By Angela Craig
Evidence shows that the more that informed discussion takes place on assisted suicide, the more that people oppose legalising it. This goes some way to explaining how assisted suicide Bills now in Westminster and the Scottish parliament are being handled. Rather than informed and wide-ranging discussion, these are marked by skewed representation, a witness list that lacks balance and breadth, and inadequate time and scrutiny.
The period before the Second Reading of Kim Leadbetter’s Private Member’s Bill in November 2024 saw the case in favour of assisted suicide legalisation supported by powerful media outlets and a highly funded pro-dying campaign – with enough money, for example, to fund large-scale advertising on the London underground. This campaign was low on facts and heavy on emotion. It was highly influential.
Those opposing the change lacked similar resources. Their opposition was routinely caricatured as restricted to those of religious belief. As the Second Reading debate approached the scale and complexity of opposition become more evident. The voices of disabled people, palliative care medics, psychiatrists and equality campaigners started to break through. This was evident on the day of the debate, which saw more opposition and expressions of concern than anticipated. From a total vote of 330 for to 275 against, 30 MPs – enough to change the result – though voting for, reportedly did so to allow discussion, uncommitted to supporting the Bill at a future stage.
Skewing the process
In Scotland, similar draft legislation is being discussed in parliamentary committee. Research in Scotland has confirmed that when people are simply asked their general view they tended to support legalisation, but that this is reversed if questions are more informed and detailed. Despite this, the Glasgow Disability Alliance described an atmosphere of fait accompli in the committee discussing the Bill. The committee and witnesses being called, they say, are biased towards support for the legislation: ‘Of the 10 MSPs who sit on the Holyrood Committee, seven signed in support of the Bill when it was proposed’ and ‘a disproportionate number of witnesses called to give evidence are similarly supportive’.
So it is with the Westminster committee discussing Kim Leadbetter’s ‘Terminally Ill Adults (End of Life) Bill’. This fundamental change in law, which would impact on different classes and social groups unequally, is proposed while health services, social care and support for independent living are all starved of funding. Life expectancy has started to fall, particularly for the poorest women, and the gap between life expectancy for rich and poor is widening. Contrary to what is often claimed, this trend predates and is not simply attributable to Covid.
Particularly in this context, legalising assisted suicide threatens profound implications for disabled people, older people, poorer women, minority communities, medical ethics and the doctor-patient relationship, end of life care and much more. Yet it has been introduced via a Private Members’ Bill. This vehicle gives strong powers to the mover of the Bill to choose the committee’s membership, limits the input of parliamentary staff to scrutinise written evidence and involves a rushed timescale: only three days were allotted to hearing oral evidence.
The composition of this committee gives a more generous representation to those who voted for at the Second Reading than their share of the vote on the day. While the government continues to claim a neutral stance, two government ministers are on the committee, both of whom voted for at Second Reading.
At the start of proceedings the committee had to agree what witnesses it would call. Against objections, it was decided to have this discussion in private, with eight members voting against this, and 14 in favour.
The list of witnesses that emerged from this private session included no Disabled People’s Organisations, eight representatives from countries where assisted suicide was legal all of whom supported those laws, and nine lawyers but none against the proposal. Amendments to remedy these omissions and also add representation from the Royal College of Psychiatrists and equality law experts were defeated.
Following a backlash, Kim Leadbetter later moved to accept representation from the Royal College of Psychiatrists along with one Disabled People’s Organisation (DPO), Disability Rights UK. Other DPOs remained excluded. A range of other organisations were proposed. Diane Abbott MP (who is not on the committee) proposed representation from organisations tackling domestic abuse and elder abuse. As the period allotted to hearing oral evidence has now closed, unless it is reopened, none of these and other important voices will be heard.
Demonstrating the evidence that an inclusive range of witnesses may bring, the representative of the Association for Palliative Medicine said that, in polls over the last 10 years, 80 per cent of their membership opposed the legalisation of assisted dying while only five per cent were in favour. They further reported that 43 per cent of palliative care staff say that if assisted dying was implemented in their organisation they would leave. Exactly the kind of details the pro-dying lobby want to ignore in their fear-fuelled focus on the so-called popularity of their position.
Amendments
A large number of amendments to the Bill have been tabled.
Key among them is Leadbetter’s proposal to dispense with scrutiny by a High Court judge – the supposed gold standard safeguarding measure argued by the Bill’s advocate hitherto – and instead have a three person panel.
Another amendment, tabled by Sarah Olney MP who voted against the Bill, seeks to close what has been dubbed the ‘anorexia loophole’. Although the Bill’s proponents say mental health alone would not qualify a person for assisted suicide, the Royal College of Psychiatrists disagrees. The concept of ‘capacity’ in the Bill could, they say, enable people with mental health conditions to an assisted suicide. Emotionally rooted conditions such as anorexia, they point out, may have physical effects that could meet the definition of a terminal physical illness, even though the underlying emotional cause is treatable. Such a person may meet the decision-making ‘capacity’ threshold. In their written evidence they say: ‘People at the end of life deserve high-quality psychiatric treatment. A wish to hasten death is strongly associated with depression.’ Instead, legislative creep in other countries which have legalised assisted suicide means that mental health conditions qualify as grounds in themselves.
Concerns have also been raised about parts of Bill that would give sweeping delegated powers to the Secretary of State in ways that could determine the provision and shape of an effective death service within the NHS.
As the Bill has been hitched to a very tight timescale – with the aim that it is ready for its next voting stage by late April – it is entirely possible that these and other amendments will not have the time and depth of scrutiny and discussion they deserve.
Disabled people say Bill unamendable and must be scrapped
The claim by the pro-assisted dying lobby of a neat distinction between people with ‘terminal illness’ who have six months to live and ‘disabled people’ was rebutted in the evidence of Miro Griffiths, an academic and disabled person. He pointed out that a person with a terminal illness is likely to be a disabled person as that is legally defined in the Equality Act. As to six months to live, many disabled people might meet this criterion, especially if they do not have adequate assistance, and also be viewed as doing so by an ableist society. Griffiths said: ‘If I remove the ventilator that I use at night, if I remove my other medical devices and if I stop my engagement with therapeutic services, does that constitute me having a terminal illness, because my rapid acceleration towards death becomes more evident?’
Fazilet Hadi from Disability Rights UK, the one DPO reluctantly invited to give oral evidence, echoed this view. She said: ‘This bill will go into the real world and that’s what’s happening in the real world – people aren’t getting social care, they aren’t getting palliative care, they are dying earlier.’ Hadi called for the Bill to be scrapped. She said ‘I can’t suggest any way in which this bill could be strengthened, and that’s because it’s the society it will land in is the thing that needs to change, not the bill, and at the moment there’s very little likelihood of that society becoming more equal, having better public services, having less health inequality, in the next few years.’
Socialists should wholeheartedly support this call. These dangerous proposals should be scrapped.