I am a supporter of the principle of legalising assisted suicide for the terminally ill. You may well know this concept by other names – assisted dying is currently the most fashionable among advocates, though euthanasia is often used by critics. But I’m also a believer in calling things what they are, and in plain English what is currently under discussion is assisted suicide.
By that I mean the idea that someone facing terminal illness should be allowed to choose their own death to reduce pain or suffering, and that someone consenting to provide appropriate means for them to do so should not be prosecuted.
I support that right because I believe that consenting, informed adults should have the freedom to decide their own lives and to control their own bodies. It seems wrong that the law requires terminally ill people to suffer more, and for longer, than they wish. It is invidious to force their families to choose between denying their loved one’s most difficult plea or facing criminal conviction.
More often than we like to admit, people suffer dreadfully because the law insists they must, or they take their lives in painful, risky and clandestine ways because the law forbids them a safer route.
So in principle, assisted suicide should be legalised.
However, I am also a believer in careful legislation, because I know that unintended consequences of bad, hurried or ill-conceived laws are all too real.
For this reason, while I support the principle, I cannot agree that this crucial issue should be resolved by the method currently proposed: a Private Member’s Bill, the text of which will be published today by Kim Leadbeater MP.
We have too many laws, and too few good laws, even when legislating with the backing of government legal teams and extensive consultation. The draft Bill attempts to provide safeguards, but the capacity for any legislation to miss potential loopholes, to produce unintended consequences, or to be outpaced by social or technological change is huge.
If it’s hard to legislate well on, say, taxing biscuits, then a law dealing with life and death, medical ethics, the philosophical question of capacity to consent in complex circumstances, and the numerous safeguards required merits more time, more consultation, more open debate, and far more scrutiny than common or garden legislation. A Private Member’s bill is insufficient – an issue which demands more consideration will instead get less. This topic, of all topics, must not be rushed or resolved on the fly.
Even brief consideration reveals the complexity and sensitivity of legislating for assisted suicide.Yet the potential for pressure to be applied to vulnerable people by family members, contentious debates over mental capacity, and recent scandals of the abuse of old people and disabled children in care facilities all show how key the wording and safeguards are.
Proposed measures in the Bill, such as lengthy jail terms for inducing someone by “dishonesty, coercion or pressure” to go through with suicide, show the authors want to address these risks, but appear hard to apply in practice to family affairs conducted behind closed doors, particularly where the only witness may well have died.
The experience of Canada’s MAID (Medically Assistance In Dying) laws should give pause to anyone who imagines legislating for such extreme circumstances is easy. The intention is to reduce suffering for the terminally ill individual – but troublingly over a third of Canadians who died under MAID said that reducing the burden of their illness on loved ones is a factor in their decision.
In the Netherlands, the slippery slope argument has come true: it is now legal to secure assisted suicide there for chronic mental illness. Over 100 Dutch people did so last year. We are yet to scratch the surface of this issue in a national debate which has hardly taken place; how do we intend to prevent a slide down the slippery slope ourselves?
There is no inherent reason to assume that the UK will make a better job of this than Canada or the Netherlands. Indeed, there is a specific reason to fear we might hit greater difficulty.
Any country would have to navigate the risk of family pressuring a patient into suicide, or a patient convincing themself to end their life on the basis of an imagined duty to reduce the “burden” on loved ones.
In the UK, the guilt of placing a “burden” on the NHS is added to the mix, too. We discovered in the pandemic that “protect the NHS” is the single most powerful and compelling message any spin doctor could conceive of to persuade people to limit their own rights, even at great personal cost. It was hugely effective.
Now apply that powerful consideration to assisted suicide. How confident can we be that the idea of costing money, using a bed, and taking up the time and resources of the health service won’t loom in the minds of vulnerable people, in the same way that we know the fear of taking up the time and care of their children or spouse does?
One of the proposed safeguards to reduce emotional pressure is that the patient should give their consent away from family members; but this fails to address the risk that institutions can impose pressure all of their own. Anyone who has fought the corner of a vulnerable patient in a hospital or care home can attest to this.
As the experienced KC Alex Ruck Keene argues, the issue requires consideration beyond clear-cut high profile cases with articulate patients: “The law can’t operate for individuals. The law has to operate for everybody.”
None of this is Kim Leadbeater’s fault. I agree with her instinct to address the injustice and cruelty of a legal position that currently insists the terminally ill experience unnecessary suffering. But this is not the right way to resolve such a risky, vital issue. Far more time, far more thought, far more scrutiny are needed – and even then an answer may not be clear.
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