Can You See Where This Is Going?

Robert Clarke writes:

Last week, Scotland resolutely rejected assisted suicide. Alberta announced major new legislation to protect individuals from the practice. And the clock is ticking in the United Kingdom’s House of Lords on a bill that would legalize the practice in England and Wales.

Debates over assisted suicide are intensifying worldwide. The Scottish vote was striking as its parliament is dominated by parties on the left and center-left, and yet opposition to the bill prevailed, cutting across party lines. Leaders from Scotland’s three major parties (the Scottish National Party, Labour, and the Conservatives), along with the country’s last two first ministers, came together to reject the bill in a rare show of unity. The result was a 69-to-57 decision against legalizing assisted suicide for terminally ill adults.

The following day, Canada’s province of Alberta announced new legislation to significantly restrict assisted suicide, including a requirement the person be likely to die within the next 12 months and a prohibition on allowing it for those solely suffering from mental illness. This move too signals growing recognition of the immense individual and societal dangers of state-backed death.

Over the last four years, deaths in Alberta from Canada’s Medical Assistance in Dying (MAID) regime increased by 109 percent. In her announcement, Alberta’s premier, Danielle Smith, was clear that the proposed law is “about protecting vulnerable Albertans.” As the federal government seeks to expand MAID across the country, including by moving to allow assisted suicide solely on the basis of mental health concerns, Alberta is drawing a line to protect its most vulnerable. If passed, the Safeguards for Last Resort Termination of Life Act would prohibit MAID for minors and when the sole condition is mental illness, in addition to introducing other key protections and delineating a right to conscientious objection.

Let us be clear: “safeguards” can never render assisted suicide safe. As long as this abhorrent practice is legal, precious human lives are under threat. But Alberta’s proposed law is a welcome step in the right direction toward protecting the most vulnerable in light of the country’s draconian MAID apparatus.

Losing Support in Scotland

Every jurisdiction that has legalized assisted suicide shows the same trajectory. Once death laws are introduced, the push to expand them further is unceasing. This is the reality now confronting the UK parliament.

At first, assisted-suicide proposals attract support in principle, only to lose it once the catastrophic real-life consequences are understood. In Scotland, when Liam McArthur’s Assisted Dying for Terminally Ill Adults Bill first advanced last year, it appeared to have real momentum. Over time, as lawmakers worked through the details, that support began to fade. By the final vote, many who had once been open to the proposal had turned against it. The closer they looked, the harder it became to defend.

One of the most compelling speeches before the Scottish Parliament came from Jeremy Balfour, a member of the parliament and a longtime disability-rights advocate, himself disabled. Drawing on his own experience, he asked fellow lawmakers to consider what it means to live in a society where dependence is framed as a burden. He told the chamber that disabled people across Scotland were watching in fear. “We cannot legislate against the feeling of being a burden,” he said.

Experience elsewhere bears that out. In Oregon, where assisted suicide has been legal for nearly 30 years, the share of patients citing concern about burdening others has grown markedly over time. Further, shifts in the patient profile are eerily telling. In the first decade, up to 65 percent of those seeking assisted suicide were privately insured. By 2021, 79 percent were on government insurance. What this shows is vulnerability to difficult circumstances driving life-and-death decisions.

In Scotland, organizations representing general practitioners, psychiatrists, and palliative-care specialists all raised serious concerns about the bill. Several moved from neutral positions to opposition as the debate progressed. Their conclusion was consistent: The safeguards did not resolve the bill’s risks.

Canada’s Expansion of MAID

Canada’s experience shows how quickly those concerns can become reality. What began there as a limited policy for those near the end of life has developed into one of the most permissive assisted suicide systems in the world. Activists have consistently pushed for and achieved broadening of eligibility criteria.

Prudently, Alberta is looking ahead to the likelihood that 2027 will bring the next round of major changes with the expansion of MAID to mental illness.

Let the UK Bill Die

Now, the hope is that Britain will stop short of this madness. The Terminally Ill Adults (End of Life) Bill, passed in the House of Commons last year, looks set to fall in the Lords, undone by the weight of its own unresolved questions and the close of the parliamentary session. Westminster should not mourn its passing.

Unfortunately, last week ushered in a tragic new reality for the UK with parliament’s vote to decriminalize abortion up to birth. Fully developed babies can now be killed without limits, even at nine months. A second amendment to reinstate doctor’s consultations in place of abortion “pills by post” was also rejected. The disregard for the value of human life is profound. The consequences for both mothers and their unborn children will be grave, and the toll on all of British society will be immense.

