On Friday 29th November 2024, MPs in the British Parliament voted (330 to 275, a majority of 55) for the reintroduction of state administered death. Britain used to have this in the form of capital punishment, suspended in 1964 and finally abolished in 1969. The state is not going to begin killing you for committing treason or heinous crimes such as the Southport murders – don’t be silly, that would be far too sensible and popular with the public. But should the Terminally Ill Adults (End of Life) Bill clear the standard parliamentary hurdles over the next two years, the British public will have the option, if eligible, to have the government end their lives for them. This will be done with the assistance of the state religion, the NHS. In short, the state can now be a party to the premature death of a citizen.
The Bill for Assisted Dying began life as a private member’s Bill brought by Labour MP for Spen Valley, Kim Leadbeater. The MP has always framed the Bill as being about choice: “If we have the choice to die, we have the choice not to die; there is no compulsion”. Nicely put. Supporters of assisted dying legislation, have always argued that such a Bill would bring relief to terminally ill people facing terrible suffering; that those struggling with terminal diagnoses would be able to end their lives with dignity. The patron saint of this Bill, former BBC presenter Dame Esther Rantzen, told The Guardian on 29th November: “Those that don’t want an assisted death and don’t want to take part in providing assisted dying can opt out of it, don’t have to do it, don’t choose to end their lives that way”. Interesting choice of language – that those who don’t want the government to administer their death can ‘opt out’, implying that ‘opting in’ will be the accepted norm. Of course, Leadbeater and Rantzen have received massive support from the professional campaigning organisation ‘Dignity in Dying’, amongst others. Anyone travelling on the London Underground public transport system in the past month, will have seen the high profile poster campaign stressing the compassion of assisted suicide with slogans such as ‘When I cannot stay, let me choose how I go’. Arguably an insensitive placement of the posters, given that 40 people die being hit by trains on London Underground every year, often suicides…
As is always the case with legislation, the devil is in the detail. Firstly, who exactly is the Terminally Ill Adults (End of Life) Bill for? The Bill will allow terminally ill adults with a prognosis of six months or less to live, to seek help from the state to end their life. As someone who has a brain tumour with a poor prognosis, I can already see a problem with this. Prognosis of death is not reliable. People are regularly given six months to live but find themselves still around years later. In the run-up to the Parliamentary vote, Leadbeater insisted that her Bill had “the most robust and strongest set of safeguards and protections in the world” with “strict eligibility”. Bold claims. To be eligible for assisted dying, someone must also have the mental capacity to make a choice about ending their life and express a “clear, settled and informed” wish, free from coercion or pressure, at every stage of the process. Do people always know what their wishes are? I’m not so sure. Committing suicide – which is what assisted dying is, just dressed up in fluffy language – is not that difficult. My own observation, is that almost everyone draws back from following through with it at the last moment. Do any of us really know what people think in the few moments before death?
As safeguarding, two independent doctors and a High Court judge must be satisfied that someone is eligible and has made their decision voluntarily. How can two doctors and a Judge detect an abusive partner, a greedy/desperate beneficiary or a malicious relative? And do so pretty damn quick. Whilst the doctors must be ‘suitably qualified’ the Bill does not explicitly define what constitutes this. This omission raises questions about whether these practitioners need to have specialised training in areas such as palliative care, psychiatry or ethics which, surely, are crucial for making informed decisions in assisted dying cases. So it could be two podiatrists and an overworked and disinterested Judge? I wonder if the Judges will get to don the infamous Black Cap again, which they used to wear when passing judgement to souls bound for the gallows? I’m told by a friend in the legal profession that High Court Judges still carry the black cap, but only on an occasion where they are wearing full ceremonial dress.
The Bill does allow medical professionals to opt out of participating due to conscientious objection. However it does not specify whether objecting practitioners have a duty to refer the patient to another willing provider. Inevitably any lack of clarity will lead to the market stepping in to fill the gap – ‘professionals’ will offer their affirmative services regardless of the safeguards intended. If a patient’s regular doctor won’t provide the care, the patient will just go elsewhere. The Labour minister Pat McFadden has already raised the pertinent issue of who exactly is going to pay for the provision of assisted dying. Speaking to Times Radio on 2nd December, days after the Parliamentary vote, he said it was “right” to look at whether terminally ill adults should cover the cost. McFadden continued: “This was a private member’s bill, remember, not a government bill…It’s got a long way to go. As you know people currently have to pay for this themselves if they go to Switzerland.” Sometimes it’s hard not to feel the shadow of Dr Harold Shipman hanging over this legislation. Shipman, Britain’s most prolific serial killer, targeted vulnerable elderly people, who trusted him as their GP, killing them with either a lethal dose of drugs or prescribing extreme levels of drugs. Shipman was convicted in January 2000 of killing 15 patients (with 284 confirmed deaths, possibly more) over more than two decades. What’s to prevent an unscrupulous doctor taking advantage of a vulnerable, terminally ill patient? Certainly, they can do this already under the existing system but the mandate to help a patient suicide themselves has to be raising the level of risk.
