Royal College of Pathologists statement on the Terminally Ill Adults (End of Life) Bill
The Royal College of Pathologists has no position on the ethical issues relating to assisted dying. It recognises that members hold a range of views.
The College does, however, have an opinion on the Bill as currently proposed. In particular, the College cannot support clause 35 as drafted in the current version of the Bill. This states that death following assisted dying will not require notification to the coroner, purely because death was assisted. By default, this means that all assisted dying deaths would be scrutinised by a medical examiner, as all non-coronial deaths in England and Wales must be. The opinion of the Royal College of Pathologists – the lead college for medical examiners – is that deaths following assisted dying should be notified to the coroner, just as other deaths following the administration of drugs, prescribed or not, must be.
The College’s concerns relate only to the involvement of medical examiners after an assisted death has taken place. As part of their scrutiny, medical examiners would need to review the process leading up to the decision to authorise an assisted death and the circumstances of the assisted death, which they are not qualified to do. They would also be required to speak to the bereaved family, who may not have been aware of the application for an assisted death until after the individual’s death.
Notification to the coroner following an assisted death would ensure independent judicial review, which is particularly important given the concerns raised by many individuals, organisations and medical royal colleges about the lack of adequate safeguards in the Bill for vulnerable people. Lawyers, not doctors, are the most appropriate professionals to review these deaths. The medical examiner system was implemented to detect problems with medical care, not to identify discrepancies or malintent in the legal process required for assisted deaths. The training and resourcing for medical examiners to take on this new role would be significant, potentially taking medical examiners away from their current important role. Coronial referral for assisted deaths would be in line with current regulations, with all deaths due to a medical intervention or medicinal product being notified.
Dr Suzy Lishman CBE
Senior Advisor on Medical Examiners
