Warning: This article discusses issues around suicide which some readers may find distressing.
On Friday, the Terminally ill adults (end of life) Bill will return to the House of Commons. In November, with almost all MPs present, it passed its second reading, accepting the principle, by a majority of 330 to 275. Since then, the 25 page bill has been debated line by line in Committee. They have considered over 500 amendments, of which a third have been approved. The most significant are replacing approval by a High Court Judge with an Assisted Dying Review Panel consisting of a senior legal figure, a consultant psychiatrist, and a social worker. They also require participating doctors involved to have undertaken specialised training, and they toughen the penalties for abuse.
If it is approved on Friday, it will go to the House of Lords for consideration.
The principle
The bill proposes that it should become legal to assist anyone over 18 ordinarily resident in England and Wales to die, if:
- They are terminally ill, and likely to die within 6 months;
- They have the necessary capacity to make the decision;
- They have a clear, settled and informed wish to end their own life;
- Have made the decision that they wish to end their own life voluntarily and have not been coerced or pressured by any other person in making that decision.
The bill makes no mention of the motive for the request. As is usual with bills, the House of Commons library has produced an impartial briefing paper.
Progress across the UK
If the bill passes into law, by 2029, England and Wales would join the 8 countries and 11 US States which have legalised some form of assisted dying. In the British Isles, the Tynwald (Isle of Man Parliament) has already passed legislation, a bill is passing through Dail Eirann (Irish parliament), and the Scottish Parliament has just approved a similar bill in principle.
Public and professional opinion, and the law have all changed
Opinion polling shows a consistent majority in favour of a change, among all age groups, men and women and social class. Support has been growing, although concerns about the detail remain. Since the second reading, when there was much media attention, net support has risen from 8 points to 12.
Until 1961 you could be imprisoned for attempting suicide, and it is still a crime. But in 2014, following some high profile ‘mercy killing’ cases, the Crown Prosecution Service issued guidelines that people should not be prosecuted if they acted in good faith, and with the clearly expressed wish of the person dying. In recent years, most of the medical professional bodies have switched from outright opposition to neutrality on a change in the law.
The Parliamentary briefing on current law and history can be found here.
Three objections
MPs have a free vote on the bill, as is usual on ‘issues of conscience’. They will come under great pressure to resist any change from a range of individuals and organisations. Although there are many issues about the detail, the main opposition usually rests on one or more of three major arguments, which can be summarised as: the ‘absolute principle’, the ‘slippery slope’, and ‘coercion/burden’.
The absolute principle
Some people believe that human life is sacred in all circumstances, and it is always wrong to take it away. For them, all life, however miserable, must be preserved until the body itself, or God, chooses, and there can be no justification for assisted dying, whatever the wish of the person involved.
This is a legitimate view, although polling suggests that even among religious people it is a minority one. For them there can be no compromise. However, it is debateable whether their views should determine the choices of other people. In a democracy, if a clear majority of people believe a change in the law is appropriate, that is what should happen, even if some believe it to be wrong.
The slippery slope
The second argument is that, once the law is changed in a relatively minor way, there will be pressure for further change, to relax the tests, making it progressively easier for people to take this step. Disability campaigners fear that it could become possible to decide that some forms of disability would justify termination simply on the grounds of limited quality of life.
The Bill’s impact assessment does not support that. Other countries which introduced laws like the UK proposals have not expanded their initial scope.
Relaxation of conditions is clearly possible, but again, if public opinion changes in the light of experience, in a democracy, the law should allow it, with proper safeguards.
Coercion and a burden
A further concern is that people will seek assisted dying because they feel they are a burden, to relatives, friends, carers, or the state. They may conclude this for themselves or because they have been coerced by others, for financial or other gain. In April, a YouGov poll for the Salvation Army which showed a very large majority in favour of the law (by 78% to 15%), also showed a majority of people concerned about the risk of coercion to specific groups of people. The bill is explicit that disability, age and mental health are not grounds for termination, and that such coercion is a criminal offence, but much of the debate has been around how to detect and prevent it.
On the other hand, some people will wish to end their lives because they believe, without any coercion, that they have become a burden. Some believe that if they have lived a full life, and feel it has come to a natural end, they should be entitled to free others from a burden which they have not chosen, and which may permanently distort their memories of people they love.
The decision
Ultimately, this is a matter of the right to dispose of my life as I choose. For those who believe, on religious or philosophical grounds, that they do not have that right, nobody is proposing any change. But other people disagree, and want the right to choose the time and manner of their death. At present they are denied that right. This law would do something to amend that situation, though only for those whose death is already imminent. The difficult issue remains regulation: establishing clearly whether the wish is genuinely the independent wish of the individual, and that they satisfy the criteria. The Committee’s amendments have tried to tighten that. We will see whether MPs agree.
