Probing The Gruesome Details

As Dignity in Dying offers a free will-writing service and suggests that those using it might make a bequest, and as a Green proposed amendment to the Scottish assisted suicide legislation seeks to criminalise dissuading people from suicide in the vicinity of the facilities, Paul Goodman, Lord Goodman of Wycombe writes:

When I searched for how to commit suicide, the internet was extremely reluctant to tell me — absolutely rightly. There are legal and cultural bars to such information. Why? Because we are instinctively horrified by the prospective loss of innocent life, even when it is one’s own, though all turns on circumstance: for example, a man might kill himself rather than endure torture.

Suicide can have searing consequences for one’s family, one’s friends, other people. The government spends some £30 million each year to try to stop it, working through such organisations as the Samaritans, the Zero Suicide Alliance and Suicide Prevention UK. Parliament marked Suicide Prevention Day with a debate on September 11 this year. 

What a striking juxtaposition it is, then, to set that debate, which sought to help prevent suicides, next to a bill currently before parliament, which seeks to facilitate more. The Terminally Ill Adults (End of Life) Bill is currently being considered in the House of Lords. I’m a member of the select committee set up to probe the bill’s potential implementation and effects. Hence my internet search. The bill would provide for assisted suicide under certain circumstances, and I wanted to find out more about how it works abroad.

Such details as are available are not for the squeamish. Assisted suicide typically starts with benzodiazepines or barbiturates to induce deep sedation. Drugs such as metoclopramide prevent nausea and vomiting. The process can take up to 120 minutes. And though failure rates are low, they are real — some 6 per cent in Oregon.

But Lord Falconer, the bill’s sponsor in the Lords, doesn’t think peers should debate and discuss which drugs should be used to first stun and then kill those who sign up for assisted suicide. Another cross-party select committee unanimously agreed that setting out which drugs will be used in the bill would be “in the interests of clarity and transparency”. When I put this point to Falconer during our hearings last week, he replied that he “could think of nothing worse than politicians deciding what drugs to use”.

One can see his point. Politicians are not usually experts in distinguishing one drug from another. Then again, most are not experts on Diego Garcia, ransomware, human trafficking or the decarbonisation of cement — all of which the Commons considered last week. Nor are most of the rest of us. And our parliamentary democracy relies on government being exercised by people much like ourselves.

The bill’s supporters are clearly reluctant to see the grisly details of assisted dying probed in public. Readers will have gleaned that I’m not one of them. For what it’s worth, I believe that assisted dying is intractably problematic — with serious consequences for patients, palliative care, the medical profession and the NHS. Nonetheless, parliament has a responsibility to consider the bill, which requires getting it into a less harmful form before peers and MPs make a final decision.

The bill’s supporters and opponents can at least agree, at the start, about what it seeks to do. Its title, though euphemistic, is accurate: its intention is not, as some backers of assisted dying believe, to relieve pain and suffering (though this may be a consequence). The bill would give adults diagnosed as terminally ill with a prognosis of six months or less to live the option of suicide assisted by a doctor. How often such diagnoses are accurate is debatable. They are not, however, at the heart of the controversy that haunts the bill.

“The essence of the bill is autonomy,” Falconer told our committee. “You have a choice. We did not take the view that it is appropriate to have as a condition the suffering of an individual, which is a subjective matter.” But much turns, once again, on circumstances. What about the possibility of coercion — especially for disabled people, for the vulnerable, the disadvantaged and those who feel themselves to be a burden? And if choice is the key principle, would people really have one, given the lack of readily available, high-quality palliative care?

Where would the NHS fit in? Wes Streeting, the health secretary, has said that “there isn’t a budget for this”. So would the NHS provide assisted dying free at the point of use, or would it simply be a private service for the wealthy? The bill would leave such crucial decisions to the secretary of state. Yet another matter that parliament won’t debate and decide in detail.

The bill may also cast light on the government’s future. My sense is that the average peer is open to the principle of assisted suicide but concerned about the practice and whether or not the bill itself is workable. Much depends on who turns out when amendments are considered. What happens if the bill falls or runs out of time? Streeting is opposed. So is David Lammy, the justice secretary. Six months ago, this might have mattered less since, as is well known, the prime minister himself is a supporter. When the bill was voted on in the Commons in June, a crucial slice of Labour MPs followed him into the Aye lobby. It passed by the slender majority of 23.

But, since then, the government has been rocked by the welfare rebellion, Angela Rayner’s resignation, the Peter Mandelson Epstein scandal and the China spy row. Labour has fallen to below 20 per cent in the polls. Sir Keir Starmer was humiliated in the Caerphilly by-election. There is a tax-hiking budget to come. The government has no manifesto mandate for another assisted dying bill. It is short of parliamentary time, and needs Labour MPs campaigning in their constituencies.

The bill’s supporters claim it has many safeguards. Its opponents say that these need reinforcement. Could it be that both are right? And that, over the next few months, layer after layer of additional protections are added to the bill? Might it then be that no one much is happy? The bill’s backers would think it almost inoperable; the bill’s critics would consider it inherently dangerous. Discontent would abound. The bill may be important not just in its own terms but as a metaphor for our present discontents.

And even if passed, assisted suicide isn’t due to come into effect until after the next general election. How fitting for our irresolution it would be were this government or a future one to pause the process and promise a Royal Commission and a review. We may be probing the gruesome details of assisted dying for a while yet.