Confront The Contradictions

Lucy Thomas writes:

MPs who backed the assisted dying bill acted out of compassion, hoping to relieve suffering and expand choice. As someone who cares for people at the end of life, I share these goals. Yet, as a doctor expected to implement this law, I see how its contradictory logic will undermine both choice and care. As the bill moves to the Lords, peers must look beyond good intentions and confront the contradictions at its core.

The bill promises “the ultimate freedom” – the right to choose how and when we die. Yet this “right” is limited to people who meet an arbitrary life expectancy threshold. The bill frames assisted death as healthcare, but discards clinical standards in the name of autonomy. Caught between a personal right and a clinical procedure, it offers neither the protections of medicine nor the freedom of choice.

The problems begin with the bill’s eligibility criteria, which serve neither of its stated aims. Unlike most assisted dying laws, it contains no requirement that someone be suffering – let alone that their suffering cannot be relieved. Nor is autonomy the guiding principle. Rather than a free choice, access depends on a doctor’s “reasonable expectation” that someone has six months or less to live – a threshold that is arbitrary, highly unreliable and lacks clinical or ethical justification.

By basing eligibility on life expectancy, not suffering or personal choice, the bill offers assisted death to terminally ill patients who need not be suffering, but denies it to those living longer with prolonged intractable distress. Patients often tell me they feel “abandoned”, or “cast on the scrap heap”, after receiving a terminal diagnosis. The bill confirms what many already fear – that once deemed “terminal”, their lives are devalued – and enshrines that into law.

Once any doctor estimates you’re in your last six months, the consequences are profound. They can raise the option – suggesting you consider ending your life, even if you’d never thought of doing so. However well-intentioned, this can feel like pressure. Yet those same doctors can certify your “choice” was freely made. Meanwhile, assisted death is guaranteed state funding – but palliative care and social support are not.

This isn’t “the right to choose when to die”. It’s the state deciding when ending life is acceptable, promoted and prioritised over care. Yet autonomy is invoked to justify removing protections. Far from “the strongest safeguards in the world”, the bill omits basic ones found elsewhere – like requiring irremediable suffering or prohibiting doctors from raising it unprompted. Even an amendment requiring doctors to explore why someone wants to die was voted down as “none of your business.” The first step in medical care – understanding a patient’s needs – dismissed as unwarranted intrusion. All to preserve the appearance of choice.

In practice, rather than gaining a new right, terminally ill patients lose the care and protections everyone else receives. If a person is considered to have less than six months to live, them saying they want to end their life won’t trigger the usual healthcare response – even though suicidal thoughts are just as common and just as treatable in the terminally ill as in anyone else. Any desire to die is deemed a “choice”, regardless of the needs that lie beneath it.

One Commons exchange laid bare what this means in practice. Pressed on whether a doctor could assist someone to die solely to save their family money, bill sponsor Kim Leadbeater called even this “a question of autonomy, dignity and choice for patients.” Life-ending decisions, even if they are driven by poverty or fear of burdening others, would need to be treated as straightforward personal choices. Social and economic hardship would become acceptable grounds for state-sanctioned, doctor-facilitated death.

Leadbeater says such scenarios would be “very unusual”. International data shows otherwise: feeling like a burden is among the most common reasons for medically assisted death worldwide – reported in up to 59 per cent of cases – exceeding the pain or physical suffering this bill claims to address.

Canada – with nearly a decade’s experience framing assisted death as both a personal right and a state-sanctioned medical procedure – shows where this logic leads. Under legal challenge, restricting this “right” to those near end of life was ruled discriminatory. Now, increasing numbers of disabled and chronically ill people, disproportionately from marginalised communities, are “choosing” death amid poverty, housing insecurity and social isolation. This bill’s supporters say that could never happen here.

The same assurances were given in Canada, yet the same contradictory logic made it inevitable.

Switzerland provides a striking contrast. There, assisting a suicide has been decriminalised, but not legalised as a medical intervention: it is a “legally permissible activity”, but not one sanctioned by the state. Their unregulated approach is far from a model to follow. Yet there is one important lesson: by not medicalising assisted death or singling out certain patients as “eligible”, Switzerland avoids pressuring those patients to consider ending their lives or compromising their medical care.

Some argue that any assisted dying law is better than nothing, that problems can be ironed out later. But different approaches reflect profoundly different aims and values. Any UK law must, therefore, be clear about its true purpose: is it a last-resort response to suffering that cannot otherwise be relieved, or is it the creation of a “right to choose how and when to die”? Each requires a very different kind of law, with far-reaching consequences for the type of society we would become.

Supporters warn any delay will increase “suffering, suicides and trips to Switzerland”. The evidence does not support this. Most of the 50 or so British residents who end their lives in Switzerland each year wouldn’t qualify under this bill. In countries with similar laws, suicide rates haven’t improved – and in some they have worsened. Meanwhile, every year an estimated 118,000 dying patients lack the palliative care they need – the most urgent issue to address if we’re serious about reducing suffering at end of life.

