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
26th June
I’ve been reflecting a great deal on why the majority for the assisted dying bill was cut so severely. I rather despair of the MPs who changed their minds. They are clearly influenced by tendentious coverage in the press and the arguments of those campaigners who have always been opposed. Indeed, my mood has varied wildly, swinging between two poles—shouting at the radio and TV, fuming at the nonsense, and trying to understand.
The bill’s opponents don’t necessarily think they are telling untruths. Is there merit in some of their arguments? I’m a mixed bag, so that’s what you get here.
First of all, the main argument is going to be whether it’s right for the Lords to block or wreck a bill that has been passed, however small the majority, by the House of Commons.
It appears to me politically unwise for the Lords to block a measure not only approved by the Commons, but also—apparently—by the vast majority of the British public. That doesn’t make it wrong for them to do so. Indeed, if I were vehemently and ideologically opposed to a piece of legislation—if I thought it was really, really bad—then I’d feel there’s nothing wrong with the Lords putting it down. It could be argued that is part of their supervisory function.
But they might look at the damage they would do—to themselves, their reputation, and the reputation of the bishops in particular, the Lords Spiritual. They, at least, surely can’t deny they’re in part motivated by religion.
There’s an argument that paying for assisted dying will take money away from palliative care. To my mind, that’s oversimplistic. However, clearly the NHS is currently—when it comes to cash—a zero-sum game. So this is, in large measure, a question of any new spending robbing Peter to pay Paul.
I have to acknowledge that one of those making this argument is the health secretary himself, Wes Streeting. Of course he’s been a vocal opponent of assisted dying—perhaps too vocal. He wrote to the people of his Ilford constituency at the weekend: “Even with the savings that might come from assisted dying if people take up the service—and it feels uncomfortable talking about savings in this context, to be honest—setting up this service will also take time and money that is in short supply. There isn’t a budget for this.”
This is politically bold and brazen—but he is correct that the cash has to come from somewhere. So far, the huge beneficiary of this debate has been the palliative care sector, with MPs almost universally playing lip service to the notion that it needs far better funding. I find it difficult to understand why assisted dying is not considered part of palliative care—a small and minor part but a part nonetheless, just as the sector itself is only one part of end-of-life care.
Or at least I think I do understand—many who work in palliative care do not in fact oppose assisted dying but feel frustrated that the government will end up giving cash to the new project rather than their tried and tested approach. They worry that if they don’t get more support and a more coherent approach, then some terminally ill people will be pushed into killing themselves by default.
This is a legitimate fear at the edges of the debate. For instance, if the NHS was starved of cash to buy pain-killing morphine but was lavishly supplied with patient-killing drugs, then it would be a possibility that some terminally ill patients might be forced into ending their life earlier than they really wanted. But this a very thin thread to support the heavy burden of denying an early exit to those who desperately need to see an end to their plight.
“Palliative care” is derived from the Greek word for shield, “pallas”. I feel campaigners against assisted dying are using the sector to deflect rational arguments in their almost manic determination to keep people alive for every last second of their allotted span lest they offend in the sight of heaven. As one Montana senator put it: “God doesn’t give us more than we can bear.” Many doctors and patients might disagree.
In any case, both campaigners and the sector should be careful what they wish for. Remember Streeting’s “choices and trade-offs”? The palliative care industry may not want to get into a fight over money with other services when it’s a veritable black hole, capable of sucking in any orbiting resource. People’s emotional sympathies may lie, bluntly, more with caring for the young and middle-aged than old people, living longer and longer lives often with multiple expensive-to-treat sicknesses.
But this is a debate that certainly needs to happen. And as I’ve said before, social care has to be sorted out before anything else is done.
Another argument that comes up repeatedly is that the bill will quickly morph into something more “liberal”, where the state extends those who qualify. This “slippery slope” argument is wearisomely familiar, but it was put with fresh vigour in the Commons on Friday by Tom Tugendhat, who has a powerful rhetorical style that sometimes runs ahead of his powerful intellect.
