Mr. Finn Keyes:

We do not know the full implications of the 2015 Act because it commenced only on 26 April of this year. On the question of how it might interact with assisted-dying provisions, some issues arise in regard to advanced healthcare directives, as mentioned by Dr. Campbell. Apparently, advanced healthcare directives under the 2015 Act allow a person, if he or she is sufficiently clear, to refuse life-prolonging treatment. A question that has been adverted to concerns whether the legislation could be amended to include, for instance, doctor-initiated assisted dying. When Dr. Mulligan was before the committee giving evidence, she alluded to people who might lose the capacity to make the decision but who might be content in their non-capacitative state, such as someone with dementia. There is something to be considered in this regard.

Substitute decision-making of courts has to be considered regarding persons who lack capacity for whom engaging in assisted dying is proposed. Currently, a decision-making representative – a person empowered under the Act to make healthcare decisions on behalf of the person who has appointed him or her – cannot consent, on the appointer’s behalf, to the withdrawal of life-sustaining treatment. One has to go to the High Court to get an order for the removal of life-sustaining treatment. Would that be applied in the same way in regard to assisted dying? The answer is that it almost certainly would be a necessary safeguard for someone lacking capacity and in respect of whom it is proposed to make a decision to end his or her life. Those are some of the interactions but the legislation is newly commenced. We will see how it operates in practice.