The following submission was made to the House of Keys Committee investigating the matter of the "Right to Die" or "voluntary euthanasia" in the case of certain terminal illnesses. October 2003

Currently, the law in the Isle of Man makes it illegal to assist a person to commit suicide in any way, including the provision of the means to do so. It is also an act of murder to administer a painkiller or anaesthetic in such a quantity that death is the likely result.

Mec Vannin accepts that there are instances when certain terminal illnesses can lead to such a profound loss of quality of life, in terms of pain or loss of faculty, that the sufferer may find death by intervention a preferable alternative.

This is popularly referred to as either assisted suicide or euthanasia and it must be recognised that there are two aspects to this.

Firstly, the provision of the means for a person to take their own life and, secondly, performing an act that will result in a person's death.

The only circumstance in which we can endorse this is where the condition has been diagnosed and confirmed as terminal with no realistic chance of recovery. The illness must also involve a profound loss of quality of life in terms of extreme pain or faculty.

Victims of such conditions would have to go through a high quality regime of impartial counselling and confirmation of desire before any assistance could be authorised.

Mechanisms must be in place to ensure that this facility would only be available to people normally resident in the Isle of Man at the time of diagnosis or have an established and strong association with the Island prior to diagnosis i.e. there must be no question of people using the Isle of Man to circumvent laws in their own country.

Such a facility must only be available through medical establishments that are primarily concerned with the treatment of illness i.e. there should be no question of "death clinics".

No person should be pressured or induced to act against their personal or professional ethics.

Assisted suicides would only be legal under consenting, qualified and authorised medical supervision using an approved method.

The opportunity must be taken to reassert the illegality of taking any action without such a high quality process of expression and consent that will end a life prematurely: It is a widely held belief that many patients of terminal illness are given such high doses of pain killers that these may well be the cause of death rather than the illness itself. This may well be done without the patient's informed knowledge or consent and this must be illegal.

There is no question and there must be no question of such a change of law being a first step towards involuntary euthanasia. As stated above, it is widely believed and even tacitly accepted that this actually happening now. That should not be the case.

Religious arguments against a change of law are not sustainable. Matters of belief in this area are specific to each and every individual. Whilst respecting the rights of religions to instruct and advise their own followers in their respective moral ethics and theology, such ethics cannot be reasonably imposed upon those who do not adhere to them. No immortal souls can be saved by legislation.

Anyone who is diagnosed as having a terminal condition should, as a matter of course, be offered a counselling service (NOT assisted suicide counselling). If this is taken up AND the specific condition would qualify for assisted suicide, this counselling would include the information that assisted suicide is legally available.

Assisted Suicide Counselling only to given after a request for assisted suicide has been made by the patient.

It should be prerequisite of the law that the patient receive a minimum course of counselling at this stage.

If a patient is adamant after undergoing such counselling that they want assisted suicide, the law must be clearly explained to them.

We believe that this should be that they are required to specify whether they wish to be provided with the means alone or means and / or assistance. This would mean that there would be no provision for subsequent assistance should they be unable to request it. This is to avoid any possibility of a person who has changed their mind but unable to communicate it, of being wrongfully killed.

To formally affirm the desire for assisted suicide, the patient must have undergone as full a course of counselling as they wish. Confirmation of their desire must be given and witnessed by both a recognised medical and recognised legal professional. Any subsequent reaffirmations should be to the same degree.

If the patient asks for assistance to commit the act, they must give clear indications of the level of debility they will undergo before they wish their request to be initiated.

We believe that it is acceptable for a specified person other than a doctor to assist if that person is agreeable but only under strict medical supervision. This person must, however, also undergo a counselling session before consent can be given to assist and, if they actually have to carry out the act, also have counselling available afterwards.

If at any point after formal affirmation of desire a patient expresses any form of doubt, this will be a positive debar for any human assistance to actually commit the act. This would not prevent the means being available to the patient to commit the act themselves should they not actually reverse their decision.

Stage of illness:

Assisted suicide should not be available until the illness reaches a profound stage. These stages can only be determined by close consultation with medical experts and will vary according to the specific disease.

At the actual act itself, apart from any persons requested by the patient, there must be at least one authorised* medical practitioner and one authorised* independent witness. Presuming death is by assisted suicide, the certifying doctor will record the cause death and the fact that it was an assisted suicide must be mentioned in some way. The specifics of the wording is a matter for further consultation with legal and medical experts.

*Authorised in this instance means approved by The DHSS and the Deemsters.

Should an act of assisted suicide take place under this regime, a full file will be passed to the Coroner of Inquests who will review the evidence to satisfy himself that the procedures have been correctly followed. This being the case, there would be no need for an inquest. Only in the event of the Coroner not being satisfied that all procedures had been correctly followed, would there be a need for an inquest.

It is recognised that current verdicts available may not be appropriate. In the event of an inquest finding that correct procedures had not been followed, Unlawful Killing is an option. Conversely, if procedures have been followed either "lawful killing" or "assisted suicide" may be options but, again, this requires consultation with legal experts.

Mec Vannin believes that the foregoing provides a framework within which a meaningful and workable Act can be established. It is intended as a set of principles and the Party would welcome the opportunity for further input into this very important matter.

Mec Vannin, October 2003

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