If you live in the UK, you could not possibly escape the discussion about the ‘Assisted Dying Bill’ which passed yesterday’s vote in the House of Commons (MPs have voted by 330 to 275 in favour of legalising voluntary assisted suicide). Once the bill passed all the further parliamentary hurdles – which might take several years – it will allow terminally ill adults who are
- expected to die within six months,
- of sound mind and capable of managing their own affairs
to seek help from specialised doctors to end their own life.
After listening to many debates about the bill, I still I have serious concerns about it. Here are just a few:
- Palliative care in the UK is often very poor. It was argued that the bill will be an incentive to improve it. But what, if this is wishful thinking? What if palliative care deteriorates to a point where it becomes an incentive to suicide? What if the bill should even turn out to be a reason for not directing maximum efforts towards improving palliative care?
- How sure can we be that an individual patient is going to die within the next six months? Lawmakers might believe that predicting the time someone has left to live is a more or less exact science. Doctors (should) know that it is not.
- How certain can we be that a patient is of sound mind and capable of managing their own affairs? By definition, we are dealing with very ill patients whose mind might be clouded, for example, by the effects of drugs or pain or both. Lawmakers might think that it is clear-cut to establish whether an individual patient is compos mentis, but doctors know that this is often not the case.
- In many religions, suicide is a sin. I am not a religious person, but many of the MPs who voted for the bill are or pretend to be. Passing a law that enables members of the public to commit what in the eyes of many lawmakers must be a deadly sin seems problematic.
In summary, I feel the ‘Assisted Dying Bill’ is a mistake for today; it might even be a very grave mistake for a future time, if we have a government that is irresponsible, neglects palliative care even more than we do today and views the bill as an opportunity to reduce our expenditure on pensions.
21 Responses to The UK ‘Assisted Dying Bill’: reasons for concern?
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I agree. The 6 months expectation of life is a random number with no clinical significance merely related to the rotation of the planet. Furthermore there is a reductio ad absurdum. This is a true example. 5 years ago I went with a dear friend suffering with backache who was diagnosed with inoperable pancreatic cancer. The median (not average) expectation of was 10 months. Do I ask him to come back in 4 months before I give him the lethal dose? In fact he lived for 4 years and died in comfort and dignity in a home for terminal patients.
thank you!
It gets worse as you think about it. Who are these two doctors. Your GPs? They may not share your ideology.
ergo -in no time you’ll have a specialist list of “death doctors”. Will they be reimbursed for their time or will they only be available in the private sector? How do we learn if there was coercion? Is that for the judge or do we have to employ private detectives to see what’s in the client’s will.
I agree
It is very interesting, I’ve been watching these arguments, in the hope that there might be help when I need it, for the last 5 decades.
I know now I’m going to have to do the deed myself, and early. I have the means hidden away, even if it is not a particularly easy way to go.
Afternoon bingo in a care home, followed by bedsores, total boredom and a slow death in a hospice even if pain free, don’t really appeal. I have sat at bedsides in both, watching loved ones die. It’s not a lovely time of “saying your goodbyes” it’s days of it all dragging and dragging uncomfortably, waiting for the end to finally come, like that uncomfortable waiting for the train to actually move after you’ve waved goodbye, watching each breath, startling at rattles, watching them sometimes suck desperately at those horrid little sponges, being told it’s a waste of time putting hypromellose drops in eyes which were so dry they were stuck half open.
I do not ever want to be imprisoned in one, at the mercy of strangers who do not know me as anything other than a. n. other body to deal with until it ceases to need dealt with and the next comes along to replace it. All doomed to being treated according to the duly performed procedures as just another object on a production line, no different to the last or the next.
I want my cat on my lap, I want to be surrounded by my art collection, and my closest people, to eat only my own kind of home-made from scratch food and I want entertained with obscure operas, not bingo and countdown. My fellow inmates might not appreciate my tastes.
The hoops and hurdles you have to go through to qualify for assistance are too great to consider bearing, I don’t want to deal with official forms and strangers, I really do not want to have to argue with people who refuse to believe me. I’m too ill to cope with it and too old to care what they think.
I’m going to have to do it without telling anybody in case somebody stops me or finds me too soon.
So somebody is going to have to find my body and it’s going to be a shock.
The catch-22 is still incorporated. The notion that somebody wants to die can still be used to declare them mentally unfit to make that decision.
There are conditions which are far worse than the sweet oblivion of death. It must be really lovely to be so ignorant of what long-term suffering can be.
I must disagree with those above who are opposed to the assisted dying UK bill.
Giving patients autonomy over their own lives is entirely justified. To do otherwise is illiberal and, overall, will lead to a great deal of unnecessary suffering.
Medically assisted dying has been available for years in various jurisdictions including the Netherlands, Switzerland and Oregon.
