Tynwald has approved a series of amendments to the Assisted Dying Bill in an attempt to satisfy UK concerns over human rights compliance, paving the way for royal assent.
The amendments, brought forward by Dr Alex Allinson were passed by 16 votes to six in the House of Keys and five to one in the Legislative Council.
The changes are intended to address issues raised by the Ministry of Justice, which declined to recommend the bill for royal assent on the basis that it did not fully comply with the European Convention on Human Rights, specifically the principles established in the Mortier versus Belgium case.
Speaking in Tynwald Court, Dr Allinson said the amendments focus on “the legislative framework, the procedures to ensure independence, scrutiny, and accountability, while preserving the individual’s autonomy and confidentiality.”
The case of Mortier versus Belgium, which became final in January 2023, held that a permissive euthanasia regime can be compatible with the convention provided “that it operates within a framework that ensures decisions are taken freely and with full understanding that individual cases comply with that framework, and that there exists an effective, independent system of post-death review capable of establishing the facts and ensuring accountability”.
Key changes to the bill
The amendments introduce an express statutory duty on decision-makers to consider coercion and vulnerability, mandate independent doctors free from financial interests, and establish a comprehensive independent post-death review system.
New clauses require enhanced safeguards in cases involving potential vulnerability, including risk indicators such as dependency on social care, family conflict, and communication impairment.
Dr Allinson told members: “These amendments collectively strengthen compliance with Articles two and eight of the European Convention of Human Rights by reinforcing the legislative framework through explicit duties to protect vulnerable persons, ensuring that decisions are free and informed and introducing enhanced safeguards in what are perceived as possible the high-risk cases.
“Crucially, they establish a comprehensive system of independent post-death review, which directly addresses the procedural requirements identified in Mort of Mortimer versus Belgium, including independence, effectiveness, and the capacity to ensure accountability.”
The amendments also confirm that individuals may withdraw their request “at any time and by any means”, with mandatory training for those assessing applications.
Rob Callister, speaking in support of the amendments, said: “These amendments do not simply refine the bill, they materially strengthen it.”
He added: “If the law is to command public trust, those involved in approving that an assisted death must not only be independent, they must also be seen to be independent.”
Concerns over process
Chris Thomas MHK raised concerns about the process, noting that members were being asked to accept assurances without seeing the full legal advice.
He said: “We’ve got a memorandum from a backbencher who brought a private member’s bill. We haven’t actually got the document that would have been available if we’re doing this in the House of Keys to address the concerns raised by the Attorney General’s chambers.”
Mr Thomas also questioned whether the bill would provide the necessary clarity on implementation, asking: “Who is going to provide the assisted dying service? How is it going to be paid for and financed? Who?
“How are the doctors going to have the nurses and the pharmacists going to have their regulatory regimes changed and their codes changed? In what timescale?”
Tim Glover acknowledged the amendments strengthen the bill but told members: “Harm cannot be undone.”
He added: “There are still, I think, equality risks in there. Enhanced scrutiny categories may affect disabled people and those reliant on care, and there is a heavy dependence on still secondary measures, training codes, and safeguarding bodies carry much of that weight.”
Safeguards and autonomy
Gary Clueit MLC spoke in support of the amendments, sharing his personal experience of witnessing loved ones die “horrible deaths”.
He said: “I know what the end of life can look like when the law offers no better answer than to wait, and it is precisely that experience that brings me, brings me to the point I wish to make next.”
Addressing concerns about coercion, Mr Clueit argued: “The law has always recognised this. It does not ask whether a decision was free from all influences, an impossible task. It asks whether it was free from undue influence.”
He also highlighted what he described as the “other half of the conversation we have not been having”, telling members: “We speak endlessly of the pressure towards death, we say almost nothing about the pressure towards suffering.”
Bishop Patricia Hillas invited “a note of additional caution”, telling members: “When legislation concerns life and death, care and caution become essential, not obstacles, but a duty.”
Flawed
Chief Minister Alf Cannan said he would be voting against the amendments, arguing the bill remains “significantly flawed”.
He said: “I still think both from a diagnosis perspective this is significantly dangerous, but I also think now, having reviewed matters further in terms of the legal risks that are presented, that this may prove to be a fatal flaw in the bill and may expose it ultimately to equality and discrimination issues.”
Jason Moorhouse expressed concerns about the wider implications, telling members: “If we move forward in this way and merely focus on the tabled amendments, we may not actually get the results that many are looking for, despite the AGs reassurance that this could be enough.”
Tim Johnston however supported the amendments, saying: “I think it is important to say that is what good law making looks like, listening to concerns, testing the framework, and refining it where necessary.”
Attorney General’s reassurance
Attorney General Walter Wannenburgh confirmed his office had worked with the Ministry of Justice to address concerns.
He said: “The amendments proposed collectively strengthen compliance with articles two and eight of the convention by reinforcing the legislative framework through explicit duties to protect vulnerable persons, ensuring that decisions are free and informed, and introducing enhanced safeguards in higher risk cases.
“Importantly, they establish a comprehensive system of independent post-death review, which directly addresses the procedural requirements identified.”
However, he cautioned that “the final decision rests with the Lord Chancellor, and will not be made until after the events in this honourable court today.”
Health Minister Claire Christian, who supported the amendments despite ongoing reservations about the overall bill, told members: “I cannot honestly say to my constituents that that is the right thing to do. I must make this safer, and I must take this opportunity.”
Julie Edge remained opposed, warning about the definition of terminal illness in the bill.
She also raised severe concerns about the ability of people with special needs, including those who are non-verbal, to properly communicate their intentions or other issues about their care.
Next steps
The bill must now return to the Ministry of Justice, which will consider whether the amendments are sufficient to recommend royal assent.
If granted, the act would still require secondary legislation and codes of practice before coming into effect.
Dr Allinson said: “These amendments are necessary to give effect to the bill this honourable court already passed over a year ago.
“They are not designed to reopen the many debates that we have previously had, but instead strengthen the safeguards we have all supported.”