IOM Medical Society 2023 Assisted Dying Survey
The IOM Assisted Dying Bill 2023 is under consideration by the IOM parliament (Tynwald) this year. If it was passed it would “enable certain persons who are terminally ill to request and be lawfully provided with assistance to end their life”
The proposed Bill covers both medically assisted suicide [the patient takes the final act of ingestion themselves] and euthanasia [the doctor injects lethal drugs].
Since the legalisation of assisted dying/euthanasia is an emotive issue with profound ethical, moral and practical considerations for society at large and doctors in particular, the views of doctors are likely to be sought by Members of the House of Keys(MHKs) and members of the Legislative Council(MLCs) who are deciding whether to support this Bill or not. We may well be asked to give evidence on behalf of doctors at a Select Committee established to look at this complex issue in detail before the Bill makes further progress through the House of Keys and the Legislative Council, hence the need for this survey of doctor’s views.
The Assisted Dying Bill had its first reading in the House of Keys at the end of June 2023. The first reading is a formality; there was no discussion, debate or voting at this first stage. More detailed consideration will come at the Second Reading, likely to be during the Autumn of 2023 A Public Consultation was open in December 2022 and January 2023 and showed a majority of the Manx public were against the legalisation of assisted dying/euthanasia though the margin was small(49.61% against, 49.01% for). If the assisted dying/euthanasia Bill was passed by Tynwald in 2023/2024 this would be in advance of similar legislation in other UK jurisdictions? In the draft Bill, doctors are given the pivotal role in assessment of people for and the overseeing/delivering of the killing action.
This survey is about whether you are in favour or against legalising assisted dying/euthanasia as a medical professional and the impacts you feel legalisation on the IOM would have on your practice and on Manx society.

There were 108 responses to the survey. Nearly all responses included answers to every question. 53 responses included a written comment. Overall, 73.83% of responders are against assisted dying/euthanasia being legalised on the Isle of Man. The charts below show the aggregated results.

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Is your medical work on the IOM primarily(please pick one)

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Taking everything into consideration, are you in favour or against assisted dying/euthanasia being legalised on the Isle of Man prior to other UK jurisdictions?

  • Answered: 107
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To what extent do you agree with the statement “On the basis of medical practice (in the Isle of Man), there is no real need for a change in the law to allow assisted dying/euthanasia at this point in time”

  • Answered: 106
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The 108 responses equate to a 61% response rate. This high level shows how concerned the medical professional on the IOM are about this Bill being put before Tynwald and the role given to doctors in the Bill. The responses are equally split between Hospital and the Community with a further 12% of responses from retired or semi-retired doctors with all their wealth of experience. Overall, 73.83% of responders are against assisted dying/euthanasia being legalised on the Isle of Man. The majority(62.2%) feel that on the basis of their practice on the IOM that there is no real need for a change in the law to allow assisted dying/euthanasia at this point in time”

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If the IOM Government introduced assisted dying/euthanasia I would be prepared to take an active part in providing assisted dying/euthanasia myself.

  • Answered: 107
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If the IOM Government introduced assisted dying/euthanasia I would be prepared to assess patients for suitability for assisted dying/euthanasia .

  • Answered: 106
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If the IOM Government introduced assisted dying/euthanasia I would be prepared to refer patients on to other doctors who would assess for and/or provide assisted dying/euthanasia

  • Answered: 106
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If the IOM Government introduced assisted dying/euthanasia what would your preference be regarding how this should be made available (pick one)

  • Answered: 105
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Doctors are indicating their strong preference not to be involved in Assisted Dying. 18.69% indicate they are prepared to take an active part. 19.81% are prepared to assess patients for suitability. However a greater proportion, 39.63% would be prepared to refer patients on to other doctors who would assess for and/or provide assisted dying/euthanasia. The majority of responders(55.24%) would prefer assisted dying(if introduced) to be operated via the legal system i.e. Court Authorised decision-making and Court directed processes outside healthcare. However the draft Bill as currently written puts doctors and Manx Care front and centre in its implementation.

