Tsachi Keren-Perez

Speaker (1) Professor Celia Kitzinger, University of York (‘Court applications for withdrawal of artificial nutrition and hydration from patients in a permanent vegetative state: Family experiences’)

Speaker (2) Dr Sue Westwood, Keele University (‘Older lesbians, gay men and the “right to die” debate’)

Speaker (3) Professor Sue Read & Dr Sotirios Santatzoglou, Keele University (‘Exploring hospice care from the perspectives of people living with multiple sclerosis: An exploratory case study’)

4.00 Q&A

4.10 – 4.15 Closing comments (Chair)

4.15 Close


Seminar: Law (and the place of law) at the end of life

10 October 2016

Tuesday 1 November 2016 16.00-18.00

Royal College of Nursing, 20 Cavendish Square, London W1G 0RN

Sir Mark Hedley, former judge of the High Court of England and Wales, joins leading barristers Alex Ruck Keene (Visiting Research Fellow at KCL) and Eloise Power in a discussion about this complex and interesting topic.

To reserve a free place please contact legal.services.events [at] rcn.org.uk before Wednesday 26 October 2016.


Seminar: My Life, My Decision: A new approach to advance care planning

28 September 2016

Thursday October 20, 2016

1:30 PM – 5:00 PM

Church House Westminster, Deans Yard, London

A free seminar organised by Compassion in Dying:

My Life, My Decision was an ambitious, multifaceted programme of work delivered by Compassion in Dying and its partners, and funded by the Big Lottery’s Silver Dreams Fund to run from July 2014 until October 2016.

Its aim was to support people aged over 50 to think about and plan their care in advance, helping to ensure they have the death that is right for them.

The project tried and tested new ways of engaging people and communities in planning for the end of life. It developed a service that placed the individual at the centre of their care decisions and supported them to express and record their wishes in a legally binding way. It also developed effective models of partnership working between health services and voluntary organisations, maximising the capacity of healthcare professionals by providing support to their patients to plan their care.

More details and registration information available via Eventbrite.


Radio: iPM on a patient with capacity having her life-sustaining pacemaker deactivated

27 September 2016

Last year, the Radio 4 programme iPM ran an item about an adult patient with capacity seeking to have her pacemaker deactivated:

“Who can make decisions about a pacemaker once it’s in my body?’ – After a listener got in touch with an ethical dilemma, we explore what the UK law says about switching off pacemakers and other implanted medical devices.”

Last week, the programme updated the story with details of the deactivation and eventual death of the patient.

“The listener who fought for her pacemaker to be turned off and the US doctor who helps to stop his dying patients’ hearts.”

 

 


Job: Researcher position in European law and ethics on end-of-life decisions

29 August 2014

Researcher position

European law and ethics on end-of-life decisions

TV-L E13 50% for one year or 100% for 6 months

Starting date: November 1st, 2014, or later

Job description:

A reseacher position is available in the area of end-of-life law and ethics in the context of a large, interdisciplinary European research project called “ALS-CarE: A Programme for ALS Care in Europe”, funded by the German Ministry for Education and Research (BMBF) within the “Joint Programme on Neurodegenerative Disease Research” (JPND). The post will be situated at the Technical University of Munich, supervised by Ralf J. Jox, Assistant Professor in Medical Ethics, from the Institute of Ethics, History and Theory at the University of Munich.

The post holder will be expected to conduct a review of current legislations of major European countries on end-of-life decisions and advance care planning. The special focus of the review will be on neurodegenerative diseases, in particular Amyotrophic Lateral Sclerosis (ALS). The post holder will be a member of the Munich project group that also conducts an international empirical survey among end-of-life attitudes of ALS patients.

Your profile
Candidates should be graduates in law, alternatively in medicine, philosophy or bioethics, but with some knowledge in medical law. A PhD or JD is an asset, but not mandatory. Candidates should have demonstrated interest in bioethics or applied ethics, especially regarding end-of-life issues. Due to the international outlook of the project, spoken and written fluency in English is essential. Native English speakers are especially encouraged to apply. Residence requirements can be discussed on an individual basis.

Our offer

We offer close supervision in a small group of highly experienced researchers. The post holder will have the opportunity to publish first-author articles in high-ranked journals and present at international conferences. The job offers home-based work and temporal flexibility.

