Click here to read my full report on the assisted dying bill
The Terminally Ill Adults (End of Life) Bill 2024 introduced by Kim Leadbeater MP is an opportunity for a national conversation about how we want to treat those at the end of life and how we approach death and dying.
My personal view, based on 40 years’ experience as a practising physician, NHS consultant and specialist in medical ethics, is that this Bill is the wrong approach and that there is a better way to give individuals and their families dignity at the end of life.
The Leadbeater Bill would fundamentally change the societal relationship with the medical profession because it would allow a doctor to assist an informed competent, terminally ill adult to end their life through self-administration of lethal substances. For the first time we would be saying that act of assisting a suicide should be exempt from prosecution. ‘Assisted dying’ sounds positive, compassionate and uncontroversial, but we would be endorsing a long term change in the role of doctors in our society, from healers to active participants in ending their patient’s life.
Of course, we all want to be treated compassionately during and at the end of our lives. Those campaigning for this Bill believe it is the compassionate response to suffering – even though a person’s suffering is not a criteria for eligibility in this Bill, as it is in other jurisdictions. Campaigners say only those who want to will exercise the choice for an assisted suicide but, by definition, this ‘choice’ will only be available to those terminally ill with less than six months to live. If we want to argue that this Bill is needed to relieve suffering, there is a logical argument to extend the ‘choice’ under this Bill to others who are chronically sick, disabled or suffering with poor mental health.
Public polling suggests support for this legislation but most palliative care doctors, who are the experts in caring for people at the end of their lives, are against a change in the law. This Bill is being debated in the context of public policies to reduce suicides, defend the rights of those with disabilities and care for an aging population with increasing chronic needs who are concerned about being a burden to their families and the NHS/social care. If this Bill passes, we can expect to see the option of assisted suicide become a regular ‘treatment option’ in the NHS . We need to recognise that our choices are also governed by the wider environment we live in so the ‘choice’ to die will always be influenced by our circumstances and the explicit and implicit views of those around us. We cannot legislate for these subtle pressures.
There are also practical concerns about the implementation of this Bill from difficulties of determining prognosis, use of drugs not licensed or tested for this purpose, potential complications of ingesting lethal substances, negative impact on the medical profession, abuse by relatives and the potential for incremental change to make the Bill’s application much wider.
Based on the experience of other jurisdictions, we can expect to see what are originally defined as ‘safeguards’ becoming seen as ‘barriers to access’ and widening of the criteria beyond terminal illness through repeated court cases. In Canada, following repeated legal challenges, the law expanded in less than 5 years to cover individuals with other conditions whose death is not reasonably foreseeable and is due to be extended again to people with mental illness in the near future. Sadly, there are numerous reports of individuals choosing to die under the Canadian law because of inadequate social care.
It has been argued that there will always be cases that palliative care is powerless to assist. But this is highly misleading. Given the complex and multifaceted nature of suffering at the end of life, it is not possible for expert carers to fix all broken relationships, cure loneliness or solve existential angst. Palliative care is not a magic wand that fixes every problem, but in my personal clinical practice I have observed time and again that with expert care apparently intractable suffering can be ameliorated and controlled.
Indeed, the UK is an international leader in palliative care, which is effective at addressing physical, emotional, relational and existential suffering. However, palliative care requires a trained and skilled professional workforce, properly funded and resourced to care for the many individuals who die in uncontrollable pain and without adequate care. Palliative care represents a tiny fraction of total NHS spending. It surprises many that currently hospices receive only one third of their funding from the Government and rely on local fundraising to provide vital care to people.
If we wish to tackle suffering and distress at the end of life, our main priority should be to enable all terminally ill people in the UK to have access to high-quality and adequately resourced palliative care. Surely it is right to fix the funding crisis and make excellent care our overriding goal before we contemplate legalising medically assisted suicide.