A recent article in the Bioethics journal analysed whether nations that permit medically assisted dying have poorer palliative care services; the answer being a clear ‘no’.
Dear Edzard. I recently co-authored a paper about people who travel from Britain to Switzerland for an assisted suicide [1] I’ve been an observer at five of them and had access to numerous files, including one for an experienced palliative care specialist with a particularly nasty cancer. Switzerland has allowed AS for over 80 years and is hardly a byword for uncaring attitudes or the coercion of the elderly. A terminal diagnosis is not necessary but the figures are still not more than about 2% of deaths. Suicide was not regarded as a sin in early Christianity. It only became a sin – and the most serious one, worse even than murder – after St Augustine (a classic reformed libertine) said that it should be around 400 AD. if you are not religious, I’m not sure why you call it a sin. I gather Frederick the Great decriminalised it in Prussia in the 18th century.
The best evidence of sound mind and settled disposition is that nearly all the Swiss-bound patients had carefully thought about human mortality (churches used to encourage that) and how they would prefer to die long before illness struck. Their decision to seek AS was never hurried unless they had very rapidly progressive cancers of recent onset. The failed suicides I saw as a psychiatrist were usually impulsive and the patient had often been drunk at the time. After they woke up, most, but not all, were pleased to have survived. Swiss AS is the polar opposite of impulsive and most patients die smiling, many of them in the presence of family members and accompanied by their favourite music. They definitely don’t want to stay alive any longer. Nearly all say they have had good lives and don’t want them to end with horrible deaths. In Australia, most applications come from patients already receiving palliative care.
1. Brewer C, Hopwood MC, Winyard G. Assisted deaths in Switzerland for UK residents: diagnoses and their implications for palliative medicine and assisted dying legislation. BMJ Support Palliat Care. 2024 Feb 23:spcare-2023-004719. doi: 10.1136/spcare-2023-004719.
You are right, Colin: I did mis-phrase this sentence, ” Passing a law that enables members of the public to commit a deadly sin is problematic”
Therefore, I have now changed it to ” Passing a law that enables members of the public to commit what in the eyes of many lawmakers must be a deadly sin is problematic”
Thanks
I watched this documentary when it aired in 2012:
https://www.standard.co.uk/hp/front/bbc-documentary-labelled-suicide-propaganda-as-channel-screens-hoteliers-death-6410633.html
https://www.bbc.co.uk/webarchive/https%3A%2F%2Fwww.bbc.co.uk%2Fblogs%2Ftv%2F2011%2F06%2Fchoosing-to-die.shtml
It was moving and upsetting. It featured two individuals who had chosen to die at Dignitas; Mr Smedley, with Motor Neurone Disease (ALS), and another gentleman, with MS. The camera crew were very downbeat at the end of it. Mr Smedley went into the clinic walking and talking, then died. He was shown taking medicine to prevent emesis and then, twenty minutes later, the barbiturates (it wasn’t said on the programme what the fatal substance was). It somehow seemed cold-blooded to me, to take beforehand a medicine to prevent the body’s natural effort to stay alive by vomiting out the poison. Mr Smedley died with his wife holding his hand, but his head clasped to the bosom of the doctor who gave him the poison to drink.
The point was made that the two individuals had to be still well enough to travel to Switzerland and to take the medicine without assistance.
As far as I have understood the position of the law in Britain up to now, it allows for Doctors to give to patients who are clearly at the end stage of life, enough strong medication to provide comfort, even if as a SECONDARY effect, the dying process is shortened. The PRIMARY intended effect MUST be palliation/relief, not death. I recognise that these can be subtle matters of medical judgement.
Assisted dying and better palliative care are not mutually exclusive (my kid sister spent the latter part of her nursing career in palliative care).
Patient autonomy must be recognised and I object strongly to someone else’s religious views on “sin” being allowed to over-ride my autonomy (bear in mind we are not talking about actual crime here, a different matter altogether).
Personally, I don’t think the proposed legislation goes far enough. It certainly doesn’t cover the likes of me with an incurable, life-changing and life-limiting combination of problems, which are only going to get worse and reduce my quality of life even further.
In addition to improving palliative care, the NHS needs to pay a lot more attention to QoL issues, as I could not get anyone one in the relevant service to talk aabout this, to the point that they were suggesting things interesting to them as medics which would only worsen my QoL.
Whose life is it anyway?
The most progressive ruling on physician-assisted suicide was probably issued by the German Federal Constitutional Court (Bundesverfassungsgericht) in 2020. Its core sentences are:
– Human self-determination includes the right to self-determined death.
– The right to self-determined death includes the freedom to take one’s own life.
– The freedom to take one’s own life also includes the freedom to seek help from third parties.