Disabled candidates are preferentially considered in case of equal qualification. Applications from women are encouraged. The position is temporary and project-based.

Please send your application (including letter of motivation, CV, certificates, 1-2 writing examples), preferentially by e-mail, to:

Ralf J. Jox, MD, PhD

Institut für Ethik, Geschichte und Theorie der Medizin

Ludwig-Maximilians-Universität München

Lessingstrasse 2, D-80336 München, Germany

ralf.jox [at] med.lmu.de

Closing date: October 1st, 2014


Comment: what is the future of the policy for prosecutors on assisting or encouraging suicide?

25 June 2014

In 2013, Martin, one of the claimants in the case known as Nicklinson was successful in his claim at the Court of Appeal. By a majority of 2-1, the Court of Appeal ruled that the Director of Public Prosecutions’ Policy on prosecuting cases of assisted suicide did not allow professionals such as doctors, nurses, carers and social workers to foresee the consequences of providing such assistance.

In the Policya group of factors in favour of prosecution are designed to ensure that assistance in suicide remains an activity carried out by inexperienced individuals without the open assistance of professionals or amateur organisations (as in Switzerland):

(11) the suspect was unknown to the victim and encouraged or assisted the victim to commit or attempt to commit suicide by providing specific information via, for example, a website or publication;

(12) the suspect gave encouragement or assistance to more than one victim who were not known to each other;

(13) the suspect was paid by the victim or those close to the victim for his or her encouragement or assistance;

(14) the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not], or as a person in authority, such as a prison officer, and the victim was in his or her care;

(16) the suspect was acting in his or her capacity as a person involved in the management or as an employee (whether for payment or not) of an organisation or group, a purpose of which is to provide a physical environment (whether for payment or not) in which to allow another to commit suicide.

The very role of such professionals was therefore a factor in favour of prosecution (factor 14), while factors against prosecution might also be present, including a compassionate motive (factor 2 against prosecution). The DPP was therefore asked to revise the Policy. Instead, he announced his intention to appeal and today the Supreme Court allowed his appeal. The court would not require the DPP to go further than he did in response to the House of Lords decision in Purdy by providing a list of factors for and against prosecution when deciding whether prosecution would be in the public interest. Martin had sought to force the DPP to identify a class of cases in which prosecution would not be in the public interest. Lord Hughes concluded (at [277]):

It is legitimate to say that Parliament no doubt recognised that there might be persons who commit the [Suicide Act 1961] section 2(1) offence, whom it turns out not to be in the public interest to prosecute. That, however, is true of every offence in the criminal calendar. It is not legitimate to suppose that there is a category of such persons which can be identified in advance by the Director of Public Prosecutions. She cannot do so without crossing the constitutional boundary into either changing the law or giving advance exemption from it to a group of potential offenders.

However, this is not the end of the story in relation to the policy for prosecutors. The DPP will need to consider whether the policy should be revised to reflect a claim made by Lord Judge (dissenting on this point) in the Court of Appeal which was accepted by counsel for the DPP before the Supreme Court ([143]):

185. … [I]t seems clear to me that paragraph 14 addresses the risks which can arise when someone in a position of authority or trust, and on whom the victim would therefore depend to a greater or lesser extent, assisting in the suicide in circumstances in which, just because of the position of authority and trust, the person in authority might be able to exercise undue influence over the victim. As I read this paragraph it does not extend to an individual who happens to be a member of a profession, or indeed a professional carer, brought in from outside, without previous influence or authority over the victim, or his family, for the simple purposes of assisting the suicide after the victim has reached his or her own settled decision to end life, when, although emotionally supportive of him, his wife cannot provide the necessary physical assistance.

186. … Naturally, it would come as no surprise at all for the DPP to decide that a prosecution would be inappropriate in a situation where a loving spouse or partner, as a final act of devotion and compassion assisted the suicide of an individual who had made a clear, final and settled termination to end his or her own life. The Policy … deliberately does not restrict the decision to withhold consent to family members or close friends acting out of love and devotion. The Policy certainly does not lead to what would otherwise be an extraordinary anomaly, that those who are brought in to help from outside the family circle … are more likely to be prosecuted than a family member when they do no more than replace a loving member of the family, acting out of compassion, who supports the ‘victim’ to achieve his desired suicide. The stranger brought into this situation, who is not profiteering, but rather assisting to provide services which, if provided by the wife, would not attract a prosecution, seems to me most unlikely to be prosecuted. In my respectful judgment this Policy is sufficiently clear to enable Martin, or anyone who assists him, to make an informed decision about the likelihood of prosecution.

