A Weighty Reponsibility

Baroness Fox of Buckley delivered this speech in the House of Lords yesterday:

My Lords, as legislators, all sorts of laws pass through our hands—the good, the bad and the ugly. All are consequential for our fellow citizens, but rarely does a Bill weigh as heavily as this one. Wherever we stand, this law change could have a seismic impact on social attitudes to life, illness and death. Our task is formidable because of how many norms the Bill will overturn; I will mention a few.

The Bill unsettles centuries-old medical ethics. It rebrands assisting someone to die as a medical treatment, upending its understood meaning. The Bill rewrites the role of doctors. They will no longer be guided by the “Do no harm” ethos of preserving and protecting life; instead, the Bill mandates that they actively engage in taking a patient’s life by supplying lethal drugs that will kill them. The Bill especially shakes the foundations of society’s attitudes to suicide—and, yes, that is the accurate word; we know this because, at present, intentionally assisting someone to end their life is a criminal offence. So the Bill is forced to amend the Suicide Act 1961 to allow medical professionals to plan, prepare and assist in intentionally ending the lives of a particular group of citizens. 

My greatest dread is that this state licensing of suicide could unleash a regressive culture change. For decades, we have made concerted efforts to deter people from taking their own life; this was brilliantly documented last week by the noble Baroness, Lady May, and the noble Lord, Lord Jackson.

Now, I pause. Any of us who have known family or friends who have committed suicide know that it is gut-wrenchingly tragic; it brings an especially visceral, raw grief. This is compounded by guilt as loved ones endlessly soul-search, totally unfairly blaming themselves: “What more could we have done?” This is why, if we see someone about to jump from a bridge, even if they give us 100 objective reasons why their life is not worth living or even if they have only a few months to live, we do not just shrug and walk on—we cling on to them and plead, “Don’t do it. Don’t jump”. All this reflects our deep humanistic intuition that, when a person acts to end their life, it should be resisted with all the energy society can muster. What happens culturally, though, when the state shouts, “Jump”, or agrees with those who say that ending their life is a compassionate choice?

I worry especially about what message this sends to the young, who are already often nihilistic and prone to anxiety, self-harm and mental health problems. When we debated the censorious Online Safety Bill, those of us who raised its negative impact on free speech were metaphorically slapped down and hectored. The one indisputable reason for that law was to close down suicide sites—something echoed by the Prime Minister only yesterday. We had to protect the young from malign online suicide influencers, but I worry that this Bill is the legislative embodiment of a suicide influencer. What do we think will happen when we tell newly franchised teens that, in some instances, taking your own life equates to dying in dignity? Saying that it will be restricted to those with a terminal illness just will not wash with a generation immersed in the language of rights and entitlements: “Why not assist me when I am suffering so much? Why am I being discriminated against?”

That brings me to my final point. We have heard some fine speeches from supporters of the Bill, stressing the importance of autonomy and giving people control of their life. I usually champion such sentiments in a political sense, but not when they are used to justify the state having a role in ending human life—forgive my squeamishness. For those who state passionately, “My body, my life, my choice”, why back a Bill that limits that choice to the terminally ill? Surely logically that right should apply to anyone who wants to kill themselves. No doubt this logic will lead to demands to expand the law—God help us once human rights lawyers get involved. As I say, we have a weighty responsibility to ensure that such nightmarish unintended consequences do not become a reality.

Lord Shinkwin delivered this speech:

My Lords, it was a day much like any other when I was diagnosed. A busy day at the office was followed by a hospital appointment to find out why, within months, my face had, in effect, shut down on the left side. Nothing prepared me for what came next: an MRI scan showed that a succession of mini-strokes was killing me, and I had six months left to live. The only hope was neurosurgery.

I asked the neurosurgeon my odds on making a full recovery. Her reply was direct. She said, “I can’t give you odds on survival”. What she did not say was, “I can help you to die”. This Bill would fundamentally alter the conversation that a patient has with the doctor whom they trust to do no harm, as the noble Lord, Lord Truscott, and others have highlighted.

Notwithstanding an excruciating and painful long recovery, the surgery was a success, although I have to speak slowly to be understood, and I am grateful for noble Lords’ patience and understanding. Ironically, my shock then and my shock subsequently at becoming, 20 years later, a Member of your Lordships’ House have something in common: they were both unforeseen.

That brings me to some wise words from Hansard on 12 March 2007:

“Our role in scrutiny is vital … we are a legislative Chamber … There will no doubt be … unforeseen consequences, but they would all need to be considered”.—[Official Report, 12/3/07; cols. 451-56.]

I thank the noble and learned Lord, Lord Falconer of Thoroton, as the words are his. It is indeed our duty to scrutinise the Bill and consider all its unforeseen consequences, for they are legion.

I wonder whether we have any idea of the Pandora’s box that the Bill will prise open. Many noble Lords have referred to jurisdictions where assisted dying has already been introduced. The precedents that those jurisdictions provide clearly show the chain of events that the Bill would set off, not just for disabled people but for older people, young people with mental health issues, and young women with eating disorders. It is the stuff of nightmares.

My noble friend Lady May of Maidenhead told us how her friend referred to the Bill as a “licence to kill Bill”. She is right: it gives the state a licence to kill the wrong type of people. I am the wrong type. As the noble and learned Lord, Lord Falconer, pointed out in his speech, there are savings to be made should assisted dying be introduced. This Bill effectively puts a price on my head. Indeed, should it become law and precedents set elsewhere apply in the UK over time, I face the realistic possibility, as a severely disabled person, of being killed as a result of legislation passed by this House. As my noble friend Lord Harper reminded us, no organisation of or for disabled people supports the Bill.

