Peers hear social work's safeguarding concerns over assisted dying
All terminally ill people applying for an assisted death should have a safeguarding assessment, BASW told peers examining the proposed law change.
The association also warned of the danger of coercive control by family and partners and the “crisis” in social care influencing someone’s decision to want to die.
The Terminally Ill Adults (End of Life) Bill which is currently going through the Westminster parliament does not make safeguarding assessments mandatory.
But speaking at a House of Lords committee scrutinising the bill today, BASW’s head of policy and research Dr Luke Geoghegan said: “BASW takes the view that all applicants should have a safeguarding assessment.
“Assisted death is irreversible, it can’t be modified or reviewed after it’s happened. Death can also trigger a substantial transfer of assets. There may be pressure from family members or partners.
“This is where the task of safeguarding has to tease that out and say, ‘Is that actually the established wish of this person, or is it the established wish of someone else?’.”
Coercive control could also be asserted the reverse way, forcing someone to stay alive against their wishes, said Geoghegan.
He called for safeguarding investigations triggered when concerns are raised under the Care Act 2014 to be “flipped” in assisted dying to happen as a matter of course. This should include a home visit in order to make a more comprehensive assessment.
The assisted dying bill was voted through by a narrow majority of just 23 votes following heated debate in the House of Commons in June.
Panels and capacity
An amendment to the legislation added the creation of panels consisting of a social worker, psychiatrist and senior lawyer to review requests for assisted dying.
BASW has welcomed the greater involvement of social work as offering better protections and helping to address concerns over capacity of individuals to make decisions.
Asked by the committee if the panels should also have the right to meet with a person applying for assisted dying, Geoghegan replied: “If Parliament legislated for that duty, we wouldn’t object.”
He added: “We think the issue of mental capacity is going to come up more often than you might expect, either from family members or from other professionals.
“Undertaking mental capacity assessments is going to be very complicated because of people being in great pain, or a fluctuation condition.”
Geoghegan said the “common safeguarding failure” of inter-agency information sharing needed addressing to prevent safeguarding risks being missed.
“The social worker on the panel must have the power to routinely access local authority records to see if there have been safeguarding concerns, and in certain cases, access police records to see if there have been any issues of domestic violence or coercive control.”
He also warned of the danger of delays in investigations. Under the proposed legislation someone requesting assisted dying must be diagnosed as having six months or less to live.
Multidisciplinary support
“Concerns raised can only be closed by the local authority and that can take time, given that local authorities have a backlog of adult care assessments of around 375,000,” said Geoghegan.
“So the bill needs an amendment that the panel is able to close their own safeguarding assessments.”
Panels should provide multidisciplinary support, including counselling and mental capacity assessments, added Geoghegan, a view echoed by the Royal College of Psychiatrists which also gave evidence to the committee.
He also called for people to be supported around thinking about assisted dying decisions before the six-month period within the bill.
The process must have “robust external inspection” from the health and social care regulator, the Care Quality Commission, he said.
Another amendment needed to the bill, said Geoghegan, is that decisions made by the panel should be “unanimous with no abstentions”. He added: “We think that if you have a professional opinion which is genuine and evidenced you shouldn’t be outvoted.
“That prevents problems later [such as] people saying someone didn’t have capacity and it would boost public confidence.”
Social care 'crisis'
Asked by the committee if there were any groups of people social workers had particular concern over if the bill became law, Geoghegan replied: “Yes, we have been clear from the outset that social care in this country is in crisis and people are not getting the services that they are entitled to.
“If you are not getting the care services and support services that you're entitled to assisted death may be something which you wouldn't have considered otherwise. “Much of social care is self-funded now. So if you're poor and you can't have access to those personal resources, even more pressure is applied to you.”
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The full evidence session is available to watch on UK Parliament TV here.