independent dr is the case dr, the independent dr is the case may be, in determining the capacity of the person to make that decision to end their own life, but it is important in its own right, that was my point. surely the psychiatrist�*s opinion is important and cannot be ignored. we need more detail about how this will work. that's the point i've been trying to make throughout that we need to understand whether or not it is the case that the psychiatrist dependent from start but my intention was to make sure this decision is taken properly and it would seem to me that whenever the votes are on this amendment it's something the rest of the council would have to look out because we need the right process to make sure all of the opinions and all the considerations are there and that everything is taken seriously. i beg to move three movements standing in

my name. they will also have to be renumbering the subsections of clause six with cross references and hassles are covered in my amendments.— hassles are covered in my amendments. �* ., amendments. i'm happy to second and su ort all amendments. i'm happy to second and support all of — amendments. i'm happy to second and support all of the _ amendments. i'm happy to second and support all of the amendments - amendments. i'm happy to second and support all of the amendments with i support all of the amendments with the suggestions with regards to the psychiatrists opinions and he does a valid point that perhaps we haven't had full consultation and understanding of the involvement of doctors and their calibre of the doctors and their calibre of the doctor and to support the individual in that decision and i completely accept what doctor allinson has said with regard to that but mr thomas makes it very clear that this is work and we should be... this is not

a straightforward process and psychiatrists opinion is important but it should be about what the right processes are for the isle of man. mr right processes are for the isle of man. ~ ., . , right processes are for the isle of man. ~ ., .,, ., right processes are for the isle of man. ~ ., ., ., ., , ., man. mr thomas to move a procedural motion. i man. mr thomas to move a procedural motion- i for— man. mr thomas to move a procedural motion. i for one _ man. mr thomas to move a procedural motion. i for one found _ man. mr thomas to move a procedural motion. i for one found the _ motion. i for one found the procedure _ motion. i for one found the procedure of _ motion. i for one found the procedure of the _ motion. i for one found the | procedure of the committee motion. i for one found the . procedure of the committee of motion. i for one found the - procedure of the committee of the whole house very valuable last week and i would like to move in standing up and i would like to move in standing up 4.4 and i would like to move in standing up1i.1ia and i would like to move in standing up 4.4 a that the house dissolves into a committee of the whole house to hear evidence from baroness finlay and doctor david randall for a period that i would expect no longer to be one hour new clauses. i would like to have baroness finlay answer questions in the case of assisted dying being only with a license and not request public monies and baroness finlay is an expert in palliative care and she is a consultant at a cancer centre in cardiff and professor of palliative medicine and a crossbench member of the house of lords and a past member of the royal society of medicine and

association. she has worked in many bills such as stopping smoking in private places and changing the system of organ donation from upton to opt out in the regulation of sunbeds and carbon monoxide poisoning reduction. ithink sunbeds and carbon monoxide poisoning reduction. i think she will be able to help us in respect to our respective legislation and i understand she chairs the all parliamentary group on dying well as vice president of both hospice uk and marie curie cancer centre and on the bioethics committee and a member of the bma ethics committee and she has chaired the national mental capacity forum for england and wales and the ministry ofjustice. i would like to invite doctor david randall to answer questions from a health care professional perspective. he has a research post at the william harvey research institute. he is a

leading medical practitioner and has campaigned on euthanasia and assisted suicide and helped found a duty of care campaign which represents the health care workers to change the law. in summary, he is a practising clinician and an expert in assisting dying. i am very pleased we have such high calibre witnesses who have travelled to the island today so i hope you will allow us to solve and is committed to hear them. allow us to solve and is committed to hearthem. i break allow us to solve and is committed to hear them. i break to move. i baked a second. i to hear them. i break to move. i baked a second.— baked a second. i will put the cuestion baked a second. i will put the question and _ baked a second. i will put the question and on _ baked a second. i will put the question and on standing - baked a second. i will put the i question and on standing order baked a second. i will put the - question and on standing order 4.4 a that the _ question and on standing order 4.4 a that the house dissolves to hear evidence — that the house dissolves to hear evidence from baroness finlay and doctor— evidence from baroness finlay and doctor david randall for a period of no longer— doctor david randall for a period of no longer the one hour and clause six and _ no longer the one hour and clause six and the — no longer the one hour and clause six and the new clauses. those in favour_ six and the new clauses. those in favour of— six and the new clauses. those in favour of pci. aye. the imax habit.

