By Angela Craig
The vote in favour of the second reading of the Terminally Ill Adults (End of Life) Bill on 29th November, proposed by Labour MP Kim Leadbeater, was welcomed with unalloyed enthusiasm by the bourgeois media. Photos featuring jubilant campaigners for voluntary euthanasia were plastered across web front pages. The real promise of this Bill is far from joyful for many. The Bill, which will now go to parliamentary committee with the opportunity for amendment, if finally passed into law, would represent a major political attack at a time of huge inequality and significant shortages in access to health care, social care, support for independent living, and end of life care, including adequate, high quality palliative care. Despite all this – and the loud opposition of disabled people’s organisations in particular – this measure is still mistakenly understood by some on the left as merely a matter of personal choice: an enabler rather than a threat.
A disturbing trend
The Bill is part of an international trend in western capitalist countries. Over the last two decades in particular, legislation has been enacted in north America, most Australian states and parts of Europe. Some laws go back further. In Switzerland’s case legislation dates to 1941. In the first half of the twentieth century, across north America and western Europe, and until the genocidal crimes of the second world war became undeniable, eugenics thinking was unashamedly mainstream.
Grounds in current legislation vary – and show that whatever is misleadingly claimed by advocates of assisted suicide, experience internationally is that initial criteria widen over time. A prognosis of death within six months (a qualifier in the Leadbeater Bill as it stands – with such prognoses being, however, notoriously unreliable) is not a requirement in Canada, Switzerland, Spain, Italy, Austria, Belgium or the Netherlands; in Canada anti-discrimination arguments were successfully utilised to widen the Medical Assistance in Dying programme, initially introduced in 2016, to people without a terminal diagnosis in 2021.
Other criteria vary: in Switzerland, Belgium, the Netherlands and, from 2027, Canada, those with mental health issues qualify; in Belgium and the Netherlands children may be killed by this method. In Belgium the initial criteria in the 2002 law were widened in 2014 to include minors judged to have ‘capacity’ to decide.
Widening eligibility is the backdrop for rapidly rising deaths by euthanasia in Canada. In 2022 alone 13,241 died by this means.
Data from Health Canada, Chart from https://www.statista.com
Different jurisdictions also permit a greater or lesser level of active involvement by doctors or others in administering lethal treatment. In this respect the Leadbeater Bill is at the more extreme end as it would allow medical practitioners to suggest assisted suicide to a patient.
The Leadbetter Bill
The Bill proposes to make it lawful to provide medications to end the life of persons over 18. The current criteria in the Bill are that a person has to have a ‘progressive illness, disease or medical condition which cannot be reversed’ and their death ‘can reasonably be expected within 6 months’. As medical professionals opposed to the Bill have said, predicting a death within a period of 6 months is extremely difficult. Moreover, many disabled people live permanently or periodically close to death by this definition. During the debate it was claimed that eligibility could not subsequently be changed, but there is nothing to prevent a future parliament doing just that.
The Bill specifically states that ‘treatment which only relieves the symptoms’ is not to count against this definition. The Bill currently rules out people with ‘a mental disorder, within the meaning of the Mental Health Act’ and disabled people within the meaning of the Equality Act. Such words on paper are no match for hard reality. The Equality Act has not prevented disabled people finding Do Not Resuscitate orders placed on them in hospital, without consultation or agreement. It did not stop disabled people dying at 11 times the rate of non-disabled people as a result of Covid.
Through clause 4 of the Bill, a ‘medical practitioner’ would be enabled to suggest assisted suicide to the patient: by ‘exercising their professional judgement to decide if, and when, it is appropriate to discuss the matter with a person’. This is a profound change in the medical role and the implications of it are unknown to us all: doctors operate by the idea of ‘first do no harm’; they currently have to weigh the benefits of medical treatment against the risks. No longer if this Bill becomes law.
Medical professionals who are unwilling to process such a request would be required to refer on. Surveys show majorities of doctors in palliative care say they would refuse. The conflict between assisted dying and medical ethics, refusal by medical professionals and an obligation to refer may lead to, as it has elsewhere, to the emergence of a concentrated group of doctors who specialise in this area. Such specialisation opens the door to profound loss of empathy, the routinisation of killing and to more extreme abuse and malpractice,
The Bill states that two doctors must assess and approve the request and must be satisfied that the person ‘has not been coerced or pressured by any other person into making that’. How would they come to that determination? Coercion can be subtle and insidious. An impatient expression, a failure to provide reassurance, a remark about money worries can all be coercive, enhancing a vulnerable person’s sense that they are a problem. People living with life-limiting conditions and little support don’t need explicit pressure to assume they’re worthless and that’s what others must think: coercion doesn’t come simply via individual relationships, nor in a vacuum. Living in poverty, in isolation, denied decent health or palliative care, can all amount to coercion. As Diane Abbott put it, people may be afraid of being a burden or a drain on the family finances given the cost of care.
