On 29 October, MP Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill will have its second reading in the House of Commons. MPs will decide, on a free vote, whether to approve the principle of allowing assisted dying, in some very limited circumstances. If the Bill passes, and survives revision in Committee and the Lords, we would be joining 18 jurisdictions worldwide which have made it legal, in some circumstances, to help people to end their lives.
The law is a mess
Some people suffering painful terminal illness express a wish to be helped to die. For some, palliative care does not work, and they end their lives in pain, with no dignity or control. As one campaigner said “if I treated my dog like this it would be called cruelty”.
But the present legal situation is confused and imposes distress on both the people who wish to die, and the people close to them. A legal opinion from three leading barristers says that the gulf between what the law says and what the Crown Prosecution Service (CPS) does, amounts to ‘discriminatory and unpredictable application of the law’. When asked in 2014 to rule on assisted dying as a human right, the Supreme Court expressed concern about the situation, and called for Parliament to clarify the law.
For those with the money to pay, assisted dying services are available in Switzerland, and at least 400 British people are known to have taken this option since 2010. However, since it is an offence to assist anyone to do this, people usually travel alone, sometimes without saying goodbye to relatives. Furthermore, a far larger number take their own lives, often in distressing ways. Since the Harold Shipman scandal, doctors and nurses are much less willing to ease death with overdoses of pain relief, as they sometimes did in the past.
The current law
It is currently illegal to assist anyone to take their own life. But in 2014, following some high profile cases, the CPS issued guidelines for the police. They advised against prosecution if the victim had reached a voluntary, clear, settled and informed decision; the suspect was wholly motivated by compassion; the actions of the suspect were only minor; the suspect had sought to dissuade the victim from taking the action; the suspect had been reluctant to assist in the face of a determined wish on the part of the victim; and the suspect reported the victim’s suicide to the police and fully assisted them in their enquiries.
Nevertheless, every year, dozens of cases are investigated by the police, causing distress to grieving relatives. But two thirds of these are dropped for lack of evidence.
What the Bill proposes
The new Bill would only allow assistance to die in a very limited set of circumstances. Kim Leadbeater, who is presenting the Bill, stresses that this is not about whether to die – these people are dying, and soon – but about when and how to die. She claims that it is one of the most tightly drawn pieces of legislation on the issue in the world.
The Bill will only apply to someone who has been diagnosed with a terminal illness which is likely to end their life within six months. It would remain illegal to assist a death for people with intolerable pain; disability, however severe; or mental illness. And the Bill also creates a new crime of coercing someone into taking their own life, punishable by up to 14 years imprisonment.
Under the Bill two independent doctors must agree: the terminal diagnosis and expected lifespan, that this is the settled wish of the patient who is mentally capable of understanding, and that the alternatives – including palliative care – have been explained to the patient. A High Court judge must then rule that the requirements have all been met. There is then a 14-day cooling off period, and the decision can be reversed at any stage The drugs must be administered by the patient him or herself.
The full Explanatory Notes on the Bill are available on the parliamentary website.
What the public think
YouGov polls have been tracking attitudes to this issue since 2019. Support for assisted dying has never fallen below 64%, and opposition has never risen above 13%. Last week they published a new poll examining attitudes in more detail. They find 59% support assisted dying both in principle and in practice; 19% support the principle but doubt that proper safeguards can be created; 7% oppose the principle but would allow it for those who want it; and only 7% oppose in principle and practice.
YouGov also found clear support for a wider scope than the Leadbeater Bill proposes. While 85% supported the very narrow terms of the Bill, over 80% also supported assisted dying for people with terminal illness, regardless of life expectancy, and 56% for people no longer mentally competent (e.g. with dementia) who had previously expressed a clear wish.
The Nuffield Council on Bioethics held a citizen’s jury on the subject. They found that support for assisted dying for terminally ill, mentally competent adults increased to 70% during the 8-week process, as members’ understanding of the issues increased.
What MPs think
Since, by tradition, MPs are allowed a free vote on issues of conscience, the outcome of the second reading debate, which is the decision in principle to go forward with legislation, is uncertain.
In October, the i newspaper gathered evidence on MPs positions from a range of sources. They found support for reform from two thirds of Labour and Liberal Democrat MPs, and all Green Party Members (it was a Green Party manifesto commitment). That would be enough to secure an absolute majority, despite opposition from three quarters of Conservatives and all the Democratic Unionists. The SNP MPs may decide not to take part, since parallel legislation is already in progress in the Scottish Parliament.
While some MPs have made their positions clear, many have not yet said how they will vote, and many say they will decide in the light of the debate. Some in favour of reforming the law may vote against because they do not believe that this Bill is the right way to do it. Some will support, expecting major revision in Committee, and if they are disappointed, they may vote against at a later stage. There have also been concerns about procedure and next steps, should it pass this stage, so the bill might not simply proceed in the normal way. So, this is by no means the end of the story.
It looks as if a lot of MPs will be making up their minds in the light of what they hear on the day.
For advocates of assisted dying, this is a very small step towards a right to make decisions about one’s own life. For opponents this is a first step on a dangerously slippery slope.
It will be an interesting day: definitely not ‘business as usual’.
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