Of Sound Mind

The Times editorialises:

If the definition of insanity is doing the same thing again and expecting a different outcome, consider the return of the Terminally Ill Adults (End of Life) Bill. That the proposed legislation faced almost 1,300 amendments in the House of Lords is testament to the poor quality of its drafting and strength of criticism. Kim Leadbeater’s private member’s bill was rightly consigned to the scrapheap in April. Peers did the country a service by exposing the risks inherent in allowing the introduction of state-sanctioned killing. Passing the Labour MP’s bill into law in undiluted form would have probably led to abuses.

Yet even though its flaws were exposed, the assisted dying bill refuses to die. Lauren Edwards, another Labour backbencher, has announced she intends to revive the legislation in order to “finish the job”. Having come second in this year’s private member’s bill ballot, hers will almost certainly receive a hearing in the Commons. This is a regrettable development. As Baroness May of Maidenhead discovered when trying to pass her Brexit legislation, attempting to drive contentious bills through parliament for a second time is highly unlikely to yield the desired result. Dusting off an unimproved bill and hoping it will sail through the Commons and Lords is delusional.

Assisted dying bills have been brought before parliament at regular intervals since the 1960s. But it was the bill proposed by Ms Leadbeater that made most progress, securing the backing of the Commons. Had it become law, it would have allowed an adult with mental capacity whom a doctor judged could reasonably be expected to die within six months to request lethal drugs for self-administration. Notional safeguards included provision of a second assessment by another doctor and final approval by a panel composed of a lawyer, a psychiatrist and a social worker. Some safeguards were eventually watered down.

Criticism of the bill was widespread. The Royal College of Psychiatrists said the bill was not fit for purpose, as did disability charities and hospices. The House of Lords identified a plethora of problems. Mired in objections, many entirely sound, the bill was timed out at the end of the last parliamentary session, a common fate for private member’s bills requiring further work. Supporters of assisted dying are seeking to paint their campaign as a struggle between the elected Commons and the unelected Lords. The truth is that, because assisted dying was not a part of Labour’s manifesto, it enjoys no mandate. Detailed scrutiny is the job of the Lords.

Such is the zealotry of campaigners in favour of state-assisted suicide that they are brandishing the Parliament Acts 1911 and 1949, typically used to drive government money bills, and occasionally bills based on manifesto commitments, through the Lords. For this to happen the revived bill must be unamended. Kit Malthouse, a Conservative supporter of assisted dying, says the bill does not have to be changed. Other supporters, such as the former cabinet minister Louise Haigh, argue that using the Parliament Acts would be wrong. This is correct: it would be a constitutional outrage to use them in this way. Ms Edwards claims that she does not have to use the acts to railroad her bill into law. But it remains a threat, given MPs are being urged not to amend the bill. If it does return, its myriad defects must be examined by both Houses.

It is remarkable that Sir Keir Starmer, who supports the principle of assisted dying, has said almost nothing about the bill. Andy Burnham, the frontrunner to replace Sir Keir if he wins the Makerfield by-election, has expressed scepticism about it. Wes Streeting, the former health secretary, is adamantly opposed. It is not too late for Ms Edwards to think again. This shoddily constructed bill represents a danger to patients. It belongs in one place: the history books.

And Professor Kathleen Stock writes:

Here we go again. Like Kim Leadbeater before her, Labour MP Lauren Edwards says she is introducing a Private Member’s Bill for an assisted dying service.

The plan, just as before, is to enable doctors to help terminally ill patients to die – that is, help them commit suicide, should they wish to – and Edwards has indicated her wording will not deviate from Leadbeater’s original. This means that, should the new bill pass in the Commons any rejection by the Lords can be overridden and the bill made law nonetheless.

I have recently written a book arguing against the organised deliverance of assisted suicide by NHS doctors, which is what Edwards and her backers are trying to get. As news of her bill was breaking, I was at the Lake District book festival, debating with a Dutch doctor Dr Rob Jonquière who himself has euthanised two people and who is now an influential international advocate for euthanasia legislation.