ayes _ favour of pci. aye. the imax habit. ayes have — favour of pci. aye. the imax habit. ayes have it — favour of pci. aye. the imax habit. ayes have it. you are welcome to the house _ ayes have it. you are welcome to the house of— ayes have it. you are welcome to the house of keys today and i will give you the _ house of keys today and i will give you the opportunity to make an opening — you the opportunity to make an opening statement and we will open to questions. opening statement and we will open to question— opening statement and we will open to cuestions. ., ~ , ., ~ ., ~ to questions. thank you, mr speaker. if i miuht to questions. thank you, mr speaker. if i might commence... _ to questions. thank you, mr speaker. if i might commence... you _ to questions. thank you, mr speaker. if i might commence... you are - to questions. thank you, mr speaker. if i might commence... you are more | if i might commence... you are more than welcome — if i might commence... you are more than welcome to _ if i might commence... you are more than welcome to remain _ if i might commence... you are more than welcome to remain seated - if i might commence... you are more than welcome to remain seated but l than welcome to remain seated but whatever— than welcome to remain seated but whatever works best for you. thank ou. i am whatever works best for you. thank you. i am delighted _ whatever works best for you. thank you. i am delighted to _ whatever works best for you. thank you. i am delighted to be _ whatever works best for you. thank you. i am delighted to be invited i whatever works best for you. “maria; you. i am delighted to be invited to be back here. i have looked after many thousands of dying patients over many many years. i have also held the visiting professorship in the netherlands after they had changed their law and i have the privilege of sitting in consultations for euthanasia where it was being discussed and also post bereavement after euthanasia. and we have had many discussions there with people. if i could make some

comments about the legislation for you. first of all, i would have to say that at the moment what is written is not workable. one of the biggest omissions we have is how the assessments are done. they are being done behind closed doors by two doctors without really knowing exactly what's going on. and there are questions that doctors cannot ask. we cannot ask about bank statements. we cannot ask about people's wills once written on them. that's not appropriate. but actually, caution we know is mr very often. our data shows that one in six people over the age of 65 experienced some form of abuse, often financial or emotional and

psychological. doctors do not detect coercion and sadly many of us clinically have seen families that we thought were loving families... they discovered... the other thing is we need to listen to american society where you have a 61% response rate and your against this. they wanted operated outside of manx health. thus the majority of responses. and i would remind you that nearly three quarters are against the bill and as you heard during questions, which i was listening to carefully, if i heard it right, you have a problem recruiting health care staff and have a shortage of health care staff. so it's really important that

you listen to them. just in terms of the psychiatrists, i have to say delirium is quite common in advanced illness and terminal illness. it may be related to the illness and to the drugs but certainly delusions are quite common and i cannot see how you can ask a psychiatrist for opinion and then discount that opinion. it is tantamount to saying, well, the psychiatrist doesn't matter and i'm not sure that the psychiatrist coughing. to point out that you cannot differentiate between suicide in these inpatients that it's reversible and those were actually you could term irrational and i point out that whenever people do go to the point of suicide itself, they believe themselves to

be completely rational. afterwards survivors will tell you that they realised that they were not rational letter on, but not of the point of it. there are other comments i would like to make over the clause but for now i will hand over to my colleagues.— now i will hand over to my colleagues. now i will hand over to my colleauues. . ,, , ., , . now i will hand over to my colleauues. . ,, , . ., colleagues. thank you very much for bein: colleagues. thank you very much for being invited — colleagues. thank you very much for being invited and _ colleagues. thank you very much for being invited and it's _ colleagues. thank you very much for being invited and it's my _ colleagues. thank you very much for being invited and it's my second - being invited and it's my second trip to the island and i'm delighted to be back. i spoke a few years ago when this issue was previously before the house. i work in east london and i look after people's kidneys and people on dialysis and people who receive kidney transplants and i am particularly interested in the health care of minority groups and of people in situations of deprivation and vulnerability and that informs a lot of what i think on this issue. i have set up our duty of care, a collection of several thousand

health care providers across the uk and the crown dependencies, particularly strong in the isle of man. we don't focus on ethical issues around this. we are much more focused on the clinical safety implications and particularly how this will effect the culture of health care, i will affect provision of health care services and vulnerable patient groups. i would put it to you that any change in law will create winners and losers and i think it's unfortunate that this is straightforward and that nobody will lose out. in my clinical experience and looking at this variance of other countries, the people who lose out include the poor the elderly, those are explored by others and also mental health problems,

