This is Prospect’s rolling coverage of the assisted dying debate. This page will be updated with the latest from our correspondent, Mark Mardell. Read the rest of our coverage here
2nd June
The start of the month that will bring a decisive vote on Kim Leadbeater’s assisted dying bill seems a fitting moment to reflect on how my views have—and haven’t—shifted since speaking at length with two people who believe the bill is deeply flawed. Their arguments are the kind that appear to have swayed one Liberal Democrat MP to change their mind, and have left another’s vote hanging in the balance.
In particular, I wanted to examine my own irritation with some of the points being made. Broadly, I’ve come away more confident that even those arguments I consider misguided are made in good faith. But, as ever, the nature of the politicians’ trade means MPs are often forced into logic-chopping that undercuts the strength of their sincere concerns.
I still feel that many of those opposing the bill are getting things out of proportion and fail to recognise that we are talking about people who are already at the end of their lives. Neither Rachael Maskell nor Katherine Sleeman convinced me that my overwhelming worry was misplaced. But Professor Sleeman challenged me in a way made me reflect on the weakness of my debating skills. It made me feel embarrassed about how inadequate my argument sounded.
But Maskell highlighted my point by repeatedly using phrases like “somebody might die early”, “die unnecessarily”, “die when they could have been treated.” I totally accept her argument that diagnosis is imperfect. It is the case that Esther Rantzen has lived through two more Christmases than she thought she would. That’s true. And all the doctors I know would admit that predicting when someone will die is informed guesswork. Within five years or two weeks, that is possible. But six months? Very hard. So this means that some people who are diagnosed with a terminal illness could in theory end their life sooner than they really need to. But all the evidence from places where assisted dying is legal suggests it is not something people rush into, and often those given the fatal prescription don’t take it.
When it came to Sleeman I found myself rather trapped by the argument I was trying to make—that MPs weren’t recognising sufficiently that the people they were talking about were those who were going to die anyway within six months, because they were terminally ill. It made me sound callous—and perhaps I was being callous to try to make the point that if someone is going to die with in six months, their earlier death within that time frame matters less.
But I do think there’s a qualitative difference between someone choosing to die a little earlier, perhaps a month or two sooner and someone choosing to die when they otherwise would have had a full life ahead of them.
That’s why the question, “How many wrongful deaths should we accept?”, feels like such a clincher. The problem is, while the obvious answer is “none”, that is never going to be the case. The trick is to make your opponent sound like an actuary—cold and unfeeling when in fact they’re just trying to be factual.
And this plays into a broader debate: society has never really confronted the question of how many deaths it finds acceptable. It dodges it. Not with assisted dying, nor with alcohol, nor with driving cars.
If someone said, “We’re going to legalise a new form of transport that will kill more than 1,500 people a year, and by the way 200 or so of them will be children,” who would dare say that was acceptable? And yet I don’t think anyone who comes top in the next private member’s bill ballot will take up the cause of banning the motor car.
So if we zoom out, I think we urgently need a wider conversation—a societal conversation—about what is and isn’t acceptable, both in general and specifically in relation to this bill.
That’s becoming clearer to me. One of the major flaws in the current moment is that we haven’t had that debate.
Maskell certainly has a fair point in saying that there’s a bit of a mess around the process, and that it is stretching the capacity of what a private member’s bill can do to the very limit.
But I don’t agree with her that it is Leadbeater’s fault.
I really do think that the government is to blame. I completely accept the argument made earlier in the week by the Hansard Society’s Ruth Fox. It’s not so much the time given to the bill, or even the level of scrutiny—which I’d still argue is much higher than that given to many, many government bills. The issue is that there was no attempt to reach any kind of consensus beforehand.
If Keir Starmer asked Leadbeater to sponsor the bill—which has never been confirmed—he seemed to have no understanding of just how hard passing it would be.
Conversations like these bring home how impossible it would be to reach a consensus on such a contentious issue. But talking things though, publicly thrashing out all the issues and examining a range of options, would have made it easier.
At least, as Fox suggested, you could vote on a range of options.
Sleeman raised the point that some of the most vulnerable people in society already don’t trust doctors. That’s important. But it cuts two ways.
First: is it actually the least vulnerable, the most privileged, who are most in favour of this bill? I think so. And those who are most opposed, or at least most anxious, are often worried not for themselves, but on behalf of others—the disabled, the vulnerable.
But this is not just true. It is a truism: the vulnerable are vulnerable. That’s the point. I just don’t think we can or should wait for a perfect society before allowing certain choices—even if those choices are only taken up by a few.
It’s the same as saying that palliative care has to be perfect before we can allow assisted dying. I just don’t accept that.
The second strand of the vulnerability argument is separate, I think. It’s about those who are already underusing medical services—ethnic minorities, poorer communities, people with a justified historic mistrust of healthcare. Sleeman is clearly worried about the low trust and low take-up in these groups.
But here’s the thing: are these concerns being projected onto the assisted dying debate? Are they being used as a reason to oppose it—when they are, in fact, part of a much wider and deeper social problem?
Yes, you could argue it’s ridiculous to spend money on assisted dying when we’re not properly supporting disabled people to live well. But you could equally argue it’s dreadful that we spend money on universities when some kids can’t read.
Where do we start drawing those lines? Where do we stop?
I am much more certain of my dislike of the attacks on Esther Rantzen for raising religion as an issue.
When Maskell says that the questioning of people’s religious values is “distasteful and, in fact, discriminatory,” and “to pick out [religion as] a protected characteristic as a mechanism—I just think it’s prejudicial,” I could not disagree more strongly.
She talks about the bill being dangerous, and it being the duty of MPs to safeguard the public. That’s based on evidence, she says. And that’s fair enough—even if we disagree over what that evidence says and what it actually points to.
But she really does dodge my point—that she could never, under any circumstances, support a bill that would legalise assisted dying—not if palliative care provision was doubled, not if the entire NHS budget was spent on this sector, not if all her own amendments were accepted. Not, I think, even if the disabled and most vulnerable were specifically excluded from the bill.
And that is my point. It’s also why I found it very difficult to articulate a counterargument rooted in something I fundamentally believe in. She was correct that my opposition to slavery wasn’t only about logic, but was rooted in my worldview (roots which have been nurtured and liberally watered by Christianity, as it happens). But the difference is that in theory I could have my mind changed by argument. But if you believe something because your God says it, then God would have to change before you do.
None of this is to say that religious beliefs aren’t valid. Of course they are—people’s religious convictions are absolutely a legitimate reason for taking a stand, whether in opposing or supporting legislation, or in any other sphere of life. But they are ideological beliefs that are unalterable even if the facts change and the evidence changes. And it is absolutely valid to want to know if some is making their decision on how to vote based on that prior position. How will any of this change my approach on 13th July? We’ll have to wait and see.
