Believe it or not, the most compelling argument against assisted dying today came from Sir Ed Davey, the Lib Dem leader, usually reliably on message with every socially progressive cause. But in a BBC radio interview, he almost diffidently put forward his reservations about the Labour MP Kim Leadbeater’s assisted dying bill, arguing that it would make vulnerable people feel like a burden.
The mere existence of the choice changes everything
Davey, who cared for his elderly mother through her final days and has a disabled son, said, in paraphrase, that if the bill became law, it could have a subtly negative effect on the elderly and disabled. He argued that if the state administers death, many vulnerable people might feel moral pressure to end their lives, whereas a good society should make them feel valued.
That is the heart of the matter, though the issue with safeguards also warrants discussion. If the state offers people the choice to die, many may feel they must take it to avoid being a burden, either to their families or ‘our’ NHS. The mere existence of the choice changes everything. Certainly, there will be people – the strong, the well-supported, the financially secure, like Esther Rantzen and Polly Toynbee – for whom autonomy is paramount. But for every Polly, and every Esther, there will be any number of humbler fry whose choice will be conditioned by the feeling of worthlessness, of not being valued or the uneasy feeling that they’re costing an awful lot of money. In Oregon, 43 per cent of those who sought assisted dying last year said they feared being a burden.
That said, Leadbeater’s confidence in her bill’s inviolability is remarkable. She told the BBC this morning that ‘the status quo isn’t fit for purpose’ and asserted that her bill has robust safeguards, ruling out the risk of a slippery slope. Not enough palliative care, as Health Secretary Wes Streeting argues? No problem – ‘it’s not either or,’ she says. Legal challenges? She suggests parliamentary sovereignty prevents that. Expansions to the law? Unthinkable.
It’s hard to know where to begin with this kind of wishful thinking. Speaking with Baroness Ilora Finlay, one of the UK’s leading palliative care consultants, offers perspective on these safeguards. The bill, if enacted, would allow only those who are able to self-administer the drugs to proceed with assisted dying, theoretically bypassing the direct involvement of doctors in administering lethal doses. But how long until this provision is challenged in court by those unable to self-administer the medication, arguing they, too, deserve assisted dying?
The bill is ostensibly only for the dying. Leadbeater contends, ‘It’s shortening dying, not ending life,’ a distinction with its own philosophical complications. Prognoses of life expectancy are frequently unreliable. A colleague recently buried his father, who was given days to live back in February. Another patient with lung cancer was given months but responded well to immunotherapy and remains in good health two years on.
Moreover, the bill applies only to the terminally ill. But as seen in Canada, there’s a high likelihood that individuals with non-terminal yet debilitating conditions, such as Parkinson’s, will challenge these limitations in court.
Each case could ostensibly receive oversight from a High Court judge, required to consult one of the doctors approving the request. Has Leadbeater consulted with High Court judges recently on the state of the criminal justice system? The backlog in criminal cases stretches years, not months. Realistically, a judge may have only limited capacity to ask a signing doctor if they were satisfied that no coercion was at play.
Leadbeater’s promise of a ‘dignified death’ needs scrutiny
Leadbeater’s promise of a ‘dignified death’ needs scrutiny. As Finlay points out, there is a lack of serious studies examining the outcomes of assisted suicide methods. Nowhere has developed an officially licensed formula for a consistent and effective lethal dose. The US state of Oregon, which provides the model for Leadbeater’s bill, often provides barbiturates, though sometimes alternative drugs have been used with varying outcomes. The process is neither quick nor consistently painless; one person took 137 hours to die.
What would effective safeguards look like? They would involve proper patient assessments by a dedicated NHS service. Such assessments would require auditing, as well as thorough consultations, which take time and money. Skilled professionals are essential to identify impaired mental capacity and coercive influences. Abuse affects a large number of people, yet clinicians often miss these cases. We currently lack adequate means to detect coercion.
An alternative option would be to provide a genuine choice: consistent, proactive palliative care that plans for needs rather than reacting to crises and that is uniformly available nationwide. Britain, believe it or not, leads the world in palliative care and is a frontrunner in hospice provision. However, even our excellent hospices face challenges, not least due to Labour’s National Insurance hike. Addressing these challenges takes commitment; let’s not discuss ‘choice’ until that commitment is realised.
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