False Autonomy and Hobson’s Choice: How ‘Assisted Dying’ Harms the Family

Executive Summary

• Kim Leadbeater MP’s Terminally Ill Adults (End of Life) Bill proposes a system of assisted suicide – where a physician provides a qualifying person with lethal drugs to end their own life – based on the purported safeguards of eligibility criteria and procedural gatekeeping.

• The eligibility criteria are meant to limit the application of assisted suicide to terminally ill adults (those who have ‘an inevitably progressive illness, disease or medical condition which cannot be reversed by treatment’) who have a prognosis of less than six months to live. It explicitly rules out those whose condition is ‘only’ disability or mental illness.

• Evidence from Oregon, the assisted suicide model of which the Leadbeater Bill is following, shows that these eligibility criteria have over time led to applications for assisted suicide for normally non-terminal conditions such as anorexia, diabetes, hernias, and arthritis, due to their becoming ‘artificially terminal’ by human action or inaction rather than the inevitable progression of the disease.

• The risk of that occurring in the UK is worsened by the potential for doctor-shopping amongst a minority of doctors who would be providing an assisted suicide service, who would be by definition those with the fewest qualms and least scruples about doing so.

• For more ‘ordinary’ cases, six-month prognoses are in any case very unreliable, and the danger exists that hundreds if not thousands of people would have their lives ended prematurely, even by a matter of years, if the Bill were passed into law.

• The procedural gatekeeping meanwhile relies on a system whereby the patient seeking to procure an assisted suicide would make two declarations followed by ‘periods of reflection’ (altogether 21 days) and two doctors would assess that they are making an autonomous decision free of duress, followed by a High Court Judge confirming that the procedure has been followed.

• Nothing however establishes how the doctors would know (certainly in 3 weeks) how to detect undue pressure or coercion in the patient, even with psychological training. As such, the inclusion of a High Court Judge (putting aside the consequences for the judiciary in being given this responsibility) would only be an added layer of bureaucracy without any ability to safeguard.

• The risk of abuses occurring in the UK is obvious from recent medical history (e.g. scandals surrounding Stafford Hospital and the Liverpool Care Pathway), and is worsened by the potential for doctor-shopping amongst a minority of doctors who would be providing assisted suicide – by definition those with the fewest qualms and least scruples about doing so.

• Given the permissive nature of a two-doctor system as demonstrated by the Abortion Act 1967, and given that opposition to the reestablishment of the death penalty exists notwithstanding the forensic nature of the investigation and court process justifying a guilty verdict for a serious crime, this raises the question as to why we would affirm the enabling of patient suicides based on procedural gatekeeping which amounts to nothing more than a box-ticking system which is certainly neither ‘thorough’ nor ‘robust’.

• The Oregon Model has shown many problems over time: amongst others, the removal of safeguards, a failure to protect those with mental illness, expansive application of terminal illness, and a rise in numbers of those opting for assisted suicide over fear of being a ‘burden’.

• Suicide prevention has been demonstrably undermined, and the development of palliative care has also been evidently retarded in those jurisdictions which have legalised assisted suicide or euthanasia. The question of difficult medical resource application in this context also has dehumanising implications.

• The rationale for legalising assisted suicide carries within itself not merely a slippery slope, but a logical cliff – the precedent to widen the eligibility criteria to all those who would claim a right to ‘choice’, ‘autonomy’ and the ‘right to die’. Evidence from those jurisdictions (Belgium, Canada and the Netherlands) which have followed this logic into euthanasia shows appalling cases of premature death for those who are disabled, mentally ill, or have had hard life experiences.

• The Leadbeater Bill, like all proposals of assisted suicide and euthanasia is dangerous and would undermine both the integrity of family relationships and the safeguarding of vulnerable patients.

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