Having accepted that a person acting in his or her professional capacity in these circumstances (for example a professional carer, motivated by compassion, who enters into a non-profiteering arrangement to accompany a patient for whom he or she was not previously caring and who has already decided to go to Dignitas) would be unlikely to be prosecuted, Lord Neuberger invited the DPP to change the policy accordingly ([146]):

Given that, in an important respect, the 2010 Policy does not appear to reflect what the DPP intends, it seems to me inevitable that she will take appropriate steps to deal with the problem, particularly in the light of the impressive way in which her predecessor reacted to the decision in Purdy. However, if the confusion is not sorted out, then, at least in my view, the court’s powers could be properly invoked to require appropriate action, but, as I have said, it seems very unlikely that this will be necessary.

If this remains the DPP’s position, then the policy could possibly be amended to limit the applicability of the current factor 14, though Lords Mance ([193]) and Sumption ([251]) were sceptical that the policy could be so amended without rendering it internally inconsistent or incoherent. Lady Hale, though, was in favour of a more far-reaching review of the policy (at [323]), returning to an argument she made in Purdy about the role such a policy could play in ensuring that the interference with the claimants’ rights under Article 8(1) could be justified under Article 8(2) (which neatly takes us back to the other argument in this case):

It seems to me, as it seemed in Purdy, that the policy has two purposes. The first, and uncontroversial, purpose is to make the way in which decisions to prosecute will be taken sufficiently clear to meet the Convention requirement that the interference be “in accordance with the law”. This entails accessibility (hence the need to clarify the policy) and foreseeability, as well as consistency and lack of arbitrariness. We can debate endlessly what the Strasbourg court meant, at para 76 of Pretty (quoted by Lord Neuberger at para 32 above) by first stating that the “Court does not consider therefore that the blanket nature of the ban on assisted suicide is disproportionate” and going on to discuss the flexibility of enforcement in the next sentence. It might have been reverting to the “non-arbitrary” requirement of legality. Or it might have been continuing its discussion of proportionality. I ventured to suggest in Purdy (paras 63 and 64) that the policy may have a part to play in securing that section 2(1) does not operate as a disproportionate interference with the right protected by article 8 and now so clearly articulated in Haas v Swizerland. The underlying theme of the factors which the DPP considers relevant to whether a prosecution will be in the public interest is clearly to identify the sort of cases which might be covered by the exception proposed above. The time may therefore be ripe for a review to see whether further progress can be made in that direction without offending against the constitutional prohibition of “dispensing with the laws”. But I agree that there is no need to make an order requiring the DPP to conduct a review. She will no doubt be considering the position in the light of the judgments in this Court and in the Court of Appeal.

What can we conclude at this point? Perhaps only that there is no evidence that this DPP will take a more restrictive position on the public interest in prosecuting these cases than her predecessor. Whether she and her team will revise the policy to make prosecutions less likely and thereby possibly encourage greater professional involvement in assisted suicide remains to be seen. As I wrote in response to the decision of the Court of Appeal:

The advantages of open medical involvement in assisted suicide are manifold, and include a lower risk of botched suicides and suffering during the suicide or attempted suicide (as illustrated in the Gilderdale case) and the possibility of screening for possibly hitherto unknown mental disorders including depression. At present, the expertise necessary to achieve a safe, peaceful assisted death is concentrated in healthcare professionals, and they are the main gatekeepers of the medications needed to accomplish this. A Policy under which those seeking assistance in dying cannot access this expertise, even in the form of advice, nor the appropriate medications, and where others are prevented from developing and disseminating such expertise, is undesirable. Allowing assistance from healthcare professionals only on a “one off” basis would frustrate the development of expertise in assessing the validity of requests for assistance. It should be possible to assign weight to the relevant factors that would not prevent compassionate, professional and expert assistance while still avoiding what the Lord Chief Justice has termed “profiteering” (at [184]-[186]).