Gavin St Pier
Deputy St Pier said that the case he was advocating for was primarily for terminally ill adults with six months or less to live.
‘I’m also supportive of 12 months for some neurodegenerative conditions specified,’ he said.
‘These individuals are dying, but they’re dying in a very real sense, that they are moving towards the end of their lives as a result of the conditions that they suffer from.
‘What has been discovered elsewhere is that many terminally ill people get comfort from the knowledge that they may have that choice, even if they never choose it themselves.’
He said that in jurisdictions where it is possible to access an assisted death, quite often those who seek help actually never go through with it. Having obtained the prescription, they don’t actually check it in, but it gives them the comfort to know that they can.
In these cases, death is brought forward by a matter of days or sometimes weeks, not months.
He said there is also inequity in the system, since someone with upwards of £10,000 can take themselves to another jurisdiction, often Switzerland, but this forces a much earlier decision on those individuals, because they have to be able to travel independently.
If they receive assistance from anyone, that person could face criminal liability for assisting a death.
‘People are doing this anyway, they’re attempting or actually ending their own lives and there is the guilt and shame which is often carried by individuals and their families,’ said Deputy St Pier.
‘For the individuals it is a very lonely journey that they are forced to go on if they choose to attempt to take their own lives because they cannot involve others and will feel like they cannot speak to others about their intentions.
‘The implications of failed suicides can be very distressing for all involved.’
He said that coercion was often used as a reason why this should not be permitted within society, but the coercion to live was also an issue, with the most common experience being families are simply not ready to let go of someone who is terminally ill and might want to end their own suffering.
Deputy St Pier said that medics were sometimes making this decision anyway, without the consent of the individual who at that stage may not be in a position to consent, or without involving family members.
‘Medics, whether it’s a palliative care nurse or doctor, are able to prescribe hefty doses of diamorphine,’ he said.
‘If the primary purpose of giving that medication is pain relief, and a secondary effect because of prior doses is an earlier death, that is fine, but it is a subjective judgement which lies in the hands of an individual doctor or medic, and their judgement may be different from the next person who walks through the door.’
He said that equating those who are terminally ill with those who may be suffering from depression and suicidal ideation was a false comparison.
‘On the question of the morality of asking others to assist, there will be some willing participants and plenty in the medical profession who see it as part of their medical ethical environment. However, no one can or should be compelled to exist, in the same way as there are legal protections for moral and ethical objections to assisting abortions.’
He added that in terms of risk, coercion and influence, doctors are well versed in dealing with their patients every day and assessing the extent to which an individual is making an independent judgement.
Deputy St Pier said that feeling like a burden is a legitimate feeling, but does not mean a person will want to end their life because of it.
The feeling would not be alleviated by someone being told they could not have an assisted death.
‘If we insist that you carry on to the end of your life until you have your last natural breath, or your last breath assisted by a doctor giving you an additional dose of something which takes you over the edge, that feeling of a burden may well still be there and I don’t think that’s an argument that can be used in this case,’ he said.
‘Palliative care has an important role, and there should be a spectrum and range of choices for individuals coming towards the end of their life. Palliative care cannot relieve all suffering for everyone in every condition.
‘We have to recognise that palliative care is not and can never be the answer for every individual.’
Carol Le Page
Mrs Le Page said she believes that everyone’s life has value and ending someone’s life purposefully is wrong.
‘However, I do realise that Guernsey people have the ability to join the armed services, where there is a legitimate reason for ending people’s lives in those circumstances,’ she said.
‘We do treat depression, but there is a difference between having someone allowed to commit suicide and the government having an active role in your death.
‘We try and treat people who have suicidal ideation. We try and look after them and work out why they have depression. We’re moving to a place where, at some point, we would not just allow them to die from their own hand but we would actively be providing a system for them to be assisted in that.’
She said that coercion was a real concern of hers as people can be manipulated in different ways.
Some people think they are going to be a burden on somebody else, and therefore want to hasten their death, particularly if that means a house or an asset is going to be left to people that it would otherwise not be.
‘People could say they’re at the point where they can’t manage at home anymore and need to go into care, but actually don’t want to do that and would prefer to take their own life or have assisted dying. It could be a slippery slope,’ she said.
‘We represent vulnerable groups here, who can sometimes feel like a burden. There is a difficulty in detecting coercion. It can be very subtle. It can be something that you believe other people want of you, and by legislation, it provides a further raft of what society and culture expects of you, and therefore that is what you should be doing.’
She questioned the value that would be put on people’s lives who qualify for a medically assisted death, versus those who do not.
Limits such as whether a person is over or under the age of 18 would be in place in an attempt to safeguard people, but they would not safeguard those who were asking for it.
‘Should you have to go through an assessment of your drug regime? Do you have depression and suicidal ideation? Someone may be having a crisis of physical pain or after being told they have a terminal diagnosis, but is that depression around the crisis and is there something that can be done?’ she asked.
‘If someone is having suicidal ideation, instead of having help for depression, they would have help to actually die.
‘Either way it is discriminatory and there is a wider social impact in terms of our relationship with government.’
She accepted that most people who work in healthcare, particularly end-of-life care, will have foreshortened someone’s life at some point but it would have been to alleviate their suffering, not end their life.
‘The normal argument for assisted dying is to do with autonomy.
‘When you’re asking for assisted death, it is not just you anymore, lots of other people are involved. If you compare suicide to assisted dying, there is a whole raft of people to ensure there is no coercive control and safeguarding in place.’
Mrs Le Page said that with other jurisdictions voting in favour of assisted dying, Guernsey should make its own decision, and not look to others to make decisions.
‘We have a government which is self-determining, it should be making this decision. I don’t think it should be waiting for UK government or somebody else to make these decisions, we are able to make them, I just don’t agree with this one,’ she said.
‘The people that we currently allow to kill other people are armed services and we know from the experiences of armed service personnel that it is a very distressing thing they go through.
‘It’s in an armed conflict zone and it’s different but we are not far enough down the line to know the unforeseen consequences to the people assisting in this.’
‘When I first came into this, I was thinking this was about somebody who is physically unable to take their own life, or unable to make that self-determined view to end their life by suicide.
‘Now this is more about a medicalised alternative to death and it changes the relationship between government and the person and the medical professional and the patient.
‘In summary, any system would be discriminatory whether you think it’s positive or negative, because of the boundaries.’