We had a respectful and friendly discussion; but still, what I heard from him and several others during the session only intensified my concerns.

For Jonquière, a Leadbeater-Edwards style bill doesn’t go far enough, since it confines provision only to people with a prognosis of six months to live or fewer, and not – as he would prefer it – to anyone “intolerably” suffering from a physical or mental disorder, whether terminally ill or not. This is the norm in the Netherlands and Belgium, where they sometimes euthanise physically healthy people with mental illnesses in their 20s and 30s.

My discussions with assisted dying supporters across the country suggest that some would agree with this approach, wishing an easy doctor-delivered death to be available wherever personal suffering is too intense to handle, and with no need for people to be dying first. They see an assisted death service for the terminally ill as the first step in opening up access to other suffering groups: severely disabled people, mentally ill people, people with dementia.

And they seem impervious to the way that, over time, this nihilistic stance inevitably saps energy from other ways of caring for especially vulnerable people; for death is a highly effective way of ending suffering, and also very cheap. If our aim as a society is to be merciful or compassionate to those in physical or mental pain, surely we can do better than this.

But even if we stick to a service aimed only at the terminally ill, there are many reasonable concerns here, reinforced by various people I’ve met over the past few months. This week, a GP told me that, when a commitment to 24/7 palliative support was withdrawn in her area, the system for end-of-life care became much more chaotic.

Like me, she worries about introducing assisted death as an option when alternative means of controlling pain are not widely available; for this will obviously funnel more people towards assisted death instead. A hospice worker also talked of the devastating lack of funding affecting her sector, with a dwindling pot of charity donations trying to cover around 70 per cent of the costs.

And perhaps most strikingly, a woman whose mother died on the notorious Liverpool Care Pathway – a standardised medical protocol for withdrawing treatment that quickly became an inhumane cost-cutting exercise – reminded me of how impersonal NHS systems aimed at ease and efficiency can go very wrong.

In the past few months, I have also met a retired care home manager, keen to convey to me how unscrupulous the relatives of elderly people can be, particularly where money is involved – an aspect of human nature with obvious repercussions for assisted death services. I’ve heard from parents of learning disabled children, frightened of a future in which their highly suggestible daughter or son might meet an over-zealous doctor.

Oncologists have explained how easy it is to get a terminal prognosis wrong, and senior psychiatrists have admitted that they have little idea how to assess the mental capacity of someone intending to end his own life.

In short, I’ve heard from a range of people with professional or personal skin in the game, gravely concerned about the ramifications of introducing state-backed suicide into a health service. Yet according to high-profile supporters of assisted dying, these worries are foolishly panic-mongering. I find this attitude bafflingly irresponsible and naïve.

Parliamentary scrutiny of the Leadbeater bill has revealed many shortfalls yet Edwards says she will be incorporating no amendments.

This means, among other things, there will be no requirement that applicants get a specialist palliative care consultation before proceeding to take their lives; no enhanced scrutiny of applicants’ backgrounds to rule out the possibility of family coercion; no prohibition on doctors suggesting assisted death to a patient unprompted; no exemption for learning disabled people generally; no engagement with the evidence offered by Royal College of Psychiatrists that the Mental Capacity Act is not a good fit.

These are just a few of the red flags that most sensible, conscientious people can see from space. Even amongst voters who support the idea of assisted death in principle, recent polling suggests that most are keen to see proper safeguards built in; and yet the people pushing the process at the top seem disturbingly keen to press on regardless.

Alongside professed compassion for suffering people, an even more popular justification of assisted death services is that they give people “autonomy” and “choice”, and never mind that the choice will hang more heavily over some than others. The attitude was effectively summed up by another person I met this weekend, who asked me why her own personal choice to die exactly as and when she wanted should be impeded by social problems affecting other people.

Rather than shocking, I found her frank expression of self-interest rather refreshing. I tend to suspect her sentiment is more common than usually admitted, and especially amongst politicians. The rest of us just have to make sure – once again – that such cheerfully myopic people do not get the last word.