Against This Backdrop

On this World Suicide Prevention Day, Lois McLatchie Miller writes:

Andy Burnham has pledged to “eradicate” internal division and restore Labour’s sense of “common purpose”. The first major test of the Prime Minister’s “common purpose” is already waiting for him. Lauren Edwards’ assisted suicide bill, set for Second Reading vote on 11 September, will be a litmus test as to whether Labour MPs still adhere to their party’s traditional core value: protecting the vulnerable.

Edwards has published her bill, virtually a clause-by-clause replica of Kim Leadbeater’s attempt, which failed during the previous parliamentary session. The previous bill exposed deep divisions. After passing the Commons by only 23 votes, it entered the House of Lords, where peers subjected it to detailed scrutiny. The legislation attracted serious criticism from large swathes of civil society. These criticisms remain with Edwards’ Bill.

Several medical bodies, including the Royal College of Psychiatrists, questioned whether the legislation can adequately protect terminally ill patients experiencing depression or fears of being a burden. Disability campaigners, including actress Liz Carr, have warned about the wider cultural impact of creating a legal pathway to assisted suicide, particularly for people who already fear being viewed as dependent. Domestic abuse charities highlighted the difficulty of detecting subtle coercion behind closed doors. Palliative care specialists have consistently highlighted that Britain’s end-of-life care system is underfunded and overstretched, a view that the Prime Minister openly supports.

Ultimately, due to the time constraints of parliamentary terms, the Lords ran out of time to amend it into a form they considered safe or workable.

Yet the new bill is all but identical to the previous one. Countless significant flaws with the drafting remain, and egregious problems have been left unaddressed. That’s no accident; keeping the legislation largely unchanged preserves the possibility of using the Parliament Acts to force it onto the statute book if it once again fails to pass the Lords.

Few issues have exposed Labour’s internal fractures more sharply. The bill has become a lightning rod for divisions not only between MPs, but between different parts of the country. In Scotland, where Labour MSPs faced a similar proposal brought forward by Liam McArthur, the party overwhelmingly rejected assisted suicide: 85 per cent of Scottish Labour representatives voted against the legislation.

In Westminster, however, Labour MPs remain deeply divided. Some are pushing for the Bill’s passage. Many others have raised concerns about a serious lack of safeguards in the Leadbeater Bill; holes which have not been adequately closed in Lauren Edwards’ near-identical draft. Many are presumably caught between pressure from well-funded, loud campaign groups and concern among their own constituents. National MRP polling of more than 10,000 people across Britain found that nearly two-thirds believe Parliament should prioritise fixing the care crisis before debating such a bill.

Asked about assisted suicide over the summer, Burnham said the debate should not take place until palliative care and social care are properly funded, adding that “that’s the position I will stick to”. That claim is well substantiated. Hospice UK have repeatedly raised concerns over the last few months that a funding crisis is leading hospices across the country to cut frontline services. One in three Brits now die without the palliative support they need. How can we justify creating a system that offers only shoddy end-of-life care or a lethal injection?

The Government’s new ECHR (European Convention on Human Rights) memorandum, impact assessment, and equality impact assessment on the bill underscore these concerns in stark fashion. They warn that structural pressures involving poverty, poorer healthcare access, lower-quality care and domestic abuse could result in disproportionate numbers of people from ethnic-minority backgrounds choosing an assisted death to avoid financial hardship or escape abuse. In addition, the key year ten estimate for annual assisted suicide deaths has increased by 60 per cent and, grimly, could result in nearly ten assisted suicide deaths every day.

For Labour to opt for something that entrenches inequality to the point of increased death would be quite remarkable. To do so at the scale projected by the Government’s own figures is unthinkable. Surely the most basic “common purpose” the party shares is to prioritise care for the most marginalised groups?

A “yes” vote on Friday would swing the government’s legacy substantially away from this core value. Burnham’s decision to abstain from the vote is cold comfort for supporters of the Bill – clearly, this Bill is not supportable according to the Prime Minister. And his public concern over the bill means his position will be weakened if MPs openly back for the bill. Many backbenchers will be looking on, reading between the lines and reconsidering previous support for it.

A party leader cannot promise unity while MPs rebel against an instinctive left-leaning, equality-driven “common purpose” for the next year. The assisted suicide Bill carries too much weight to be ignored; it goes to the heart of questions about the role of the state, the value placed on disabled and elderly people, and the protections owed to those at their most vulnerable.

For Labour, already under pressure to reconnect with working-class voters on bread-and-butter issues, another year spent fighting internally over a matter that divides its own MPs could prove politically costly. Burnham will most likely hope to see the divisive legislation voted down once and for all on 11 September. Any other result could jeopardise his unifying legacy before he’s even begun. MPs on the fence would do well to follow his lead.