I close with a plea that we do not allow anything to deter us from doing our duty and subjecting this Bill, with all its unforeseen and irreversible consequences, to the scrutiny it not only deserves but so desperately needs. I support the Motion in the name of the noble Baroness, Lady Berger

And recovering from spinal injuries, this is the speech that Lord Alton of Liverpool would have delivered this speech:

It is worth acknowledging at the outset that the issue Parliament is considering is not a new one. Euthanasia of the weak was practised in the ancient world but was rejected as we became more civilised and recognised the equal and inherent worth of each person, regardless of ability or disability, age or capacity. It was also practised in the mid-twentieth century in the name of eugenics.

But, of course, a practice cannot be dismissed simply because of the bad company it keeps. Assisted suicide or euthanasia — a difference without a distinction in many ways — has been reintroduced in a small number of countries in recent decades, and we can look at these jurisdictions to observe what has happened and inform our deliberations in the House of Lords.

And what we can observe from these jurisdictions is a pattern of creeping incrementalism, away from their original supposedly tight eligibility restrictions, and laws which put vulnerable people at risk.

In introducing the assisted suicide Bill at Second Reading, Lord Falconer suggested that assisted suicide laws which have started as terminal illness-only laws have remained that way. However, this is misleading.

Where assisted suicide has been legalised, however tight the initial safeguards and however sincere the assurances that it would be a narrowly defined law for rare cases, the practice has tended rapidly to expand.

Sometimes this is by a clear expansion of the law, such as in the Netherlands and Belgium where assisted deaths are now permitted for children of all ages and have been granted for tinnitus, autism and dementia; or in Canada where it only took five years from the introduction of euthanasia and assisted suicide in 2016 for those whose death was “reasonably foreseeable” — in other words, who were terminally ill — to an expansion to the ill-defined and subjective “serious and incurable illness” criteria in 2021. And Canada has now not only approved the euphemistically-named “Medical Assistance in Dying” for people with mental illness from 2027, but there is also a push to join the Netherlands in allowing infant euthanasia for severely disabled babies. This is not progressive but regressive, a return to pre-civilisation.

In other jurisdictions, the law has expanded by stealth, by the interpretation of “terminal illness” being broadened. For example, in Oregon in the US, a state held up as a model for the law proposed here, people have been approved for assisted deaths with diabetes, arthritis, a hernia and, perhaps most disturbingly, anorexia.

Even if we were to permit assisted suicide with an initially narrow scope, there is a danger of human rights challenges whereby courts rule it is discriminatory to allow assisted suicide for some groups of people but not others, similar to what happened in Canada. Once you permit the practice, you cross a moral and legal Rubicon and it is hard to control the consequences as different groups demand “access” to the same provision. Even last week in the House of Lords, one of my colleagues expressed support for a wider law.

The countries I have cited are not rogue states. In many ways, they are like ours. And yet they have not been able to prevent a rapid expansion in the law or increase in the number of people who die under laws that are sold as being for exceptional cases. In Canada, in 2023, nearly 5 per cent of all deaths were from euthanasia or assisted suicide — over 15,000 people in a country with a population smaller than ours. This is a warning to us.

Other countries have learned these lessons. In Denmark, in 2023 the Council on Ethics looked at this issue and concluded, by a majority of 16 to one, that it was “in principle impossible to establish proper regulation of euthanasia” and recommended to the Danish Parliament that the law should not be changed. We should heed their warnings.

Indeed, during its inquiry into assisted suicide two years ago, Dr Lydia Dugdale, Director at the Centre for Clinical Medical Ethics at Columbia University, warned the Health and Social Care Select Committee that “As soon as [assisted suicide] is legalised it expands. The language shifts; it goes from ‘guardrails’ to ‘lack of access’. That is very pernicious. Guardrails are there to protect society more broadly and to keep us from becoming a death-inducing state”.

In light of what we have seen elsewhere, I contend the only safe approach is to keep the current prohibition on assisted suicide, while investing in improved palliative care to support the thankfully very rare cases of people who suffer greatly at the end of life.

I note that the House of Lords Constitution Committee has joined the Hansard Society in confirming that the House of Lords has every right constitutionally to reject this legislation if it believes, as I do, that it would endanger vulnerable people, whether those who may face subtle, often undetectable coercion, such as the victims of domestic abuse or people with Down’s syndrome, or the “self-coercion” of those who feel a burden and will think they have a duty to die if a so-called “right to die” is introduced.

In summary, Pandora’s Box has been opened in countries where assisted suicide or euthanasia have been legalised, and the sad consequences are plain for all to see. Once Pandora’s Box has been opened, there is no going back. We must not proceed along this path if we have any doubt about the consequences.

According to Greek mythology, when Pandora opened her box and unleashed all kinds of ills on humanity, she closed the box before the last thing was able to escape — that thing was hope. Hope is what we need to offer people instead. Assisted suicide is chosen by people who have lost hope — who lack any reason to go on living. Passing this Bill would send a tragic message that sometimes there is no hope and some lives are no longer worth living.

But it does not have to be this way. By investing in social care, by continuing to be a world leader in palliative care and expanding access to it, by being a society that respects life and upholds the dignity of the elderly and people with disabilities, we can give hope to the hopeless and create a society where people can die with true dignity, not by ending their own lives. That is the kind of society we ought to be striving for.