It simply isn’t the case that the bill is based on the Canadian model, as he suggested. If Canada has seen a slippery slope, it’s been because the courts have ordered lawmakers to fall in line with the Canadian Charter of Rights and Freedoms, which is part of the constitution. Could that happen here? There certainly could be legal changes, and probably will be.
But despite some Tories’ atavistic fear of European legislation, exacerbated by hard-right newspapers’ determination to titillate their dwindling band of Euro-loathing readers, challenges to liberalise the legislation are unlikely to succeed here. The proposed new law is very tightly drawn—designed, in large part, to avoid not only the charge but the possibility of sliding down a slope, slippery or otherwise. It seems to me this argument against is a better debating point than a realistic fear, but I grudgingly accept there is a slim theoretical possibility of it being realised.
It’s because I saw this early on—and that MPs would not buy in to the assisted dying bill without such strictures in place—that I decided, reluctantly, that there was no point in pressing for “unbearable suffering” to be the criteria. It couldn’t be a more liberal law than this and still succeed with our illiberal MPs.
But we are not Canada.
In point of fact, the law is based on the model in Oregon.
Which is interesting, because one of most vehement groups attacking the bill, Care Not Killing, is making this central to their case. Minutes after the Commons vote last Friday, CEO Dr Gordon Macdonald proclaimed: “The current bill fails to protect vulnerable and disabled people from coercion. This is not hyperbole but based on what happens in the US state of Oregon, the model for this law. There, a majority of those who have ended their lives in recent years cite fear of being a burden on their families, carers or finances as a reason.”
I showed this to a supporter of assisted dying in that US state, whom I have talked to regularly but who does not wish to be named. This was their response: “Dr Macdonald’s description of Oregon’s experience with assisted death is deeply flawed and just plain wrong.
“The percentage of patients citing financial concerns in Oregon has never risen above 10 per cent and the average over the entire 27-year history of ODD has been 6 per cent. Similarly, the percentage citing burden on others has risen above 50 per cent in only a few years and over the entire history has averaged below half.
“Compare those numbers to the patients citing the desire to make their own decisions (control and autonomy), their desire to die with dignity rather than in a pool of their own vomit, and their desire not to live lonely and isolated from their community because they cannot participate in the activities of daily living. Overwhelming percentages of patients cite these three concerns year after year.”
They continued: “It is not at all surprising that some patients have financial concerns or concerns about being a burden. If they are disabled, those concerns may well have had significant negative impacts throughout their lives. But in making the decision to have control over their lives in the most fundamental possible way—life or death—patients are telling us loudly and consistently that what they most want is control, dignity and an end to the solitary imprisonment of their dying bodies.”
This is where we move into distinctly choppier and darker waters. Clearly, some people with only six months left to live do, at least in Oregon, worry that they may be an emotional and financial burden on their relatives. Is this an illegitimate concern? Anna Morgan, in a recent piece for Prospect, argued powerfully that this concern for community is, ironically, at odds with the neoliberal obsession with personal autonomy. It strikes me that the terminally ill people filling in these forms feel it is more acceptable to cite the feelings of others than their own suffering.
However, in Oregon is it possible for somebody who is terminally ill, with only six months to live, to be coerced by a greedy relative to shorten their life unnecessarily? Evidently, it could happen. But in the law’s 28-year existence there has never once been such an allegation, for all the eagle-eyed opponents.
But would it be possible here?
Yes, if that grasping son or daughter manages to fool two doctors and the panel, it is at least a theoretical possibility. But one where, if the culprit is discovered, a heavy prison sentence awaits them.
Whereas now, of course, nothing prevents a relative from encouraging suicide.
This is where many opponents move seamlessly to the argument that this applies not just to the terminally ill, but to any elderly person who may feel they are a burden.
Again, one can invent scenarios where this is possible—where somebody is elderly and does feel a burden, and is persuaded by cunning relatives or cunning doctors to consider ending their own life.
But they’d have to persuade the doctors—wrongly—that they were suffering from a terminal illness. It seems extraordinary to me.