As Mary Creagh MP puts it:

Andy Burnham has left the forthcoming “assisted dying” vote to the conscience of individual MPs, but only after clearly setting out his own view. Ahead of parliament once again considering whether people should be given a legal route to end their lives prematurely on the NHS, the prime minister recently told journalists that we should first tackle the current crisis of care inadequacy, which risks leaving vulnerable patients feeling without hope at the end of their lives.

The prime minister’s instincts are right. In the furious rush to legalise assisted dying in parliament, the question of what alternatives might be available to a frightened, frail or terminally ill person has too often been treated as an afterthought. We should follow Burnham’s lead in reversing that order of priorities: fixing palliative and social care first, and only then asking whether it would be wise to introduce assisted suicide.

The government’s own revised assessment of the new bill makes the wisdom of the prime minister’s position painfully clear. It warns that poverty, poor access to healthcare, low-quality care and domestic abuse could create structural pressures leading to disproportionate numbers of people from ethnic minority backgrounds choosing an assisted death. It has also newly identified neglect, poverty and difficult living conditions as potential pressures on disabled people considering assisted suicide.

Surely Labour, of all parties, cannot possibly back legislation that would so directly disadvantage those who suffer under the burden of structural inequality?

We are often told that assisted dying is about personal autonomy, as though decisions take place in a vacuum between an entirely free individual and an entirely neutral state; but circumstances shape choices. A mother who is terminally ill and worried about becoming a financial burden on her children; a wife who is under pressure from a domestic abuser to stop “dragging things out”; a wheelchair user suffering from advanced cancer unable to access adequate support, struggling with poor housing or conscious that their caregivers are exhausted may reach a very different conclusion from someone who has the means and privilege to know that first-class palliative and social care will be there for them for as long as they need it.

The government’s warning about poverty and poor care is an acknowledgement that coercion does not always look like somebody standing over a vulnerable person and demanding that they die. Sometimes it can take the form of a social environment in which death appears easier, cheaper or less burdensome than continuing to live.

The new impact assessment has also revealed that the scale of the proposed change is considerably greater than the public debate has sometimes acknowledged. The government has increased its central estimate of the number of assisted deaths in England and Wales ten years after legalisation by 60%, from 2,183 to 3,502 a year – almost ten deaths every day. Its high-end scenario has risen from 4,559 to 6,257 a year – more than 17 every day – and the government explicitly says that even this scenario should not be treated as a definitive upper bound. 

One new sensitivity analysis produces a figure of 9,810 assisted deaths in England and Wales in Year 10 if New Zealand’s actual and projected assisted-death rates were followed here. 

The concerns Andy Burnham rightly highlights with the care system will not be resolved by an increase in premature deaths. The government’s central estimate of the cost of health and social care staff time required to deliver assisted dying has risen by around 69%, from £5.49 million to £9.27 million in Year 10. We are told that there is not enough money or capacity to provide everyone with the palliative and social care they need, yet simultaneously are considering constructing a new state-funded system requiring doctors, nurses, social workers, psychiatrists, lawyers and other professionals to use their professional time to administer assisted deaths. 

Against this backdrop, it is perhaps no surprise that the public is not clamouring for parliament to make assisted dying its priority. In a recent poll of more than 10,000 people, just 7% of the public and 7% of Labour voters selected legalising assisted dying as one of the three priorities they would most like their MP to focus on if they had the opportunity to make a law change over the next year. And in every constituency in Great Britain, a majority of voters agreed that parliament should prioritise fixing the NHS and improving palliative, social and end-of-life care before considering whether to introduce assisted dying. 

The prime minister has therefore articulated what the evidence, the government’s own assessment, and the public are all telling us should be our focus instead: fix the NHS. Fix social care. Properly fund hospices. Strengthen palliative care. Make sure disabled people and the terminally ill have the support they need to live with dignity.

Only then should parliament ask whether assisted dying is really the answer. If we cannot yet guarantee that vulnerable people will receive the care they need, we have no business guaranteeing them that we can help them die.

Ashley Dalton MP writes:

The Assisted Dying Bill returns to Parliament tomorrow having failed to pass this spring because of major concerns about the safety of the Bill among professionals and in the House of Lords. I have a terminal cancer that will kill me, so this is not a hypothetical debate for me. 

I would be lying if I said that in the early days of my diagnosis, the thought didn’t cross my mind that it would be easier to just die and avoid all the unnecessary suffering and burden upon myself and my loved ones. I know the fear and the pain that so many people in our country face at the end of their lives. But when I look at the Assisted Dying Bill MPs have been asked to consider I cannot vote for it. 