– The right to self-determined death, as an expression of personal freedom, is not limited to serious or incurable illnesses or certain phases of life and illness.
Unfortunately, not only the churches, but also politicians and medical associations in Germany are fighting with all means to obstruct and circumvent this ruling. People who want to die still have no recognized right to receive the necessary medication. No medical association gives them the addresses of doctors who are willing to assist in a self-determined suicide. That is why many people who are afraid of rotting away in a nursing home in the last phase of their life still see the only way out in a violent suicide – a suicide that often burdens those who ultimately find the disfigured corpse for the rest of their lives.
“rotting away in a nursing home in the last phase of their life” means poor palliative care; would it not be better to improve it such that suicide is no longer desirable?
For some people who are bedridden in a nursing home, it may be important whether the nursing staff are friendly or unfriendly, competent or incompetent. For others who have always lived an independent life, the idea of not only being fed by strangers for years, but ultimately needing strangers’ help even to turn over in bed is unbearable. Anyone who can imagine living under the control of others for years should be provided with better palliative care. Anyone who does not want that should have the right to die at a time of their own choosing and in a way that does not burden other people.
Bolding mine.
Many politicians would use the same rational to vote against abortion access, care for trans folks etc. Therefore, I don’t think any politician in a secular democracy should be voting one way or another based on religion.
I understand that there are issues with palliative care in the UK, but I think terminally ill patients should have the option of assisted dying along with the option of palliative care. It should be left up to the patient and their family to decide which option they would like to go with, with the help of their doctor and/or psychologist.
Unquestionably the filter to get to a decision to have one’s own life taken away needs to be strong. However, it should not be denied. Having lost a Grand Father, Father, Mother & Uncle suffering & within weeks of dying & all saying the same phrase “you would not keep a dog alive under these conditions!” All died in hospital after 1-3 weeks, presumably at very significant cost, suffering to many & at a time when the NHS was & is struggling. If the will of the people is that >2/3 want this bill passed & presumably a primary objective for MPs is to reflect the will of the people & not their own wills or religion, surely this bill should be passed with caveats. In the case of all my relations aforementioned, they were terminally ill & everyone knew what was coming, including the doctors, it would have saved alot of suffering & cost. In the UK we seem to have moved increasingly towards a society that is guided by supposed intelligent individuals knowing what is best for the electorate & the BBC is a great reflection of this. Editors, Commissioners & Presenters with little to no accountability controlling what we see & hear under their or the Boards definition of “Impartiality” & a Live TV Tax to enforce. Surely the bottom line is about choice & the will of the people is considered rather than supposed intelligent people reflecting that the electorate do not know what is best for them. Is some of this not reflected in the recent US election & recent polls reflecting the vast majority of the US Electorate supportive of their way forward?
So what happens when “the will of the people” is to euthanize everyone over the age of 75 to save the “very significant cost”?
There is a clear, very distinct difference, and such conflating is known a False Equivalency; a ploy used by the ignorant and irrational trying to be clever.
One is voluntary, you know when someone decides their own fate (I can’t believe this level is necessary but there are all types), while your nonsense (apart from being plucked out of your arse) would be forced by legislation.
Do I have to use a glove puppet for any further explanation?
Yikes… you make a scary speculation. It could be the first step to a slippery slope. For the sake of those who prefer to end it all with dignity, let’s hope sane safeguards can be adopted.
Slippery slope indeed. The figures for Canada, Belgium and Holland are bloody terrifying. People with mental illness are being euthanased. 5% of deaths are via the state.
California seems to be doing it more sensibly. Might be a model to study.
Well, the mentally ill already have less rights that the rest of the population. Many are not given driving licenses, others do not have control over finances. In places where gun ownership is legal… not so for them, and that all makes good sense. However, the right to make a decision to end life should not be restricted for the mentally ill in my view. I’m speaking as the father of a son of 39 years and with schizophrenia for 19 years, so please don’t attempt to school me. They should be free to choose for themselves, but by no means euthanized.
Having posted about a Grand Father’s painful & drawn out death along with Father & Mother over weeks & nothing like 6 months, we have people talking about the mentally ill, disabled, tax avoiders as well as someone raising the issue if the will of the people is to euthanize the over 75’s. I really like the tone of Frank Collins reply & whilst I am not smart enough to have heard of “False Equivalency” I will be using it a lot from now. What are these people on. All the deaths I alluded to were terminal for weeks not months & I was involved with all of them being upset about their predicament & helping 2 take water via a small sponge on a stick! All the medical staff knew what was coming within a month. Fortunately, I believe in science so happily & logically not religious. Anyone religious or not who believes that the aforementioned should have been kept alive until the bitter end (which is what it was) then in the words of Frank Collins above, they must be ignorant & irrational & one can add to that have no feeling.