There Are Still Too Many Concerns

Now gone to his reward, a wise man once told me always to read The Economist and the Financial Times, since they were where the Establishment talked to itself on the assumption that no one else was listening. Yet even in the FT, previously very supportive indeed of assisted suicide, even so Liberal Establishment a figure as Thangam Debbonaire writes:

The bill regularly referred to as the “assisted dying” bill is described by its proponents as a choice for terminally ill adults with less than six months to live, in order to end their suffering. But that is not what it is called, and that is not all it is likely to do, if passed as it stands.

The title of the legislation is actually the Terminally Ill Adults (End of Life) Bill. This implies that it covers a range of options for end of life. Yet it presents only one, early death. Speeches made by its supporters focus heavily on pain and suffering — but there is nothing in the bill about alleviating pain or suffering, other than through assisted dying.

One major issue is that the key definition of terminal illness is not as precise as is being implied by the bill’s supporters. Putting a figure on life expectancy for people with a terminal illness is notoriously difficult and some physicians hesitate to do so.

Another issue is the concept of “choice”. There are many reasons why the choice of an early death is not a genuine one. Delays to diagnosis and treatment increase the risk of a treatable condition becoming a terminal one. Palliative care doesn’t alleviate all pain and suffering — especially for those who can’t get it. Drugs can do a great deal — but not when there are gaps in supply. Social care can help people to be comfortable at home — but not with the long-term problems in our health and social care systems. There are chronic staffing problems in both, which will probably take many years to fix.

If someone has been late to receive a diagnosis or life-saving treatment, can’t get palliative or social care, or is struggling financially — the “choice” of early death is not a genuine one. And that matters, when what our healthcare system is being asked to offer is assisted death.

Last week’s debate in the House of Lords included thoughtful, considered, detailed and respectful speeches from people of all views. The House will vote on the bill this Friday. There are strong supporters of the principle and the legislation. There are others who support assisted death but cannot back this bill as it stands. There are those of us who are so concerned that we have asked for more time to examine evidence and amendments.

Supporters say in doing so, we risk the bill running out of time. But just because “something must be done, and this is something”, doesn’t mean it should be done.

The UK government is starting to address the problems within the NHS. But it could take years to see material change. Do we want early death to become a substitute for decent care?

A key criterion for the request for assisted suicide to be granted is the mental capacity of the individual in question. In the bill, this hinges on the Mental Capacity Act. Yet the definitions in the MCA were not intended for this purpose and neither does one assessment of mental capacity apply to all situations.

For example, people with severe learning difficulties may have the capacity to make a range of decisions, but possibly not this one. Mental health practitioners and other professionals have spoken of the dangers of reliance on the MCA for this purpose.

With the bill as currently written, and UK health and social care as it is, we face huge risks. While patients face delays to diagnosis and treatment, huge gaps in palliative and social care persist, and key definitions and criteria lack precision, I and many others — including some who support the concept of assisted dying — will be voting against this bill.