Supporters of Assisted Dying talk about giving terminally ill people like me a choice. But the truth is we cannot talk about meaningful choice when we know that palliative care in our country is simply not good enough. Far too many people do not get the good quality palliative care they need and face pain and suffering at the end their lives. There can be no meaningful choice if people’s options are continued suffering or an assisted death. 

And we know from the Government’s own impact assessment that vulnerable people risk being pressured or coerced into an assisted death. That assessment makes clear that domestic abuse victims, older people, people with a mental illness, from minority ethnic backgrounds and people with disabilities will all be at risk. At risk of feeling pressured to end their life, of feeling like a burden or left desperate because our care system fails them repeatedly. Because of this many royal medical colleges and professional organisations made up of the doctors, psychiatrists and social workers who would have to deliver the assisted deaths, have raised serious concerns about this Bill. None of them will say that this Bill is safe to be made law. 

So MPs like me have a choice tomorrow. Not a choice about the principle of assisted dying. Our choice is whether we vote to pass a law we know will harm vulnerable people and the experts refuse to endorse. Or whether we accept this Bill should fail and instead turn our efforts towards fixing and supporting social and palliative care in our country so that no one faces suffering and indignity at the end of their lives.

And Dr Cajetan Skowronski writes:

Among the first items of parliamentary business for new UK prime minister Andy Burnham is yet another attempt to introduce assisted suicide into British law.

Labour MP Lauren Edwards reintroduced the Terminally Ill Adults (End of Life) Bill in July, just before parliament’s summer recess. In doing so, she took up the baton from Kim Leadbeater, who failed to pass her bill during the previous parliamentary session. Edwards’s bill will have its second reading in the House of Commons on Friday 11 September.

Leadbeater’s original assisted-dying bill contained so many flaws and loopholes that the House of Lords simply ran out of time to amend it into a functional piece of law. Yet the bill introduced by Lauren Edwards is to all intents and purposes identical to Leadbeater’s. That’s no accident: Edwards must present the same bill if she wants the Parliament Acts of 1911 and 1949 to come into effect. These acts allow for the same legislation, if passed in the House of Commons in consecutive parliamentary sessions, to automatically become law regardless of what the Lords think.

The decision to use the Parliament Acts is revealing. Supporters of assisted dying could have brought back a radically reworked version of Leadbeater’s bill that addresses the criticisms raised by doctors, psychiatrists, disability campaigners and legal experts over the past year. But instead, they have brought back exactly the same bill. The goal seems simply to get the legislation over the line, whatever state it’s in or however widely experts may critique it. This should concern everyone, whether they support the principle of assisted suicide or oppose it.

Over the past year or so, in both houses of parliament, the assisted-dying bill has received one of the most exhaustive examinations ever faced by a private members’ bill – that is, a bill introduced by MPs and members of the Lords who are not government ministers. Royal Colleges, professional bodies, domestic-abuse charities, disability organisations, mental-health experts and the Equality and Human Rights Commission all identified significant flaws in the bill. Many of those organisations and experts were not ideologically opposed to assisted dying. Several supported assisted suicide in principle or were neutral on the issue. They were concerned above all with whether this particular legislation is safe, and whether it can protect vulnerable people.

Even Lord Falconer, one of Britain’s longest-serving advocates for assisted suicide and sponsor of Leadbeater’s bill in the Lords, has acknowledged that important changes are needed. He questioned the safeguards for younger adults, the treatment of patients with suicidal thoughts, the risks of remote consultations and the absence of proper recording requirements.

Using the Parliament Acts to push the legislation through is not simply about avoiding the Lords. It also means that MPs will be unable to amend the bill in the House of Commons. This is a wholly inappropriate way to legislate on a question of life and death.

Private members’ bills have never before been forced through parliament using the Parliament Acts. Nor has this bill earned anything approaching an overwhelming democratic mandate. It was absent from Labour’s election manifesto, and passed the Commons only narrowly, with fewer than half of all MPs voting in favour at the third reading. Now, after months of criticism, it has returned unchanged.

Andy Burnham’s recent intervention makes the problem even sharper for supporters of the bill. The PM has now said the debate on assisted dying should not happen while palliative and social care remain poorly funded, confirming, ‘that’s the position I will stick to’.

This is a major setback for the assisted-dying lobby, which had relied heavily on the backing of then PM Keir Starmer. Burnham has correctly made clear that the question of assisted suicide cannot be separated from the state of palliative and social care, and that the funding and reform of the latter must come first. At the very least, that puts him at odds with the strategy of forcing the bill back through parliament and hoping to avoid scrutiny.

Those MPs backing this zombie bill need to think again. Making it acceptable to bypass parliamentary scrutiny because it is convenient to do so sets a very dark precedent indeed.