Compassion and Coercion

The Daily Telegraph editorialises:

Whatever view one may hold of the merits of assisted dying, the Bill currently making its way through Parliament is a travesty. It is nominally a Private Member’s Bill, allowing Sir Keir Starmer to officially keep his hands clean, but has the way paved for it by the Government at every stage in the process.

It has faced a rushed timetable, with just five hours of parliamentary debate before its first Commons vote, and in its passage the safeguards it purported to offer have been repeatedly watered down: what began as “two medical professionals and a high court judge” evaluating every case is now a panel of a social worker, a psychiatrist and a lawyer.

This deeply flawed Bill has rightly faced considerable scrutiny in the Lords; a great many amendments have been put forward as peers attempt to address the problems in the legislation. Unsurprisingly, this has brought forth the ire of its advocates, with Labour peer Harriet Harman claiming it would be unconstitutional for peers to allow the legislation to fail.

This is nonsense. As Lord True, Conservative leader in the upper house, has noted, the Lords has no obligation to push forward Private Members’ Bills in a timely manner. There was no manifesto commitment from Labour to introduce assisted dying. Blocking its passage would be entirely legitimate.

That this would likely frustrate Sir Keir and his allies, who appear to have wished to use the private members’ process to push through the change without adequate scrutiny while remaining officially neutral, is no reason to abandon constitutional precedent. Nor, for that matter, is the Prime Minister’s promise to Esther Rantzen: his duties to Britain’s good governance must take precedence.

Toby Young writes:

The Government is passing laws to expel its political opponents from Parliament, flooded the House of Lords with its own appointees, cancelled elections it’s likely to lose and is curtailing the right to trial by jury.

Yet the “constitutional abuse” the progressive Left is up in arms about is the prospect that the Lords won’t rubber stamp the Terminally Ill Adults (End of Life) Bill.

What the English constitution has to say about the deference the Lords owes to the Commons when it comes to private members bills, if anything, is a subject of much dispute in Their Lordship’s House.

During this autumn’s committee stage debates, the supporters of the bill kept making bad-tempered interventions, urging those who’d tabled amendments to stop dilly-dallying so it can complete its passage through the Upper House. Needless to say, we would have made swifter progress without these constant interruptions.

The bill’s sponsors, Kim Leadbeater and Lord Falconer, are anxious that if the Lords spend too long scrutinising it, the current parliamentary session will come to an end before it can get to a Third Reading. They say it will be “talked out”. Various “we the undersigned” letters have been dispatched, and articles written, fulminating about this supposed “abuse” of the constitution.

The rejoinder from those who have reservations about the bill, among whom I count myself, is that we’re not trying to wreck it, but make it safer. Yes, more than 50 peers have tabled hundreds of amendments, but then Leadbeater tabled 203 amendments and Lord Falconer 38.

If there isn’t time to debate all the amendments in the current parliamentary session, that’s because the time set aside for Private Members Bills is limited. Never has this route been used for legislation that is both this complex and this contentious.

The Commons devoted 11 days to line-by-line scrutiny and, typically, the Lords spends 50 per cent longer, scrutinising legislation more carefully than their less conscientious colleagues. Should we really cut corners on a law that gives the state the power to end lives?

Peers are also aware that some MPs only voted for it on the understanding that its numerous flaws would be fixed in the Upper House – an assumption its supporters encouraged. Leadbetter said she would welcome their Lordships’ “experience and expertise” and Falconer assured his Labour colleagues the bill would “benefit from the experience and expertise of the Lords”. It’s a bit rich for them now to complain that the bill is being examined too forensically.

As someone who’s been witnessing this Punch and Judy show for weeks now, I’ve been scratching my head over the invocation of the constitution by the bill’s backers. Would it really “jeopardise the reputation of Parliament as a whole” if the Terminally Ill Adults (End of Life) Bill was to fall, as various panjandrums asserted in a letter in The Times?

My understanding is that the Salisbury Convention protects what the public has voted for. The Lords must bend the knee to the elected house when the bill in question was in the governing party’s manifesto. This one wasn’t. Indeed, it’s not even a Government bill.