The Equality and Human Rights Commission (EHRC) has noted that the exclusion of disability as a stand alone category for eligibility does not eliminate the need to consider rights and protections for disabled people in relation to the Bill. The EHRC emphasises that there is not always a clear line between terminal illness and disability, and that disabled individuals can also suffer from terminal illness. This grey area between disability and terminal illness will potentially be where ‘mission creep’ will flourish. How long before someone with a disability decides that they too have the right to have the state end their life for them and decides to bring a test case? Critics of Leadbeater’s Bill have cited the example of the Medical Aid in Dying (MAiD) legislation in Canada as the proverbial slippery slope of assisted dying, although Leadbeater has insisted that the Canadian system is not what is being proposed. Introduced in 2016, initially only for the terminally ill, MAiD was amended in 2021 and extended to those experiencing ‘unbearable suffering’ – a very broad term. The law now extends to the disabled, those unable to access the correct medical care and, as of March 2024, those whose sole medical condition is mental illness. A recent coroner’s report from Ontario revealed that roughly half of those euthanised are from economically and socially disadvantaged backgrounds. It’s the fastest growing assisted suicide program in the world. Four in one hundred deaths in Canada are now assisted, compared to one in one hundred in Oregon in the United States.
Oregon was one of the very first places in the world to offer assisted dying, in 1997. As with the proposed UK model, it is open to terminally ill, mentally competent adults expected to die within six months and must be signed off by two doctors. On 29th November 2024, the BBC reported that two thirds of the 367 that were helped to die by the state of Oregon last year had cancer, one in ten had neurological conditions and around the same number had heart disease. When asked why they’d chosen to die, loss of dignity, losing control of bodily functions, concern about being a burden on family and friends and inadequate pain control were cited. On the surface, the Oregon model would seem to have avoided the mission creep that critics of the UK Bill fear. It would appear to be the model upon which Leadbeater and her supporters drafted their Bill. That said, the number of assisted deaths has gradually risen and the state residency requirement has been lifted. Assisted dying is also available in Spain, Austria, most states in Australia and in New Zealand, and is being considered elsewhere. Of course, Switzerland was the first country in the world to create a ‘right to die’ when it made assisted suicide legal in 1942. It is one of the few countries which allows foreigners access to help, via organisations like Dignitas in Zurich. Over 500 British citizens have died at Dignitas in the past two decades – 40 last year. Again, the lethal medication must be self-administered. The significant media attention given to cases of British people going to Switzerland to die, undoubtedly increased pressure on the UK government to revisit assisted dying. MPs last rejected a Bill on the issue in 2015.
In a rare outbreak of common sense, Labour’s Diane Abbott was among those who argued that the UK Bill’s safeguards were simply not sufficient, stating that the role of the High Court Judge could be little more than “a rubber stamp”. The House of Commons’ longest serving female MP also rightly pointed out that some terminally ill people might feel under pressure to end their lives due to the cost of their care or for fear of being “a burden” on family and carers. Abbott voted against the Bill. Opposition to the Bill also came from religious leaders and anti-euthanasia and disability rights’ groups. A joint letter by 29 faith leaders opposing the legislation was published in leading newspapers, including The Guardian, on 24th November; Labour Justice Secretary Shabana Mahmood said her faith was “the start point” for her opposition to the Bill. More than 30 prominent KCs expressed their joint support for the Bill, including such luminaries as Michael Mansfield, former Labour minister Lord Falconer and fox killer and trans rights activist Jolyon Maugham. It was interesting that the new batch of Labour MPs elected in 2024, predominantly voted for the Bill; 234 for, 147 against. 23 Conservative MPs out of 121 voted in favour – 19 percent; 3 Reform MPs out of 5 voted in favour – 60 percent. The Ulster Unionist parties all voted against it and Sinn Fein predictably abstained (Northern Ireland remaining the most socially conservative region of the UK). Ed Davey (leader of the Liberal Democrats), who voted against the Bill, drew on his experience of looking after his terminally ill mother as a teenager, stating he would rather see improvements to end-of-life care: “I think if people knew that the palliative care was better, many of them wouldn’t support this legislation.”