disabled people and people from minority groups. my duty as a doctor is to fight their cause. notjust look after dialysis but to ensure that the legal structures we work with in medicine protect those people and ensure that they are not exploited by others. in my comment is going to focus primarily on clauses six to do with the declaration because that really involves so much about how doctors and patients interact. i have major concerns about it and i don't consider to be a safe piece of legislation. my concern is to put assisted suicide and euthanasia right at the centre of health care, this is something that will be happening on great british surgeries in acute admissions units and elderly care warns on us for these consultations happen. as baroness finlay has said, i don't think

doctors want people to do this we don't have the skills for detecting coercion or not always good at establishing... it seems to me is very similar to the canadian legislation for 2015 which didn't last long and was very rapidly amended and which has unleashed real dangerous system for vulnerable people in canada and i am worried that the legislation stands will do the same for vulnerable people in the same for vulnerable people in the island of man. i the same for vulnerable people in the island of man.— the island of man. i will turn to questions _ the island of man. i will turn to questions and _ the island of man. i will turn to questions and feedback - the island of man. i will turn to. questions and feedback received about— questions and feedback received about brief questions and succinct answers— about brief questions and succinct answers will be necessary to give members — answers will be necessary to give members the opportunity to give questions. mrthomas. | members the opportunity to give questions. mr thomas.— members the opportunity to give questions. mr thomas. i thank both of ou for questions. mr thomas. i thank both of you for coming _ questions. mr thomas. i thank both of you for coming to _ questions. mr thomas. i thank both

of you for coming to our _ questions. mr thomas. i thank both of you for coming to our island. - questions. mr thomas. i thank both of you for coming to our island. i i of you for coming to our island. i think baroness finlay might want as this first, given it something doctor on the i think he said the bill was unworkable and i want to put the question now specifically in the context of clause six. this clause six workable or is it unworkable and if it's unworkable, why? i unworkable and if it's unworkable, wh ? ., unworkable and if it's unworkable, wh ? ~' . ., , , unworkable and if it's unworkable, wh ? . , , , why? i think clause six is the beginnings — why? i think clause six is the beginnings of _ why? i think clause six is the beginnings of a _ why? i think clause six is the beginnings of a being - why? i think clause six is the i beginnings of a being workable. why? i think clause six is the - beginnings of a being workable. the problem is that this is just about who was involved but there is nothing at all about how that assessment process is monitored. there is nothing at all about what has to happen or how which you audited and sadly, i'm afraid, we know from countries that have gone down this road is sometimes a second opinion is very cursory at the end of the day. it is not as thorough as it ought to be in that the assessment forms end up being tick

boxes and i would just remind you of the dangers of tick boxes, which were part of the liverpool care pathway protocols that were meant to improve end—of—life care but when they were rolled out, actually, what happened as the boxes got ticked but the patient was not adequately assessed and looked at. on the other thing that i would point out is over prognosis. you cannot predict prognosis. you cannot predict prognosis. the department for work and pensions in england and wales changed the benefits system so that benefits could be applied for a year ahead but they have allowed three—year leeway of error and in the event that somebody survives those additional three years, it would only be a light touch assessment for benefits after that. you just cannot predict. we have all had patients who we thought were going to be dead within days or

weeks and who were alive months or years later. i had the situation with my own mother. so the assessment process is something which needs to be addressed and is not being addressed here at all but i would like to hand over to doctor randall if i may.— i would like to hand over to doctor randall if i may. randall ifi may. yes, thank you. to ick u- a randall ifi may. yes, thank you. to pick up a few— randall ifi may. yes, thank you. to pick up a few specific _ randall ifi may. yes, thank you. to pick up a few specific points - randall ifi may. yes, thank you. to pick up a few specific points from i pick up a few specific points from clause six, it strikes me that there is a very scanty requirements placed on the attending doctor. as far as i can work out the only restriction there is of their medically qualified and not related to the patient. there is nothing said about seniority or suitable qualification the attending doctor. that is of great concern. i can remember making terrible mistakes when i was a house officer and i was a house officer in the days of the liverpool care pathway. i remember of my own volition placing a patient on the liverpool care pathway which i thought was the right thing to do,

stopping all