The bill’s supporters often point to opinion polls showing a majority in favour of euthanasia, as if that created a constitutional obligation to waive it through. But would they apply the same principle to a Private Member’s Bill backing capital punishment? I doubt it.

Until now, the position of all the major political parties is that assisted dying is a matter of conscience, with parliamentarians free to make up their own minds.

I don’t see why that should only apply to the Lower House, or why peers like me should set aside their moral reservations about euthanasia because a majority of MPs are in favour. If I believe something is wrong, it remains wrong regardless of how many people disagree with me.

Assuming the bill doesn’t make it out of the Lords, Leadbeater and Falconer can try to persuade the Speaker to invoke the Parliament Act, meaning it will receive Royal Assent regardless. This is the real reason the bill’s supporters keep banging on about how “unconstitutional” the behaviour of my parliamentary colleagues is. If they can win that argument, they think they’ll be able to persuade the Speaker to use this nuclear option.

Before the Speaker is asked to weigh in, MPs will once again have to vote for the same flawed bill which has failed to win the support of any Royal College. And Labour MPs will have to confront the prospect of looking obsessive, spending another year fighting over the details of this bill, despite the problems the country faces. And at the end there will need to be a majority in the Commons for using the Parliament Act on a bill that allows any future government to fundamentally alter the NHS and the circumstances in which people’s lives are ended.

No, if the bill doesn’t complete its passage through the Lords, or is defeated at Third Reading, I think that will be the end of it. It’s possible the Government will then decide to include a similar bill in the next King’s Speech, but they will need to do the hard work that they’ve been avoiding, be honest about the suicide protocols they’re drawing up behind closed doors, and the trade-offs involved in creating a new Assisted Dying Service in the NHS.

Given that it wasn’t in Labour’s manifesto, it would likely run up against the same problems. And its legislative programme will be crowded enough without shoehorning in a bill that’s guaranteed to split the Cabinet.

The advocates of assisted dying write to me every day, warning that a failure to pass the bill will lead to a public outcry and the further erosion of what little power the Upper House has.

But what do Tory peers like me have left to lose? Forty-four of my hereditary colleagues have been given their marching orders and Sir Keir Starmer has already created 87 Labour peers. Is he really going to show more respect for the Lords if we vote for this bill?

There are constitutional vandals in this Parliament. But those of us wanting to scrutinise the Assisted Dying Bill in the Upper House are not among them.

Victoria Smith writes:

On 1st January 2021, my mother died of cancer. This was shortly before the third national lockdown. I was permitted to be with her in hospital, clad in huge quantities of protective gear, but my partner was back at home. Driving back alone on New Year’s Day, I stopped to buy petrol and thought of telling the attendant, apropos of nothing, “my mum’s just died”.

It felt such a mad, surreal thing — how could that have just happened? How was it allowed? As though suddenly I was carrying an experience that could blow everyone else’s out of the water. Yet at the same time I knew it was utterly mundane. Everyone dies, in some cases slowly and painfully. Most of us witness the death of someone we love. What did I know that I didn’t know before?

This January the writer Anthony Horowitz wrote for the New Statesman about the death of his own mother from pancreatic cancer, and how it informed his view on assisted dying. I have no desire to rank deaths on degrees of suffering, but the experience was clearly horrific. What struck me, though, were the conclusions that followed. Horowitz believes that “almost everyone who has had this experience supports assisted dying […] while the majority of those who oppose it are coming from a theoretical, more high-minded starting point”. If you’ve had the experience, you will have the insight — the only insight, apparently, that matters — and if you haven’t, it’s all a bit abstract to you. Moreover, if you then argue that changes in UK law to permit assisted dying may put the vulnerable at risk, you aren’t just indulging in pointless pontification. You’re in the realms of fantasy.

Horowitz writes mockingly of those who “believe that allowing a change in the law will encourage pensioners less intelligent than themselves to sign their own death certificates the moment they get flu”:

… or that dastardly relatives will arrange Agatha Christie-style exits for their elderly aunts. They worry that people they have never met will be worried to death that they have become a burden. They might even expect the angel of the Lord to appear with trumpets and fires.

