The use of arguments and justifications in Westminster parliamentary debates on assisted dying.

Assisted dying, the practice whereby healthcare professionals provide lethal drugs to end the life of patients at their voluntary request, remains unlawful in the United Kingdom, despite multiple attempts to change the law during the past two decades. Using qualitative and quantitative research methods, our research analysed eight debates on this topic that have taken place in the Westminster Parliament between 2014 and 2022, with a view to (a) providing a detailed classification of the arguments used by Parliamentarians (b) establishing the range and balance of anecdotes, evidence and authority statements underpinning those arguments and (c) generating insights into relationships between these argumentative strategies and the stances and characteristics of the speakers. Supporters of change emphasise principles such as autonomy and compassion and make extensive use of anecdotes that describe awful deaths under the current arrangements. Opponents contend that vulnerable individuals will suffer pressure and abuse, that the health and social care system will be adversely affected, and that legalisation will inevitably lead to expansion in the eligibility criteria and the numbers ending their lives in this way. By promoting evidence-informed debate and closer scrutiny of the arguments deployed, the findings and discussion should be of interest to any legislative (or executive) bodies around the world that are contemplating a change in the law with respect to assisted dying.

Views of disability rights organisations on assisted dying legislation in England, Wales and Scotland: an analysis of position statements.

Assisted dying is a divisive and controversial topic and it is therefore desirable that a broad range of interests inform any proposed policy changes. The purpose of this study is to collect and synthesize the views of an important stakeholder group-namely people with disabilities (PwD)-as expressed by disability rights organisations (DROs) in Great Britain. Parliamentary consultations were reviewed, together with an examination of the contemporary positions of a wide range of DROs. Our analysis revealed that the vast majority do not have a clear public stance; those that do exhibit a significant diversity of opinion. DROs opposing legislation on assisted dying have argued that it would be premature, misguided, inequitable and culturally undesirable. Some specify conditions that would have to be satisfied before they could support legalisation, such as radical improvements in health and social care services (especially those relating to end of life care) and the elimination of discrimination against PwD. DROs supporting assisted dying maintain that a change in the law would promote autonomy, end intense suffering, can be delivered safely and is supported by the DRO's membership. The discussion considers the reasons why several DROs adopt a neutral stance and the argument is made that, whatever their overarching stance on the issue, DROs need to be involved in the policy debate so that the crucial perspectives of PwD are heard and addressed. This is an important message for countries around the world that permit, or are considering legalising, assisted dying.

Corporations' use and misuse of evidence to influence health policy: a case study of sugar-sweetened beverage taxation.

BACKGROUND: Sugar sweetened beverages (SSB) are a major source of sugar in the diet. Although trends in consumption vary across regions, in many countries, particularly LMICs, their consumption continues to increase. In response, a growing number of governments have introduced a tax on SSBs. SSB manufacturers have opposed such taxes, disputing the role that SSBs play in diet-related diseases and the effectiveness of SSB taxation, and alleging major economic impacts. Given the importance of evidence to effective regulation of products harmful to human health, we scrutinised industry submissions to the South African government's consultation on a proposed SSB tax and examined their use of evidence. RESULTS: Corporate submissions were underpinned by several strategies involving the misrepresentation of evidence. First, references were used in a misleading way, providing false support for key claims. Second, raw data, which represented a pliable, alternative evidence base to peer reviewed studies, was misused to dispute both the premise of targeting sugar for special attention and the impact of SSB taxes on SSB consumption. Third, purposively selected evidence was used in conjunction with other techniques, such as selective quoting from studies and omitting important qualifying information, to promote an alternative evidential narrative to that supported by the weight of peer-reviewed research. Fourth, a range of mutually enforcing techniques that inflated the effects of SSB taxation on jobs, public revenue generation, and gross domestic product, was used to exaggerate the economic impact of the tax. This "hyperbolic accounting" included rounding up figures in original sources, double counting, and skipping steps in economic modelling. CONCLUSIONS: Our research raises fundamental questions concerning the bona fides of industry information in the context of government efforts to combat diet-related diseases. The beverage industry's claims against SSB taxation rest on a complex interplay of techniques, that appear to be grounded in evidence, but which do not observe widely accepted approaches to the use of either scientific or economic evidence. These techniques are similar, but not identical, to those used by tobacco companies and highlight the problems of introducing evidence-based policies aimed at managing the market environment for unhealthful commodities.

Patient participation groups: the national picture.

This article brings together research carried out by the National Association for Patient Participation from 2005 to 2009. Its aim was to capture the views of GP surgeries that have patient participation groups (PPGs) as well as those who do not. It also studied the views of PPGs affiliated to the National Association for Patient Participation (NAPP) about their role, their organisation and the support that they require to maximise their success. With the exception of the online, UK-wide members' survey, the research was carried out through postal surveys sent to more than 4000 English practices in three separate studies. The main results relate to the prevalence of PPGs, their geographical location, their activities, the attitudes of practices towards PPGs (especially those that do not have one) and the future needs of PPGs. PPGs are seen to play an important role in providing the practice with the patient perspective but they are active in several other areas, including health promotion, information provision, influencing commissioning, supporting other patients and fundraising (for their own needs as well as those of the practice). Three central challenges are highlighted, relating to (a) the most successful strategies to promote more PPGs; (b) the importance of support from primary care trusts (or their equivalent organisations); and (c) ways in which PPGs can increase their ability to represent the wider patient perspective. A future research agenda is also proposed that would evaluate the costs and benefits of PPGs across their broad range of activities.

Discovery Interviews: a mechanism for user involvement.

Discovery Interviews have become widely used in the UK National Health Service as a service improvement tool and patient involvement mechanism. This first paper in a series of three explores the development of Discovery Interviews in the NHS in the context of explicit central government policy of the development of patient-centred services and user involvement in shaping health service organization and delivery. It draws on the published literature on Discovery Interviews to date, including that on evaluation.