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If the IOM Government introduced assisted dying/euthanasia this might well have a negative effect on recruitment of doctors to the IOM

  • Answered: 107
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If the IOM Government introduced assisted dying/euthanasia this might lead to me leaving the IOM to practice in the UK or elsewhere.

  • Answered: 104
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Recruitment and Retention - this is a major concern. 54.21% of responders feel this legislation would have a negative effect on recruitment while 20.56% feel it would not have an effect on recruitment. More worryingly 33.65% indicate they might consider leaving the IOM if this legislation was passed. Further negative impacts on the already parlous state of medical recruitment and retention levels, might leave IOM Health Services on the point of collapse leading to even greater spending on temporary medical staff.

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If the IOM Government introduced assisted dying/euthanasia what do you judge would be the psychological impact on those citizens with vulnerabilities (physical illness and disability, poverty, learning difficulties and mental illness) on the IOM.

  • Answered: 107
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If the IOM Government introduced assisted dying/euthanasia what do you judge would be the impact on access to palliative care?

  • Answered: 105
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If the IOM Government introduced assisted dying/euthanasia what do you judge would be the impact on the doctor/patient relationship on the IOM.

  • Answered: 107
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Only 2.80% of doctors think that If the IOM Government introduced assisted dying/euthanasia this would have a positive psychological impact on those citizens with vulnerabilities (physical illness and disability, poverty, learning difficulties and mental illness). This group, whose welfare most needs protecting, by those in authority are most likely to be harmed by this legislation. Only 15.23% feel this legislation would have a positive effect on palliative care services and 58.88% think it would have negative effects on the doctor-patient relationship.

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To what extent do you agree with the statement : It would be straightforward to decide who had a “life expectancy of 6 months” and who did not

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Predicting the future is inherently difficult. This is particularly the case in attributing likely life expectancies to people with serious conditions. Every condition is unique and every individual is unique. It is not surprising then that only around 10% of doctors thought it would be straightforward to decide who had a life expectancy of 6 months( a fundamental aspect of the draft Bill)

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To what extent do you agree with the statement “legal safeguards will be sufficient to prevent  harm to vulnerable patients if assisted dying/euthanasia were legalised”

  • Answered: 107
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To what extent do you agree with the statement “The current bill has robust safeguards to protect people from being coerced into asking for Assisted Dying”?

  • Answered: 107
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To what extent do you agree with the statement “The current bill has robust safeguards to protect people with treatable depression from requesting Assisted Dying due to their transient low mood”?

  • Answered: 106
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The responses indicate a certain scepticism about the robustness of safeguards in the Bill. Only 17.76% of responders feel the Bill's safeguards will prevent  harm to vulnerable patients, 13.08% feel they will prevent coercion and 12.27% think safeguards will ensure people with treatable depression will be prevented from requesting Assisted Dying due to their transient low mood. In other jurisdictions, safeguards in Assisted Dying laws tend to be challenged and removed quickly by the Courts without further involvement of lawmakers, extending both the scope and eligibility criteria of the original legislation.

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Please feel free to write any comments you have regarding the proposed legalisation of assisted dying/euthanasia on the Isle of Man. 