The same legislative body now faces the end-of-life question too, and if the bill expires without passing, as now seems likely, that will be cause for relief rather than regret. Scotland has shown that the closer legislators look at assisted suicide, the harder it becomes to defend. Alberta has shown where the alternative path leads. There is no safe version of this law. Westminster should let this bill die, and keep it that way.

As James Moore writes:

“I could be wrong, James, but I thought the bill only applied to terminally ill people? What’s the connection with disabled people?” A telling tweet, that. It was written in response to my hailing the decision by the Scottish Parliament to decisively reject MSP Liam McArthur’s assisted dying bill. The initial vote went 70-56 in favour. However, after an emotional debate, the final tally was 69 votes against to just 57 saying “aye.”

The significance of the contributions made by disabled MSPs such as Jeremy Balfour and Pam Duncan-Glancy should not be understated. “I want you to imagine that you’ve heard on numerous occasions the words: ‘I’d rather die than live like you,’” said Balfour. “How do you think you would feel watching this debate? I think you would rightly feel terrified…For many in our country who are not that fortunate, the protections in this bill are not good enough. They could never be good enough.”

Disabled people have long feared that a bill like this is the thin end of the wedge, and that the inevitable result of it passing would be for supporters to shift focus to campaigning to remove safeguards and expand eligibility beyond the terminally ill with six months to live. It is when the implications of that are set against Balfour’s point that they start to become frightening. To my correspondent: that, right there, is the connection to disabled people.

Nor is it just MSPs’ worries about overt coercion that played a key role in the Scottish debate, or the inadequacy of the safeguards that need to be addressed. It is the more subtle pressure that people may feel. Here, the contribution of the SNP’s Ruth Maguire, stepping down as a result of a cancer diagnosis, should be heard. “I find it really hard to put into words the impact that the language of dignity and compassion being used to talk about ending life has had on me – as if somehow wishing to carry on but with help is undignified and burdensome, unfair to people who love me,” she said. “My blood runs cold thinking about sitting in a room in a hospital and having a doctor raise that with me as we weigh up treatment options.”

Consider that these MSPs are successful, influential and relatively well remunerated people. If they feel fear, what does that say about the implications for those of more limited means, without power, influence, or agency, for whom accessing the necessary support to live can be extraordinarily difficult, if not impossible. Take it from me, as a user of the NHS in England, it isn’t easy for anyone. To secure the treatments I need to be able to survive with a level of pain I can more or less handle, my family and I have been pitched into a series of bitter bureaucratic battles. I have sometimes been driven to the depths of despair, and from there into some very dark places. Can you see where this is going? And those battles are far from over.

When it comes to the “help to live” Balfour referenced, governments north and south of the border are failing – badly. Attempts to distract from this by portraying disabled people as “burdens”, “costs”, even “scroungers” are deeply troubling. Bills like this open a very grim door to these people. Cynical? Call me so. But when responsibilities are so routinely shirked, do you blame me? A particularly ugly example of this in practice was the treatment meted out to Lucinda Ritchie, a master's student and charity ambassador, while these debates raged. Against her will, she was discharged from hospital to a nursing home – she repeatedly stated her denial of consent – instead of the adapted bungalow where she had lived. “Life will not be worth living if I cannot go home,” she said.

This is the backdrop against which the Labour peer Lord Falconer has suggested the use of the Parliament Act to force the southern bill on England and Wales. It would be a first for what is notionally, like its Scottish equivalent, a private members’ bill, albeit one that has received significant government input. The more than 1,100 amendments that have been tabled have led to accusations of filibustering. But these would not have been necessary had the bill not been profoundly flawed. As the Paralympic gold medallist Baroness Grey-Thompson stated, it has “many loopholes” and is “vaguely written”. Far from flouting democracy and filibustering, as critics have charged, the amendments are an example of the Lords doing its job and paying heed to a vulnerable group in a way that the House of Commons did not.

Like many people with disabilities, I support the principle of bodily autonomy: the right of a person to decide what to do with his or her body and to steer its treatment. The danger in these bills is that they would lead to the opposite of that, to situations in which the sick and disabled feel forced into a terrible choice. They have floundered because they do not stand up to scrutiny. If that debate also serves to draw attention to the daily struggles people like me face as we battle to live, then maybe that purpose goes further still.