Coercion can also be blatant, of course: in one case reported in Canada a doctor told a mother that she was selfish for not considering assisted dying for her 17-year-old daughter who had cerebral palsy. Others report a bleak choice between assisted dying or abusive and dangerous ‘care’ services.
The vote
In a free vote, the Bill passed its Second Reading by 330 votes to 275, a majority of 55.
Of Labour MPs who voted, 61 per cent voted in favour: 234 for, 147 against. There were 18 with no recorded vote. The Labour Cabinet showed a similar split, with 15 voting for, eight against and one not voting.
For the Conservatives there was a reverse pattern with 23 voting for and 92 against.
The Liberal Democrat vote was also strongly in favour, with 61 for and 11 against, among whom was the leader, Ed Davey.
All four Green MPs voted for, while three of the four Plaid Cymru MPs vote for.
Among those who did not vote were the seven SNP MPs and 18 Labour MPs.
Those who voted against included 15 MPs sitting as Independents. All 15 voted against the Bill with the exception of John McDonnell MP who voted in favour. Jeremy Corbyn was prominent among those opposing. On the day of the vote he pointed out that choice required real alternatives to exist, which would mean reversing austerity and building decent palliative care and social care. Their lack, along with the lack of adequate safeguards against coercion, meant that ‘this legislation puts the poorest, the elderly and disabled people at risk of serious neglect and discrimination’.
Interestingly the London vote reversed the overall pattern, with a majority of London MPs voting against the Bill: only 28 of the 75 voted for. Of the 57 Labour MPs in London, 31 voted against, with 24 in favour and two not voting: a reversal of the overall Labour pattern. Two Labour MPs recorded no vote, Ellie Reeves MP and Gareth Thomas MP. Among the London MPs voting against the Leadbeater Bill were Diane Abbott and Bell Ribeiro-Addy, along with Jeremy Corbyn and Apsama Begum, voting as an Independents.
Raising awareness is key to stopping this dangerous proposal
In the run up to the Second Reading debate bourgeois media coverage was clearly biased in favour of introducing assisted suicide. Voices against were marginalised and often presented as coming solely from those of religious belief. The ‘right to die’ lobby was able to use its highly funded base to run an expensive advertising campaign. Perhaps the most grotesque example was adverts on the London underground (a site of many tragic suicides) promoting assisted suicide. Well-heeled, socially protected celebrities used their public platforms to advertise support. The fact that no disabled people’s organisation or disability charity supports assisted suicide was poorly reported – contrasting with the publicity given to a handful of disabled individuals who voiced support.
While pro-voluntary euthanasia advocates argue their proposals are no threat to disabled people, politically organised disabled people got the message across that disabled people’s lives are routinely considered not worth living. The campaign by Not Dead Yet UK bit by bit established a wider hearing and influenced the debate. The documentary Better Off Dead?, presented by actor and activist Liz Carr, heard from many disabled people how they’d be told by complete strangers that they ‘rather be dead’ than disabled. If you acquire a severe impairment, ending one’s life is commonly viewed as understandable. In a Guardian article, Liz Carr cited the example of a young rugby player who was paralysed by injury and took their life 18 months later: ‘the press and public reaction was: ‘Of course, it’s the right things to do. It’s difficult, but it’s the brave decision.’ A disabled young man wants to end his life and we don’t question that?’
This is the reality within which disabled people have to live. If assisted dying is a legal, socially approved medical option, obviously it is going to be a threat for people whose lives are viewed by others as pointless.
While the Bill stands as it stands is a threat to disabled people, there is also every reason to think its criteria would also be widened in time. Many of the cases publicised by the ‘right to die’ lobby are those of people who do not have a terminal illness.
Particularly at a time of massive income inequality and shrinking health, social care and other public services, making killing the patient a legal option is hugely dangerous. This is not abstract – it could not be more contextual. As Diane Abbott said, people might need support like access to hospice or end-of-life care, but it could be cheaper to get them to ‘sign on the dotted line for assisted suicide’. Not Dead Yet UK are continuing their campaign to stop this ‘unsafe and discriminatory’ Bill. They are ‘relying on you to continue to support disabled people and our fight for assistance to live, not assistance to die.’ Socialists should be unequivocal in supporting that demand.