This leads us to the hardest of hard cases: the disabled—who campaigners say feel really threatened by the medical profession. Already ignored, already vulnerable.
Is it possible, in some dystopian future, that the NHS—so strapped for cash—actually persuades someone to die rather than to live in order to save money, rather than to ease their suffering?
Again, the tightness of the bill and the way it’s drawn seem to be a clincher against this. This is something that campaigners persistently ignore. This is a bill for those who are already dying, who have very little time left to live, and want to end that time on terms of their own choosing.
It’s not a bill aimed at victimising the disabled.
Which leads me to the group of MPs who seem to be persuaded that assisted dying—and who knows what else—needs to be opposed until there is a perfect system. When they claim this bill is unsafe, they mean any assisted dying bill is unsafe.
Chi Onwurah said in the debate: “There seems to be an assumption that those who have been most unequal in life will suddenly be rendered equal in death, but the least valued by society are often those who value themselves the least.”
Munira Wilson was concerned that such a law would make some people distrust doctors even more than they do already. “The result will be either people choosing to end their life before they want to, or those who already have a huge distrust of the system—particularly those in minority and disadvantaged communities, whose voices have been heard the least in this debate—choosing not to access the care that they need, and dying an even more traumatic death,” she said.
Jess Asato put this point of view most clearly: “Coercion and abuse are real—they happen all around us all the time, whether or not we want to see them, as does feeling like a burden. Perceiving yourself as a burden is a common phenomenon associated with having a terminal illness, one that often leads to a desire to die.”
It is not simply the circular vacuity of this argument that so appals me—knowing you are going to die within half a year may make you wish to die, so you mustn’t be allowed to do so at a time you choose. It is more the assumption that people whose choices are constrained by “poverty, the patriarchy, racism, trauma, ill health, and state and societal failure” can never be trusted to make their own decisions, even when they are dying. Perhaps Labour MPs might turn their attention to attempting to eliminate these seven evil giants, for they will stand in the way of any and every reform. To declare that while they still exist dying people must be robbed of a final choice is as complacent as it is cowardly. So like the infamous curate’s egg, their arguments are good in parts, but spoilt by their flaws—and the suspicion of hidden motivations.
23rd June
Cynics used to say the House of Lords is where MPs go to die. Now some are arguing the second chamber should be where Kim Leadbeater’s bill receives its quietus.
There’s no doubt, after the narrow victory secured by Leadbeater on Friday with a much reduced majority, opponents feel emboldened. Catherine Robinson, spokesperson for the charity Right To Life UK, which campaigns against what it calls “assisted suicide”, said: “Although the bill passed the Commons, momentum remains with its opponents, with support consistently falling every time MPs have considered it. The bill leaves the Commons lacking a majority, with fewer than half of all MPs voting for it at its final stage.
“We will be fighting this bill at every stage in the House of Lords, where we are confident it can be overturned given its continued loss of support.”
Others will feel confident that would be a constitutional outrage. Esther Rantzen, the woman who extracted the promise from the prime minister that led to this bill, told the BBC that she did not “need to teach the House of Lords how to do their job”.
“People who are adamantly opposed to this bill—and they have the perfect right to oppose it—will try and stop it going through the Lords.”
But she said the duty of peers was to make sure “law is actually created by the elected chamber, which is the House of Commons, who have voted this through”.
We will hear a lot in the coming weeks and months of the proper duties of the Lords, but I have been reflecting on what happened on Friday and why. I have a lot of sympathy with my wife Jo shouting at a particularly virulent opponent on the radio: “Can’t you just put a sock in it for a moment?” I too feel fury at those continuing to peddle what I regard as falsehoods about the bill, and even more exasperation at those MPs I consider feeble-minded for falling for what is little better than a string of lies. And yet this polemical self is at war with what I regard as an imperative of good journalism—to understand the motives and worldview of those one profoundly disagrees with. So I’ve been trying to work out if there is any merit in their arguments. That will be coming soon.