Ha! What a bunch of idiots! He goes on to note that “gay marriage, television, the internet, Big Mac hamburgers, trains, planes and automatic vending machines have all had their Cassandras”. It is strange, I think, for him to accuse others of taking a purely “theoretical” approach towards agonising deaths from cancer and then go on to write as though occurrences of potentially lethal coercion between relatives are not just “hypotheses”, but ridiculous, comical ones at that. They happen right now; the argument is not that a change in law would bring them into being, but make them worse. Do you really have to have experienced this yourself to grasp it?

Perhaps in some cases, you do. However difficult it is, it is possible to speak and write of the physical pain suffered by a relative towards the end of life. Explaining the dynamics of carer coercion is much more difficult, not least when it coexists with and masquerades as love. Suggest that some ‘care’ may not be quite what it seems and you may well be accused of lacking the deeper insight of the carer. Indeed, the carer may themselves be convinced that their insistence that an individual has no quality of life is motivated by empathy and that anyone questioning this simply isn’t close enough to the situation to see it.

These are complex human truths, not Agatha Christie stories. Love, abuse and coercion can intermingle. This is something that feminists have fought long and hard to convey with regard to domestic abuse. The typical abuser is not a pantomime villain and a victim does not have to be “less intelligent” to believe that what is being done is for his or her own good. You can make someone feel their life is not worth living in small increments. The outlandish, mocking scenarios put forward by assisted dying coercion deniers — alongside their insistence that coercion would be easy to identify — only suggest that in this, a situation where people can be even more vulnerable than the average abuse victim, coercion would be missed because it doesn’t look like the caricatured version. It never, ever does.

None of this is to say that I don’t agree it would be wonderful to avoid agonising, drawn-out deaths, or even unremitting, unbearable long-term suffering. Nonetheless, I am beyond sick of the false dichotomy between “people who’ve seen a parent die of cancer and now understand why assisted dying is compassionate” and “total bastards who evidently have immortal parents but would like other people’s to suffer untold agonies because they’re religious fundamentalists, a bit funny about death and / or have some weird need to control other people’s bodies”. In a piece on his excellent Substack, the political philosopher Paul Sagar — who has written repeatedly about assisted dying in relation to his own experiences following a catastrophic climbing accident — describes the need to “just acknowledge that complex social policies have winners and losers — and that in cases like this, the losers will be forced to suffer (sometimes severely)”:

It may well be the case that even people with terminal illnesses in agonising pain should not be entitled to medically assisted suicide […] All I ask, however, is that if those who want help to die ahead of time are told that they cannot have it, then society at least looks them in the eye and admits that they are the political losers, being sacrificed accordingly.

I think this is perfectly fair. I’d ask at the same time that those who take the opposing position could at least admit that the very existence of assisted dying as an option will make some coercive relationships even more dangerous than before. A refusal to admit the costs and complexities of your own position does not make it a strong one.

As someone who supports a woman’s right to end an unwanted pregnancy, I’ve long considered “if you don’t like abortion, don’t have one” to be a terrible slogan — one which wilfully avoids the fact that many of those who oppose abortion take a different moral position on the relationship between foetus and gravida and are not just obsessed with controlling women’s bodies. Similarly, “if you don’t like assisted deaths, don’t have one” is a way of denying the social, economic and relational context in which lives are understood to have value (or not). I’m relatively confident no one will convince me personally that my life is no longer worth living — that if I make that decision, it will be on my terms. That I don’t think this is necessarily true of others isn’t because I think I’m more intelligent. It’s because I appreciate the safety I have right now (but know that could change). Horowitz’s claim that people like me are worrying about “pensioners less intelligent than themselves” is another way of casting concern for others as disrespecting agency or free choice, as if everyone lives on their own personal island.

Horowitz himself is writing “in glorious Crete”, where he muses on the injustice of Dignitas being an option for the wealthy but not the poor. There is no class of people untouched by the deaths of loved ones — or by the approach of their own mortality — so it’s good of him to check his privilege. What’s clear to me, however, is that there is another privileged class, one with many members, who clearly haven’t encountered or noticed how abuse and coercion can operate in seemingly loving relationships, or how sex, disability, illness and social class can make the dynamics even more corrosive. I’m increasingly of the view that if you haven’t noticed this — indeed, if you think it’s all a bit made up — then you do not have the insight into what is at stake in this debate that you think you do. I’m not asking you to change your mind. Just be honest about what it is you’re asking. None of this is fiction.