  • Answered: 53
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  • If this assisted dying bill is passed by the MHKs it will be bad for IOM society. I’ll be looking elsewhere for employment!
  • I hope this bill will never come to light
  • the people have already narrowly voted no. why is this still being pushed ahead as if the vote was victorious when the opposite is true? i hope opinion will be listened to this time, as it doesnt seem to have been so far.
  • Legalising euthanasia will likely lead to abuse for both personal and financial reasons.
  • Very happy this progressive piece of legislation is being discussed and promoted on the Isle of Man
  • Manx society would be worse off if this Bill was passed. People at end of life need support and care, not an obligation to end it all quickly. MHKs please vote against this Bill.
  • I fully respect and support the work presently done within palliative care - they provide a wonderful service. There are a very small number of individuals, from my past experience and from present evidence in the UK of them accessing assisted dying/euthanasia and putting pressure on their loved one to assist them and exposing them to being punished at present within our legal system for doing so. The system should be outside the healthcare system as such and individuals assessed by a panel of three, at least one of whom should be legally qualified, and another medically qualified. I am retired and no longer on the medical register so unable to respond to some of the questions.
  • No vulnerable person would ever be safe or supported again at the end of their life if the politicians vote for this Bill
  • I am horrified at the prospect of assisted dying/euthanasia becoming legalised in the IOM. We doctors provide evidence-based practice. Worldwide no assisted dying drug has ever been approved by a regulatory authority. I will take no part in this. Data from jurisdictions where this has been legalised is at best poor, but is mostly non-existent. There is little or no monitoring of the death itself. What data there is shows that the death can take many hours or even days, funding for palliative care either reduces or does not increase, and the criteria for eligibility always change making the vulnerable more vulnerable. On the IOM this would be directly at odds with the Suicide Prevention Strategy. Do MHKs really believe that the suicide rate will go down if we live in a society where doctors are expected to intentionally kill people? A wish to die can be transient. Patients given a cancer diagnosis can initially feel overwhelmed and hopeless, and may at this point think that assisted dying/euthanasia is their only option because they do not want to become a 'burden' or suffer terrible symptoms. Some cancers are curable. Others can be treated giving the patient years of life,often with a good quality of life. This is invaluable time for patients and their loved ones to create memories and ultimately process/come to terms with dying. The consultation written by Alex Allinson was biased in it's construction. Despite this more respondents actually said 'NO' to this legislation. I understand that he said he would not pursue this if the majority said no. Clearly that was not true. Also the consultation made no mention of euthanasia by lethal injection. This has now appeared in the bill. How dare he sneak this in? Have the other MHKs noticed this? Appalling. Absolutely appalling! MHKs do you really want the IOM to be the only jurisdiction in the UK to do this? Do you actually want such a society? Do you want death tourism? Nothing can stop them coming to over-burden an already struggling health care system. Manx Care cannot recruit and retain staff as things are. This will undoubtedly get worse if you bring in this legislation. MHKs - Go and visit Hospice IOM. I don't expect many or any of you have bothered. Go and speak to the professionals who provide care for palliative care patients, and have been doing so for 40 years on the island. Please give them your backing and support. Please do not impose this legislation on Manx society and on the medical professionals who choose to practice on the IOM.
  • I feel the IOM gov is missing a very fundamental point and opportunity here. Increased(state-funded/contributed) palliative care services would almost negate the need for this to be discussed. We have an opportunity to embrace end of life and EoL care and make it part of our culture. Assisted dying stigmatises the dying and end of life phase of a persons life as something to be avoided. Instead we should invest in palliative care, celebrate individuals lives and help families through what is such a very difficult time. We have an opportunity to drive culture change here - and we can change it for the better, not worse
  • The vocal religious lobby must not be allowed to impose their views on patients who do not share their beliefs.
  • I am glad to see this survey is more balanced than the public consultation earlier this year. I am strongly opposed to legalisation of assisted dying because of its likely effects on the vulnerable in society. Doctors who support assisted dying need to reflect on the fact that it is incompatible with the oath they swore on entry into the profession.
  • This survey is written from a biased standpoint of 'we don't like assisted dying'. Personally I'm in favour, with appropriate safeguards. And the views of the religious minority shouldn't be foisted upon the rest of us who don't believe in a god-given life force.
  • I do not condone assisted dying but I will support better care for terminally ill patients and appropriate support for patient's relatives and carers.
  • The experience with the introduction of euthanasia/assisted suicide in Canada is a salutary one, with even Hospices there being legally obliged to provide euthanasia whatever, ignoring the conscience of medical and nursing practitioners concerning this process
