Isle of Man parliament to debate assisted-dying plans
The right for terminally ill people on the Isle of Man to be helped to die could be a step closer after crucial votes in its parliament on Tuesday.
Members will debate whether lethal drugs should be self-administered or given to those eligible by doctors.
The island could become the first part of the British Isles to pass assisted-dying legislation.
If royal assent is received next year, its first assisted death could come as soon as 2027.
Another crown dependency, Jersey, is set to vote on proposals next week, although it has yet to introduce a bill. Both islands set their own laws.
Dr Alex Allinson, a politician and doctor, introduced the private members' bill at Tynwald, the Isle of Man parliament.
He told the BBC that "fewer than a dozen" people a year would be expected to opt for an assisted death, which was now "a step closer" to becoming reality.
How will the legislation work?
Last week, members of the House of Keys (MHKs), roughly equivalent to the House of Commons at Westminster, began debating the clauses of the Assisted Dying Bill, which passed its second reading in October.
This is a pivotal stage of the legislation as politicians vote on the details of who would be eligible.
The bill allows for the provision of assisted dying for terminally ill adults with capacity and a "clear and settled intention" to end their lives.
Two key changes to the original bill have been approved so far. Firstly, MHKs voted to increase the required residency period on the Isle of Man from one year to five, after concerns that it could encourage so-called "death tourism".
Secondly, politicians backed a change to allow those with less than a year to live the right to die, rather than six months as originally proposed.
Dr Allinson said the legislation would help "a very small number of people" to have "autonomy and control over how and when they die".
But Julie Edge, another member of the House of Keys, described it as a "kill bill" saying there were not enough safeguards in place, adding that it could put "additional cost and pressures on the health service", and deter doctors from coming to the island.
The clauses yet to be voted on concern the involvement of the medical profession in assisted dying.
The bill currently states that two doctors must verify that people meet the eligibility criteria.
One of the most controversial areas to be voted on is whether patients could ask a doctor to give them a lethal injection, a form of voluntary euthanasia. The other option is to restrict it to patients self-administering the drugs.
Once the clauses stage is completed at the House of Keys, the bill will then go for Third Reading - usually a formality - before being sent to the Legislative Council, the equivalent of the House of Lords. After that it would require the Privy Council in London to grant Royal Assent.
There would then follow a period of at least a year while the health service on the island sets up the system and decides how it should operate.
However, the island's chief minister, Alfred Cannan, has said the bill should be put to a public vote before it becomes law. His proposal for a referendum may not be voted on until next month.
Medical concerns
A third of doctors who responded to an Isle of Man Medical Society survey last year said they would consider leaving if the legislation was introduced.
Dr Duncan Gerry, a geriatrician, fears that the legislation will be a "slippery slope". He told the BBC: "When you allow people to be killed by their doctor, it begins a journey that doesn't stop.
"Vulnerable people will start out with an offer, which becomes a suggestion, which becomes an obligation to die."
However, Sue Biggerstaff says the current law forces people like her husband Simon to die in excruciating pain.
Simon was diagnosed with motor neurone disease, or MND, in July 2021 and within a month was paralysed from the neck down. She says his final months were "hateful" because he was in constant pain despite "wonderful" support from district nurses, doctors and a hospice team.
"Simon had intravenous morphine in both legs, and both arms and patches. And he was still in pain. It was unbearable to watch."
She says Simon had open wounds which would not heal: "They told me that Simon's body was decomposing while he was still alive. Nobody should be made to go through that."
Sue says he asked a doctor how long it would take to die if he refused food, and was told about 30 days.
Simon, 65, died 11 months after his diagnosis. She concluded: "I hate having to relive this but I will do it over and over again if it just stops other people having to go through it."
Clare Barber, a former nurse, is another member of the House of Keys who is backing the legislation. She says she has seen "first-hand" some people unable to have a pain-free death.
"I have worked in intensive care, hospice, nursing homes, and I've come across people who have openly expressed a will for assisted dying, because they're suffering.
"They have absolute capacity and the ability to make those decisions, but they're not allowed to," she says.
"We empower people to make decisions about their healthcare all the way through their life, but when it comes to making those decisions around a good death, we take the ultimate decision away from them."
Religious objections
Bill Leishman, a Baptist minister, is part of Churches Alive in Mann, a Christian faith group which is united in its opposition to assisted dying.
"My big concern for this bill is for vulnerable people, who don't have much agency for themselves and the effect that it could have: the dangers of coercion, the dangers of unintended consequences and the dangers for people who feel suicidal."
He said with annual nursing home costs "north of £50,000" a year, where a child's inheritance is "quickly dwindling away" he could see pressure being brought to bear on an elderly parent to opt for an assisted death.
He told the BBC he would feel he was living in a place that was "less compassionate" than other parts of the British Isles if the Isle of Man was to set a precedent by introducing assisted dying.
Jersey also looks likely to change the law after its politicians approved the principle of legalising assisted dying in 2021.
Jersey's States Assembly will vote next week on specific proposals including an option to allow an assisted death for those who are not terminally ill but who have an "incurable physical medical condition that is causing unbearable suffering".
If proposals are approved, and legislation is drawn up, the Jersey parliament says the earliest date the law would come into effect would be the summer of 2027.
In Scotland, a private member's bill to allow assisted dying was introduced in March - the third attempt since 2010. It is expected to be debated at Holyrood later this year.
France looks set to change its law after President Macron gave his support for assisted dying. The National Assembly will be debating a bill introduced by the French health minister later this month.
At Westminster, a fresh attempt to introduce assisted dying is likely after the general election. In 2015, MPs overwhelmingly rejected plans for a right to die in England and Wales.
Since then, several countries, including New Zealand, Australia and Canada, have introduced assisted dying.
Contentious
Assisted suicide, as many opponents would prefer to call it, is one of the most contentious issues facing society. It involves a complex balance between ethics and law, morality and medicine.
The question is whether there should be a right for people to control how and when they die, and whether the health service should be allowed to provide the means to hasten their end.
The Commons Health and Social Care Committee recently published a report analysing the spread of assisted dying globally.
It concluded that palliative and end-of-life care had not got worse in countries following the introduction of a right to die, and that "in several jurisdictions" there had been an improvement.