Adam James Pollack writes:

On Wednesday, a British man was jailed for 14 years for selling poisonous chemicals online to allow people to commit suicide. Miles Cross sold the fatal drugs to four people, two of whom, tragically, have since died as a result. In court he appeared to defend his actions, arguing that he simply wanted to “help others end their lives”.

The case, believed to be the first of its kind in the UK, is shocking. But it is also symptomatic of a broader and deeply troubling trend: the normalisation of suicide across Western societies. The House of Lords is currently scrutinising the Terminally Ill Adults (End of Life) Bill, which would legalise assisted dying in England and Wales. At the same time, society has rightly condemned reckless individuals who promote or provide instructions for people to end their lives.

One such individual, Dr Philip Nitschke, has long campaigned for assisted suicide. Nitschke, the inventor of the controversial Sarco assisted suicide pod, published an online suicide handbook that teaches people how to end their lives. People in England have allegedly used this information to decide how to end their lives, including one teenager, Tom Parfett. After the teenager’s death, his father said he “would still be alive and would have found the support he needed to get through his dark times if taking his own life hadn’t been encouraged as a valid option”.

Nitschke’s seminars on assisted dying introduced a Canadian man, Kenneth Law, to one specific poison. In 2023, it was reported that Law had been selling the poison online, in a manner very similar to Miles Cross. Law is facing 14 murder charges in Canada and is being investigated for criminal offences linked to the deaths of 109 people in Britain. Nitschke has been delivering suicide workshops in London as recently as September 2025, at which he instructed individuals on new methods of suicide that he has developed, the latest of which is a horrific suicide collar designed to strangle the wearer to death.

But enabling dying, possibly even through means of one of Nitschke’s devices, is exactly what many British parliamentarians are trying to legalise. If it becomes law, the Terminally Ill Adults Bill — which returns to the Lords on Friday following the Christmas recess — may give criminals like Cross legal grounds to appeal their sentences. If assisted dying is legal, then it wouldn’t be Cross’s act that was illegal, but merely that he did so without a licence and through the proper channels. It would also encourage fanatics like Nitschke, who believe that people should be given help to end their own lives — even while we maintain as a society that we have a duty to prevent suicide.

What’s more, campaigners like Nitschke may see a tangible financial benefit from legalising assisted dying. It has been reported that legal academics have advised that Nitschke’s suicide pod would be legal for use to end lives in the UK under the wording of the assisted suicide Bill, with Nitschke himself stating that he is ready to launch his suicide pods in Britain at the press of a button.

Up until very recently, we have lived in a society where life is valued, and where individuals who would seek to encourage others to end their lives have rightly been demonised and held to account. Of course, some who advocate for assisted dying do so out of a genuine desire to reduce suffering. But our nation’s ethical framework is in danger of being turned on its head if we wholesale abandon our duty to protect society’s most vulnerable. If that duty is surrendered, we should not be surprised when the line between compassion and coercion quietly disappears.

And this letter appears in the Wall Street Journal:

Kevin Díaz purports to correct the record on “medical aid in dying” (Letters, Dec. 27). The thrust of his argument: Anorexia can’t be a qualifying condition because it is illegal. If MAID deaths reportedly owed to “severe protein calorie malnutrition,” Mr. Díaz writes, it may simply be the case that the condition was “present for people dying from cancer or other terminal diseases.”

On the other hand: We have Oregon’s 2021 annual report on assisted suicide and correspondence with Colorado’s Vital Statistics Program, published in a 2024 peer-reviewed article by Chelsea Roff, which confirm that anorexia has been reported as the primary qualifying illness for assisted suicide. We also have a case study by Jennifer Gaudiani—an eating-disorder specialist and assisted-suicide clinician in Colorado—on two of her patients with eating disorders who were prescribed assisted suicide. The evidence abounds.

Mr. Díaz is free to contend that lawmakers didn’t intend for anorexic patients to die under MAID. But to suggest it isn’t happening is hopelessly naive.

Alexander Raikin

Ethics and Public Policy Center

Washington