Notably, the issue of palliative care is not mentioned in the Bill. Leadbeater has stated: “(The Bill) will not undermine calls for improvement to palliative care. Nor will it conflict with the right of people with disabilities to be treated equally.” All well and good, but there appear to be no specific government plans to address any calls to improve palliative care. Opponents of assisted dying have been united in calling for improved end-of-life care. Dr Gordon Macdonald, Chief Executive of Care Not Killing said: “I would strongly urge the government to focus on fixing our broken palliative care system…rather than discussing this dangerous ideological policy.” In May 2024, Dr Katherine Sleeman, a specialist in palliative care told the BBC of her concern for people who may feel they are a burden to their families: “Patients will say to me ‘I don’t want to go to a care home really, but I know my family want me to do it and I know it will be easier for them, so I think I’m going to say yes’ – substitute ‘go to a care home’ with ‘have an assisted death’ and I think it’s a completely different picture.”
Dr Sleeman believes that no assisted dying law can be completely safe and that some people who do not really want to die will always “slip through the net.” Previously, the NHS hasn’t exactly excelled in palliative care that tip-toed around the net of assisted dying, as evidenced in the Liverpool Care Pathway For The Dying Patient (LCP). This was a palliative care practice developed in the late 1990’s, to guide doctors and nurses in how to provide quality end-of-life care. Typical of the Blairite target-driven approach to medicine at that time, hospitals received cash incentives to achieve targets for the number of patients placed on the LCP. For every ten patients on LCP, only one would survive. The ‘Pathway’ involved allowing patients to suffer days of dehydration and sedation, leaving them unable to even ask for food or drink. It was widely felt that patients were being left to die. An investigation by the Royal College of Physicians found that up to half of families were also not informed of clinicians’ decisions to put a relative on the Pathway. Opponents described the Liverpool Care Pathway as a one-way street to death with no care or comfort. After an Independent Review in July 2013, and intense public scrutiny and criticism, including from the anti-euthanasia charity Care Not Killing, the LCP was phased out in the 2010’s.
As an ‘Ill Adult’, who will eventually qualify for assisted dying, I cannot help but take this Bill to its inevitable, depressing conclusion of two words – ‘Why bother?” Why bother spending millions on palliative care for the elderly? Some 80 percent of the money spent by the NHS on each patient is spent in the last three years of their lives. At the other end of life’s journey, why bother spending millions on disabled and ‘special needs’ infants and children? Their life outcomes are often poor and, some will argue, their quality of life is questionable. Why bother helping children and adults with chronic eating disorders? Studies variously rate the complete recovery from anorexia to be as low as 21 percent; others place the figure at 40 percent (but often with life-long health issues such as osteoporosis). A third live a half life of just existing between relapse and recovery. The rest die, often from cardiac issues related to anorexia. It has the highest mortality rate of any mental disorder. Not impressive Blairite outcomes on that one. Research into my own illness, brain cancer, has made woeful progress for well over half a century now. Since 1971, there has been an overall increase in survival of less than 10 percent for people with a high grade tumour, one of the poorest improvements across all cancers. Yet huge funds have been directed at it. The unpalatable truth that no one wants to admit, is that medical ethics have constrained researchers for decades now, so progress is slow. People live longer but the body does not stay young and healthy. And then this law comes along. Why bother getting a cure for anything whatsoever come to think of it – everyone has to die of something don’t they? Why bother?
It’s curious that someone as reptilian as Starmer should have allowed himself to be bullied by a retired tv presenter. On 4th October, The Independent reported that Dame Esther Rantzen had a telephone conversation with Starmer earlier in 2024, in which she repeatedly pressed him to ensure time for debate on the issue in Parliament. Starmer said he was pleased he could keep his vow to the tv presenter (Starmer voted in favour of the Bill). Perhaps it’s simply that the son of a toolmaker was a big fan of Rantzen’s tv show ‘That’s Life’ as a youngster. We may never know. What we do know is that in countries where assisted dying has been legalised, social pressure on the old, the weak and the very ill to ‘not be a burden’ has increased. We do know that not all off-spring are loving, kind and protective of those who gave them life; nor are all parents very nice to their children. A quick peruse of the daily newspapers will confirm that one for you.
I don’t think people should be made to keep on living when they are in dreadful pain – we don’t expect it of animals, we shouldn’t ask it of people. “I don’t want to be a burden” – how many of us have heard ourselves saying that in our heads, when we contemplate the end of our life. But we’re all burdens – that’s the point. We’re all a burden to someone and to ourselves. That’s the nature of living and dying. The 1967 Abortion Act was supposed to apply to a narrow criteria of exceptions. Quickly the exception became the norm; according to UK government statistics, there were 214,256 abortions in England and Wales in 2021, the highest number since the 1967 Act. Will assisted dying become routine when we become a burden, just as abortion has become another form of contraception? Sometimes it seems like we have it all wrong – we kill the unborn child, we don’t kill murderers and now we’re telling the seriously ill that they’d be better off dead. I hope someone not emotionally deranged by false compassion syndrome can see the problems with this Bill. Life is precious – the bit at the beginning, the bit in the middle and the bit at the end.
This was originally published here and is republished by kind permission of the author.