The real risk is not delay, but passing a law that singles out the very patients whose care is so neglected and presenting them with the “choice” to end their lives. It would subject them to pressures no patient should ever face and enshrine discriminatory treatment of the terminally ill at the heart of our healthcare system.

Peers must ensure this complex issue finally receives the rigorous, independent scrutiny it has lacked. A parliamentary commission could be established to develop legislation that is clear in purpose, ethically coherent, and grounded in the needs of those most affected. This is the last chance to get it right, before a law that undermines both choice and care is imposed on those least able to navigate its harms.

And Simon O'Connor writes:

I strongly encourage British parliamentarians to look at what has happened in New Zealand since the introduction of assisted dying.

Ahead of the introduction of assisted suicide and euthanasia in New Zealand in 2021, I chaired the New Zealand Health Committee, which undertook an inquiry into assisted suicide and euthanasia, and the similarities between the debate in the UK now and the one that took place in New Zealand then are striking.

First, just as the UK assisted suicide bill sponsor Kim Leadbeater and her allies argued, there is, or will be, no "slippery slope" when it comes to the expansion of legislation, so too, we in New Zealand were promised that the eligibility criteria would be strict and that the argument was a “fallacy”. The laws have been in place in my home country for less than four years, but I have already seen that slope in action.

Most significantly, a new members’ bill has recently been lodged in our parliament that would remove the requirement that a person is likely to die within six months. Instead, in a change which could have been inspired by the Canadian model, a New Zealander who "experiences unbearable suffering" with "a condition that is advanced [and] progressive" and "is expected to cause death", will be eligible for state-assisted suicide or euthanasia. It also proposes to limit conscience rights, force hospices to allow euthanasia on their premises, and propose more targeted promotion to reluctant indigenous groups.

These renewed efforts make clear that far from remaining tightly controlled as advocates once promised, the law is already being pushed in a more permissive direction.

Second, while the proposed legislation in England and Wales probably resembles the law in Oregon most closely, Leadbeater and supporters have seemingly stopped referring to the Oregon law entirely and didn’t invite oral evidence from any Oregon-based witnesses. Perhaps this was because inconvenient facts emerged from the law in Oregon, such as people with anorexia qualifying for the scheme and a high proportion of those opting for assisted suicide citing feeling like a "burden” as a motivating factor. The same dynamics happened here in New Zealand – the moment inconvenient statistics or examples came from other jurisdictions was the moment proponents stopped discussing their previous ‘gold standard’.

As a consequence of all of this, Leadbeater seemed to gravitate towards focusing on Australian models of assisted suicide/euthanasia. While the models used in the Australian states differ from the one proposed in the UK, a key advantage for advocates is that the laws have not been established for very long, resulting in limited data available for analysis. Therefore, it is more difficult to draw conclusions or examine where things may go wrong.

Third, the "End of Life Review Committee" in New Zealand, and the proposed "assisted dying review panels" in England and Wales are also very similar. In New Zealand, this committee was meant to be a key safeguard. Three experts sit on this committee, each with a two-year term that can be renewed. Two must be health practitioners, and one a medical ethicist. Its role is to review reports of deaths that have resulted from assisted suicide/euthanasia and, in particular, to scrutinise complex cases where something may have gone wrong.

Has this committee been the reliable safeguard it was sold to be? Hardly. In fact, developments since its establishment have been deeply concerning.

When it comes to the inaugural committee, one resigned (Dr Dana Wensley) due to her concerns regarding serious problems with the committee's ability to oversee the implementation of assisted suicide and euthanasia, and another (Dr Jane Greville) was pushed out, it is thought, because she was raising too many concerns about the operation of the new law.

Both Dr Greville and Dr Wensley went public and stated that the committee’s oversight of the law was so limited that wrongful deaths could go undetected. They cited being “extremely concerned” about how little information they received relating to patient deaths, leading to them feeling “constrained to the point of irrelevance”. This ought to serve as a warning to British parliamentarians about Leadbeater's proposed panels to oversee assisted suicide decisions.

In one deeply troubling case in New Zealand, the committee was able to establish that a patient suspected of having frontal dementia, and who did not speak English, was approved for assisted dying despite not having an interpreter present for their assessment.

New Zealand’s experience has not yet played a significant role in the UK debate so far. However, I strongly encourage members of the House of Lords to reflect on our experience ahead of the Second Reading of Leadbeater’s Terminally Ill Adults (End of Life) Bill, and take home two lessons: safeguards are rarely ever as strong as advocates suggest at the outset, and the “slippery slope” is not a hypothetical risk, but a real and present one that can manifest rapidly.

Simon O’Connor is a former New Zealand MP who chaired the parliament's health committee.