  • Hospice provides excellent care for those with advanced disease to end their lives peacefully.
  • If I wanted to end my life as a result of terminal illness, I have sufficient knowledge of herbal medicine that I could make my own arrangements. Most people don't have that knowledge and would be reliant upon the medical / legal system.
  • Regarding question 7, a separate facility would probably be ideal, but is not practical in fitting the bill into the healthcare system, some ‘assisted dying’ may need to occur when an acute illness worsens a quality of life with a longer term illness which was bearable to the individual, but with this new deficit in abilities which is not likely to improve to the bearable state life becomes they would rather not prolong. In Short, the bill would ideally be in dedicated site, but still needs to be applicable in the acute care areas, as long as all caveats and guidelines are followed.
  • It is my strong belief that patient autonomy cannot be truly exercised if patients do not have a legal right to die at a point that fits them and in a way that eases their suffering, when the only alternative is an indeterminate period of unliveable quality of life and ongoing invasive medical investigations and treatment while doctors are reluctant to determine them to be end of life. Which, if there is no prognosis other than death, is frankly medical torture.
  • We disagree for the following reasons: 1. There have been incidents in the past where a terminal illness diagnosis has been incorrect. 2. There may be pressure from relatives to recommend Assisted Dying for someone who is not well but is known to have financial assets which could then be released. 3. A diagnosis may appear terminal because it has been aggravated by another condition such as for example depression. What are the qualifications and experiences of the 'Heath Care Professional' who would be appointed to administer the intravenous medication to achieve death?
  • On the basis of what has developed in assisted dying/euthanasia in countries that has legalised this. I feel that future legislation would expand the remit and lead to a watering down of safeguards. Making many groups more vulnerable and inevitably numbers dying by this method would rise. I say care not kill.
  • Doctors are not trained or good at detecting coercion. A right to die will become a duty to die. Murder will be able to hide in plain sight.
  • Give greater support to the education and services for palliative care both in hospice and at home. Whilst I am retired I also have many years of experience working in the community, providing palliative care at home 24/7, medical education and with disabled patients including those with learning difficulties. I am aware of many concerns and do not feel there has been adequate consultation
  • The stipulation that a patient must have a terminal illness and is reasonably expected to die within 6 months, I believe misses the demographic of patients who would benefit most from this bill - those experiencing pain/suffering where all medical and psychological options have been exhausted, but for whom life expectancy is not short and have no option but to suffer for a prolonged period. Further, patients in their last 6 months of life with a recent diagnosis are particularly vulnerable, and although may have capacity, may not make wise decisions and the legal requirement to be "fully informed of the palliative, hospice and other care which is available to that person" may not be sufficient to safeguard against this.
  • “I understand the wish of the small number of individuals who develop diseases with inevitable, irreversible neurological deterioration to be in control of their own death, in the way they had control over the lives. I do not agree that, on balance, the Island should have assisted dying written into law. As a doctor, I want no part in it. I don’t trust our local legal system would protect the doctors involved who acted in good faith should there be a challenge to the decision after the person had died. Much as my heart goes out to those patients in inevitable, slow decline, I think it’s too much to ask of another human being to help a person end their life”
  • The health care system on the Isle of Man is thread bare and malfunctioning. People are suffering as a result. Offering them a way out of their suffering with an Assisted Dying Bill is badly timed and cynical.
  • Although safeguards are offered, there is no way of completely mitigating the risk to patients of feeling they 'ought' to go down the route of assisted dying if it is available I do not believe that staying at proposed position of the legislation in its current form would be the final destination, I am sure there would be subsequent steps to broaden the scope of assisted dying
  • Whilst the effort to make this a neutrally worded survey, some of the questions are still loaded. For one thing, AD and euthanasia are not the same thing. For another, "taking an active part" as per the Bill means assessing and prescribing self-administered medications, but may be misconstrued by uninformed colleagues as administering medications that terminate life. A question regarding whether survey participants have actually read the Bill or consider themselves sufficiently informed about its content should have been included in the survey to provide context.
  • As a medical professional and a manx person I am very strongly against euthanasia and assisted dying. I am also strongly disappointed that this is being carried through for further reading when the majority was against in the pubic consultation. I have great concerns that the medical profession will be ignored- it will massively affect the manx population not only because the vulnerable are at risk but because medical professionals will leave/not be able to be recruited! (Already in OPAL 4, the IOM cannot risk further degradation and stretching of the health service). Additionally I’m disappointed for the incredibly biased survey ‘dr’ Allinson wrote.
