Christian Jensen, a member of Central London Humanists, hosted a lively online event on the topic of “Assisted Dying: Your Questions Answered” on 19th October. Humanists from London, Watford, Bournemouth, Birmingham, and Stockport were present.
Assisted Dying is highly topical in the UK because of a Bill going through Parliament: the Terminally Ill Adults (End of Life) Bill. This Bill, introduced by Labour MP Kim Leadbeater, aims to permit terminally ill adults in England and Wales to seek medical assistance to end their lives under strict safeguards. The bill requires approval from two independent doctors and a High Court judge to ensure the patient's decision is well-considered and free from external pressures. The bill is scheduled for its Second Reading in the House of Commons on November 29, 2024.
Humanists UK “wholeheartedly support Kim Leadbeater MP’s Terminally Ill Adults (End of Life) Bill, which will ‘allow adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own life’.”
Panellists were Susan Watt, a science and philosopher editor who works on the Humanists UK campaign for assisted dying; Barry Newman, a retired medical doctor (intensive care) and a member of Dignity in Dying UK; Christopher Geake, a former priest who now works for the Non-Religious Pastoral Care Network; and Trevor Moore who is chair of My Death, My Decision.
The main questions addressed by the panel were:
Would vulnerable people be coerced into Assisted Dying?
Would legalising AD ‘send a message’ that disabled people’s lives are of less value?
Will legalising AD in a limited way lead to a ‘slippery slope’ where AD will sooner or later be allowed for anyone by choice?
Should we simply improve palliative care instead of trying to legalise AD?
What are our views on the Leadbeater Bill, as drafted?
After the event, Dr Barry Newman kindly sent us this written response to three of these questions (1, 3 & 4):
Assisted dying (AD) is very much in the news currently because of Kim Leadbeater’s Terminally Ill Adults Bill that proposes legalising assisted dying for those with a diagnosis of a terminal disease causing unrelieved suffering and who have less than six months life predicted. This Bill will only apply to adults with full mental capacity and specifically excludes disability as a reason for granting assisted dying. Antagonists to this bill present several arguments and three of the most prevalent are:
the “risk to the vulnerable” argument
the argument that adequate palliative care makes assisted dying unnecessary; and
the "slippery slope argument”
The claim is made that vulnerable people could be persuaded or coerced into applying for AD when it may be inappropriate or they really do not want this option. Who are these vulnerable people and what are the risks? Firstly, they are the elderly who, it is claimed, might be influenced into taking their lives to reduce a burden on relatives or leave them more in their wills. As the Bill applies only to those who have a clear diagnosis of a terminal illness with a very limited predicted lifespan, it simply doesn’t apply to anyone just because they are elderly. What about people who may be vulnerable to manipulation due to limited intellectual abilities? Those adults with special educational needs are already protected by very effective safeguarding laws, as anyone working in social care, the law, medicine, charities and education will know, and the Bill being considered requires two doctors to verify full mental capacity, a lethal diagnosis, less than six months predicted survival, plus the permission of a High Court judge who examines the evidence and can interview the applicant. Of course no safeguarding system is faultless, but the safeguards proposed in the current Bill will be the strictest in the world. People with full mental capacity have the right to refuse life-saving treatments for reasons that might seem quite irrational to most, but the law recognises their autonomy and requires these decisions to be respected. So denying people with full mental capacity access to AD appears to be at least inconsistent with the concept of autonomy. So I believe that the concerns about vulnerable people being manipulated into committing suicide through AD are baseless, and there is no evidence from other jurisdictions where assisted dying is legal that it is a problem.
Palliative care is offered to people who have a terminal illness that is causing suffering. The care involves medical interventions to manage pain and other distressing physical symptoms, as well as emotional, psychological and practical support. The UK is regarded as a world leader in providing palliative care. But even ideal palliative care often cannot provide adequate symptom relief for all – not because palliative care is scarce or poor quality, but because the drugs and techniques available to palliative care physicians and nurses are not sophisticated, have major side effects and are often ineffective. So people do continue to suffer, despite best care. Some palliative care representatives claim that all that is required is sufficient funding and there will be no need for AD. I think that this is disingenuous because it implies that money placed in their hands can somehow solve the problem of suffering at the end of life. The claim is also made that AD will undermine palliative care and reduce its funding. The evidence is that the opposite often happens. In countries where AD has been legalised, palliative care has usually improved. And even if palliative care was lavishly funded, not everyone chooses to accept palliative care, particularly in a hospice. Not everyone wants to have a drawn out death where tomorrow only offers more suffering requiring more palliation. Some might wish to decide for themselves when they have had enough, and many do. Tragically, up to 6,000 terminally ill people attempt suicide every year despite the availability of palliative care. Most do not succeed, and failed suicides are awful experiences for the person and their families.
I would like to introduce a rather radical idea here, an idea that would perhaps shock those working in palliative care currently. Is AD in fact a form of palliative care? Can giving the terminally-ill the right to choose how and when to die be beneficial in itself, even if they do not choose to use AD? There is in fact good evidence to show that giving terminally-ill people the power to decide on the time and manner of their death is hugely beneficial to their mental health and can even prolong life.
The “slippery slope argument” claims that safeguards and limits to what is legally permissible will be eroded over time and that the vulnerable and disabled will be at risk. However, there are very many legal protections and limitations in force in our society, and there is no evidence that these are regularly or carelessly broached in such a way as to place people at greater risk. Because something could happen, it does not follow that it will.
Finally, I would like to address the financial criticisms of introducing legal AD. Our current Minister for Health has claimed that AD will be a financial burden on the NHS, a claim that is not supported by any evidence or logic. In fact, in the past, the accusation has been levelled that AD is some dark plot to save the NHS money. Both cannot be right. I believe that both are wrong. The numbers will be so small that the financial effect will be undetectable.
Other responses
There was a broad consensus on the panel in favour of AD with the strict safeguards proposed in the Leadbeater Bill. If anything, the panel felt that the Bill did not go far enough, in that it limits assisted dying to the terminally-ill, but the view was expressed that the status quo is unacceptable and we can't do nothing. The question about legalising AD ‘sending a message’ that disabled people’s lives are of less value was responded to by saying that the Bill only applies to the terminally ill.
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