It was less than three weeks before the Second Reading of the Terminally Ill Adults (End of Life) Bill that Kim Leadbeater published its text.
Within the debate, a number of MPs who voted the Bill through made it clear that they were voting on the principle only; and that they would want to see a number of changes made to the Bill if they were to vote it through at Third Reading.
Kim Leadbeater has claimed her Bill is safe, and that the safeguards are “the strongest in the world”. Whenever assisted suicide legislation is introduced, proponents always talk a lot about safeguards. This is central to their argument for law change: they know that the weakest part of the case for assisted suicide is the very real prospect that cases of abuse and exploitation could take place.
As we might expect - for we do not believe that an Assisted Suicide Bill can ever be made safe - there are a number of significant flaws that fatally undermine the claim that the safeguards would actually work.
1) The legislation relies on an accurate prediction that a patient has six months or less to live. But anyone who knows anything about medicine knows that predicting someone’s death is notoriously difficult. Doctors suggest that generally a prognosis can only really be predicted with any confidence in the final few days, or in some cases, hours, of someone’s life. A recent report indicated that doctors providing a six-month prognosis were wrong in around half of cases, and that a third of those they had predicted to die within that time were still living twelve months on. Within the debate at Second Reading, MP Mary Kelly Foy spoke of her daughter Maria, who was non-verbal and had cerebral palsy; she was often given just six months to live. She lived for 27 years.
2) There are just three weeks from asking for assisted suicide to being dead. This might be dressed up as a safeguard, but that is still a really short period of time. Does this properly allow for due diligence? Are we confident that courts will have time to consider all the requests that will come their way in detail? The courts are still dealing with huge backlogs. This is likely to mean that requests will be rubber-stamped, rather than properly considered.
3) Complications can and do occur when taking the lethal drugs that end your life. The legislation acknowledges this when it says that doctors involved must discuss with the patient’s wishes with them, in the event of complications. But the mere fact it makes this concession is significant. In other countries, like Belgium, where both euthanasia (doctor administers the lethal drug) and assisted suicide (where the patient takes it) are legal, there was a recent case where a patient did not die after the lethal drug, and so the doctor and nurses suffocated them. Palliative care doctor Ilora Finlay recently wrote for The i Paper about how taking these lethal drugs does not necessarily result in instantaneous deaths, and that in Oregon, about half of patients had taken between 53 minutes and 137 hours to die.
4) All the Bill says about talking with family is that if the doctor thinks it appropriate, they should advise the patient to ‘consider’ discussing the request with their next of kin. That’s a shockingly low bar for family involvement given the gravity of the decision. This is one of the major flaws behind the Bill. It is the product of our culture’s obsession with autonomy. But no man is an island. All our decisions have an impact on our nearest and dearest. This legislation does not do justice to the role of the family. And while courts will be involved, it is slanted one way. If the High Court says no to your request for assisted suicide, you can appeal. But if the High Court approves, there is no appeal process open to family members who are concerned about abuse. How is this right?
5) Despite multiple doctors needing to be involved, if the ‘independent doctor refuses to make a statement’ supporting the request for assisted suicide, the coordinating doctor may refer the patient to a different doctor. In other words, if you don’t get what you want the first time, you can try again. To a degree, you can ‘shop for a doctor’ who will approve your desire. Furthermore, it is highly likely that, given that doctors who will approve assisted suicide will be a self-selecting group, the doctors will not be truly independent.
6) It is doctors who are expected to spot the signs of coercion, despite not being formally trained to do so. Coercion is notoriously difficult to identify, and can take many forms. It is rare that it is as simple as someone trying to outright convince another person to take a course of action. Generally it is much more subtle, and in this case, there will not be a witness around to ask about it afterwards. The MP Diane Abbott spoke in the debate at Second Reading about how “Coercion in the family context can be about not what you say but what you do not say—the long, meaningful pause.” There is also a strong chance that some will fall prey to an unspoken ‘societal coercion’, where they feel they do not want to be a burden, on their friends and family, or even upon the NHS.
7) The Bill does not make any provision for palliative care. As a number of people have pointed out, choosing between the prospect of an assisted suicide and non-existent or sub-standard palliative care (in much of the country) is no choice at all. We need to properly invest in and support the provision of palliative care, so that people are not faced with a postcode lottery. The genius of this approach is that it provides holistic care for the patient, and in the vast majority of cases, it makes a good, dignified death possible.
In summary, there may be attempts to fix some of these problems at Committee Stage, or through amendments at Report stage, but we should conclude that this Bill is unworkable. It will cause chaos in our healthcare, in our justice system and will also create pressure on some of the frailest in our society. If this is genuinely representative of the ‘strongest safeguards’ in the world, it merely proves the point: Assisted Suicide cannot be made safe.