  • As an independent nation state, IOM is in a prime position to offer this much needed service. If we wait for UK legislation, we will be waiting a long time. I would support this 100%.
  • The introduction of assisted dying/euthanasia being legalised on the Isle of Man will put vulnerable patients being placed at risk of consenting to euthanasia against their will and depressed patients not seeking alternative treatments. More emphasis should be placed on provision of excellent palliative care.
  • It should be left to personal choice after having reviewed and counselled the individual.
  • more effort by the politicians should go into helping those patients who want to live.
  • Dr Allinson is a disgrace to the profession. He said he would drop the bill if the public consultation was against the bill and he did not. He refuses to the address the very serious consequence of such legalisation in the countries that have already gone down this root- ie that safeguards can never never work becuase there will always be the person just over the boundry who insists rthart it is their right to have the state to kill them and there is never a justifiable defence to prevent this. Dr Allinson relies on the fact that grossly superficial argument of 'personal choice' will convince people that this is a great idea. He relay upon the laziness of fellow MHKs to look into the deeper reallities- and as such he will probably succeed. What has assisted dying/ euthanasia got to do with the medical profession anyway? Should this not be the domain of Vets? One final point, I wonder how he will fare in a GMC hearing where he is being judged for his obsession for killing rather that preserving and promoting life.
  • This proposed bill is against all the human morals, ethics and medical profession teachings
  • Do not push medics to follow route of notorious Nazi Dr J. R. Mengele.
  • As medical profession, this is one of the most important areas that we should champion- defending true autonomy of people, especially vulnerable groups such patients with mental health issues, with disabilities, with unknown fear of future pain! Once approved, it will truly be a slippery slope and it will be hard to recover from it as a society who cares for its vulnerable people.
  • I do not think the Isle of Man has the emotional maturity in government or the legal system to deal with this complex issue safely.
  • Not only the ethical aspects need to be carefully considered but also the details of the actual processes of providing and experience of them, problems and how to manage etc etc
  • There are many more pressing issues with the health care system that should be addressed. This legislation is an unnecessary distraction
  • Less thought has been given to community at large. It is a very individual approach to life not a community or society
  • I have ticked 'community based' as I work in Public Health.
  • The Hippocratic oath states “I will use my power to help the sick to the best of my ability and judgement; I will abstain from harming or wronging any man by it" I consider actively being involved in ending someone's life as being harmful
  • There is no need for this bill on the IOM. In 20 years working as a GP here I have never been asked about assisted dying or euthanasia. The majority of the Manx public are against it. It seems to be solely a political move and surrounded by scaremongering about suffering at end of life, which is not inevitable and is not untreatable. Our hospice and end of life care is excellent and better funding would make this even more accessible to everyone who needs it. GP recruitment is very difficult now and if this bill is introduced it would become virtually impossible, leading to a marked reduction in healthcare for our Manx population.
  • It would be shortsighted to enable assisted dying . Lots of drs will either leave the Isle of Man and it will definitely affect recruitment negatively
  • Excellent Hospice care is the only moral course. The Isle of Man government should provide better funding and access to compassionate Hospice care rather than instigate an approach that is irreconcilable with the hippocratic oath
  • End of life care here does not adhere to any of the GMC guidelines and allows the patient no control. I have every expectation that the introduction of assisted dying would disastrous
  • I would select neutral on the issue if this was an option
  • As happens in other countries like Canada, medical practitioners would most likely be pressured to take part in assisted dying, meaning than many, myself included, would choose to leave the profession.
  • We have a poor health system that is not fit for purpose. It is unlikely to get better. It is only humane for the those suffering with incurable condition to escape with dignity. Please do not stop patients accessing this escape route unless you are able to make the health system, particularly the palliative care fit for purpose. (A senior clinician who has worked in the IoM health system for about 2 decades)
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Across the UK, some medical organisations are opposed to the legalisation of assisted Dying such as the Association of Palliative Medicine which represents doctors working most with people at End of Life. Other national organisations such as the British Medical Association have taken a neutral position. There is not a single national organisation which actively supports Assisted Dying legislation. On the basis of this 2023 survey of doctor's views on the Isle of Man the IOM Medical Society remains opposed to the legalisation of Assisted Dying.

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