Our Deputy-Director Hardeep Singh writes about the controversial Assisted Dying Bill 2021 which will be debated in the House of Lords tomorrow.
The push for legalised assisted dying for the terminally ill is back with a private members’ bill (PMB) introduced by Baroness Meacher. We’ve been here before, with Lord Falconer’s 2013 Assisted Dying Bill, and the 2015 Marris Bill – which was overwhelming defeated by 330 votes to 118 in the Commons. But this issue remains emotionally charged and goes to the heart of medical ethics. It is also true that euphemistic language is often deployed by advocates in framing the narrative – another way of describing ‘assisted dying’, is of course, the grislier ‘assisted suicide’, or ‘assisted killing’. Even euthanasia, which is the act of intentionally ending a life to relieve suffering means ‘good death’. Meacher’s PMB will be debated by more than 140 peers tomorrow, but has it addressed concerns like those highlighted by Lord Tebbit during the passage of Falconer’s Bill, when he said legalising assisted suicide, ‘will be a breeding ground for vultures, individual and corporate. It creates too much financial incentive for the taking of life’?
The Bill states it is designed to, ‘enable adults who are terminally ill to be provided at their request with specified assistance to end their own life; and for connected purposes’. A terminally ill individual having capacity to make the decision and is, ‘reasonably expected to die within six months’, must get the consent of a High Court judge. A witnessed ‘declaration’ is however first to be approved and countersigned by two independent medical practitioners. The doctors must examine the patient (and their medical records) and be satisfied the patient: (i) is terminally ill (ii) has the capacity to make the decision to end their own life; and (iii) has a clear and settled intention to end their own life which has been reached voluntarily, on an informed basis and without coercion or duress. But therein lie the inherent problems with these proposals.
Firstly, the Bill is founded on the premise that it is possible to ascertain the time of death for a terminally ill patient accurately up to six months. How can any doctor possibly know? Could a wrong diagnosis not also be made? Second, it is difficult, if not impossible to be certain if an asset-rich individual who feels, ‘they don’t want to be a burden’, has not been pressurised by relatives (or other ‘vultures’) into deciding to end their life. How to then safeguard the vulnerable at end-of-life? Section 8 of the PMB talks of ‘codes of practice’, but says, ‘The Secretary of State may issue one or more’ – ‘may’ is simply not good enough for what in practice would equate to intentional killing.
Supporters of change like the campaign group Dignity in Dying, argue dying people from Britain are already going overseas to end their lives. They say, ‘The absence of an assisted dying law forces dying people to take drastic measures to control their death’. Statistics, however, show that only 42 people travelled to Dignitas (Switzerland) in 2019, and 24 the year before – the highest annual number since 2002 was 47 in 2016. Given these small numbers, why should a right requested by the few be imposed on the majority in law? Dignity in Dying indicate 84% of the public support a choice in assisted dying for the terminally ill, and in September the British Medical Association (BMA) moved their position from opposition to ‘physician assisted dying’ to neutrality. But despite the polling and the BMA’s shift, which is now on par with the Royal College of Physicians, there remains a groundswell of opposition, not least the voice of Dr Gordon Macdonald, Chief Executive of Care Not Killing.
Macdonald told me, ‘It is disappointing that in the midst of the COVID pandemic, which has seen widespread discrimination against the elderly and disabled people, Baroness Meacher is pushing a dangerous bill that seeks to legalise assisted suicide for terminally ill people.’ He went on, ‘Setting aside the considerable issues with the Bill such as the difficulties in securing an accurate diagnosis, the whole thing seems based on a lie which perpetuates a dog whistle message that those with a terminal or chronic condition will die in pain, that current palliative care cannot help them and simply taking a pill will end their lives peacefully.’
Macdonald said in the US State of Oregon, six in ten people ending their lives in 2019 referred to the fear of being a burden on families as a reason. He warns of where things may head if assisted suicide is legalised here, citing the expansion of those qualifying for an assisted death in other jurisdictions. Several countries have legalised assisted dying, including a growing number of states in the US and Australia – a third attempt to legalise assisted dying is afoot in Scotland too. In the Netherlands, assisted death (legalised in 2002) is not limited to those with terminal illness and less than six months to live – but routinely extended to include the disabled, those with chronic non-terminal conditions and those with mental health problems, like depression and dementia – it also extends to children. Were the law to change, there are no guarantees we would not head down a similar and frankly frightening trajectory.
Right To Life UK are the secretariat for the All-Party Parliamentary Pro-Life Group. Their spokesperson Catherine Robinson told me all the main disability rights groups in the UK oppose any change to the law – including SCOPE, Disability Rights UK, Not Dead Yet UK and the United Kingdom’s Disabled People’s Council. She said, ‘We are calling on Peers to speak against and oppose Baroness Meacher’s assisted suicide Bill on Friday. The overwhelming majority of doctors who work in end-of-life care continue to oppose assisted suicide, according to the latest BMA survey. They know from experience that what vulnerable people need at the end of their lives is love and support, not offers to accelerate their death.’
Robinson is right. Moreover, if the law were to change, vulnerable people at end-of-life are at risk of interpreting it as, ‘a duty to die’ to alleviate emotional burden, whilst Tebbit’s point on financial incentive remains. Assisted suicide has been debated and rejected in parliament before, it must surely be rejected again.
Hardeep Singh @singhtwo2, journalist and Deputy-Director of the Network of Sikh Organisations