Absurd for assisted deaths not to be probed by coroners, warns ex-chief coroner

Assisted deaths not being automatically referred to a coroner for investigation has been branded “dangerous” and “frankly absurd” by the former chief coroner for England and Wales.

Retired judge Thomas Teague told peers at a House of Lords select committee that the current draft legislation to legalise assisted dying risks making coercion easier and for some cases to ” slip through” if coroners are not involved as the default.

The Terminally Ill Adults (End of Life) Bill currently states that an assisted death would not be classified as an “unnatural death” and therefore would not require automatic investigation by a coroner.

The Royal College of Pathologists and Mr Teague have previously voiced their opposition to this element of the Bill and both gave further evidence to peers on Thursday.

Mr Teague described it as a ” retrograde step” to have deaths looked at only by medical examiners, arguing coroners “are best equipped to pursue wider and deeper inquiries than purely medical ones, and can investigate the background of a case, can seek evidence from different sources, other than medical sources”.

He warned that categorising assisted deaths, which he said “are in reality, deaths by suicide”, as natural deaths could have the “unfortunate and unintended consequence of tending to obscure and conceal those risks, and of making it easier for persons who want, for example, to exercise coercion or pressure or deception to do so”.

He said having a filter system of medical examiners looking at deaths and deciding which ones to refer to a coroner presents “an obvious risk, I would suggest, that cases that ought to go to the coroner will slip through” because medical examiners would be applying “a less rigorous form of scrutiny and a much narrower form of scrutiny” as per the scope of what their role allows for and what they are trained to do.

He added: “That is why it’s so important these matters should stay with coroners and, indeed, it is why it is dangerous, in my view, to take any element of control over the investigation away from coroners.”

He said clause 38 of the Bill as it stands was effectively reversing part of a system for scrutinising deaths that had been 200 years in the making and described the proposed approach as “frankly absurd”.

Dr Suzy Lishman, from the Royal College of Pathologists, when asked about whether it would be safe to remove coronial oversight, told the committee: “No, I don’t believe it would be safe.”

She said medical examiners are trained to scrutinise patient care, rather than trying to identify discrepancies in the legal process around assisted dying.

She told peers: “Lawyers, not doctors, are the most appropriate professionals to review assisted deaths.”

Dr Aneez Esmail, who sat on the inquiry into serial killer GP Harold Shipman – from which emerged the recommendations to create the role of medical examiners – disagreed with the calls for all assisted deaths to be reviewed by a coroner.

In a statement reacting to Mr Teague’s comments he said this approach would not be “proportionate, reasonable or safer”.

Detailing the level of assessment involved in the assisted dying process, Dr Esmail said: “I cannot think of any death that would be the subject of greater scrutiny in advance of the person dying than an assisted death.”

He added: “If assisted deaths are reviewed by a medical examiner in the first instance, with the option for them to refer to a coroner should they need to, we would lose nothing in terms of safety, but it would be more compassionate for loved ones and would ensure the dying person’s decision to have an assisted death or not is not unduly influenced by what might happen after they die.

“The simple fact is the legal framework set out in this Bill is clearer, safer and more transparent than what is happening under the status quo.”

Dr Annabel Price, from the Royal College of Psychiatrists (RCPsych), said “professional involvement” in assisted dying should be opt-in, rather than opt-out as it currently stands.

This echoed views from the Royal College of GPs aired in the previous day’s session.

RCPsych announced in June it had “serious concerns” and therefore could not support the Bill in its current form, citing various issues including the safeguarding of people with mental illness and around the assessment of mental capacity.

A number of psychiatrists subsequently expressed their support for the Bill, distancing themselves from the opposition stance taken by their professional medical body.

Dr Price accepted there was a 50/50 split among RCPsych members on the principle of assisted dying.

He told peers there should be a review of the expert panel – on which a psychiatrist will sit alongside a social worker and senior legal figure – to assess assisted dying applications, as it “does not serve the same function as a multidisciplinary team in clinical practice”.

Dr Luke Geoghegan, policy lead at British Association of Social Workers, said decisions of the three-member expert panel “need to be unanimous with no abstentions”.

He said the Bill as it stands is “contradictory” on this point, but said the requirement for unanimity would “boost public confidence”.

He warned that social care is currently “in crisis” and said for people who are not able to access the care and support they need “an assisted death may be something which you wouldn’t have considered otherwise”.

The committee will have further evidence sessions over the next fortnight, and is expected to deliver a report to the Lords – although limited only to information-gathering and without presenting conclusions or recommendations – by November 11.

The Bill is due to come back before the Lords for a whole-House committee on November 14.

In its current form the draft legislation, which applies only to England and Wales, would mean terminally ill adults with six months left to live could apply for assistance to end their lives, with approval needed from two doctors and the expert panel.