In Britain since the 1961 Suicide Act, a person can choose the time and manner of their death without being criminalised (if they fail). Plenty (mostly men) do so: 6,069 suicides in 2023, up on 5,642 in 2022, the highest rate since 1999. The data and analysis can be found here and here. There are some people who are unable to do so because of their almost total physical incapacity. Worth noting that all the very sad court cases brought to change the law have involved such people seeking legal approval for someone to do to them what they are unable to do for themselves. Not for those with the ability to commit suicide.

The courts have always ruled that changing the law on assisting a suicide is a matter for Parliament. Kim Leadbetter’s Bill to do just that has just been published, barely 2 weeks before its second reading, after pressure on her (it was originally going to be published only a week before). It contains 12,000 words, 38 pages, 43 clauses & 6 schedules with lots of references to subsequent regulations (as yet undrafted) to clarify necessary details. Only 5 hours have been allocated for debate. There is something unseemly about this rush, the lack of consultation and Leadbetter’s demand that MPs should vote in favour even if they are unsure with the details to be worked out later because there won’t be another opportunity for ages (untrue – there have been votes/debates on this issue 10 times in the last 27 years, 9 times since 2003).

Those details are a pretty fundamental change to the ethical basis of our approach to suicide – there is a Suicide Prevention programme – and the care of the seriously ill and vulnerable. She demands an approach which would be a red flag if pushed by a financial consultant or double glazing salesman. 

Why the rush and wish to avoid proper scrutiny, consultation and consideration of all the evidence from both here and abroad is the first question to be asked.

There are many troubling issues in the Bill. It is not limited to those in serious pain which cannot be alleviated or those unable to commit suicide themselves. It applies to everyone over 18. The only limitation is that the person must be likely to die within 6 months according to a doctor, an assessment hard to make with any accuracy and often wrong. It imposes a legal duty on the NHS to make this service available, effectively making it a money bill requiring government backing to proceed. It was not of course part of Labour’s manifesto. A medical practitioner cannot opt out of providing information about this option for reasons of conscience but must refer the person to someone else. They can tell patients of this option, even if the patient does not want to know (S. 4(2)), and at a time when they may be feeling vulnerable and suggestible. The NHS is not under a legal duty to offer palliative care so this Bill would shift the balance in favour of one option, with significant financial implications for the NHS, as well as for the patient and their family.

There are two particularly worrying aspects:

1. It creates an obvious conflict of interest between the NHS/doctors and their patients. It damages the trust which patients ought to be able to have in those providing them with medical care. It will be in the financial interest of the NHS for patients to take this option. How to distinguish between informing someone of an “option” and the sort of suggestion which can easily become or be perceived by the patient as coercion? It has taken society a great deal of effort and evidence to understand properly how coercion works and manifests itself, particularly in domestic settings. No-one who truly understood this would so blithely recommend obliging a person in a position of trust to present assisted suicide as an option.
2. The medical practitioner is meant to make an “assessment” that there has been no coercion. How? Medical practitioners have zero expertise in this, no qualifications or training for doing so, no ability, resources or experience (or likely time) to conduct the necessary inquiries into a person’s history, wealth, situation, family situation, family relationships, interactions with people who might have coerced the patient, let alone in determining whether coercion has been established, writing the report etc.,. Given that this assessment is to be made by the same person presenting the option and determining life expectancy, it enhances rather than mitigates the conflict of interest. This is not a safeguard. But a loophole and one which will inevitably lead to abuse. The same applies to the second doctor and to the judge. How will this be any more than rubber-stamping if there has been no proper investigation. Or is the judge supposed to do a separate investigation? He “may” do so but is not obliged to.

This proposal makes a fundamental mistake, namely, assuming that anyone can do an investigation or assessment simply because they are able to ask their way to the local bus stop. In reality, inquiring into such matters requires skill, training and sensitivity and, even with these, is much harder than it looks. It is not what doctors are there to do nor is it what they are trained to do. Far from a safeguard – let alone the best in the world as Leadbetter claims, the Bill contains no effective safeguards at all. 

There are plenty of other failings. The drafting is sloppy, feeling like the work of first year law students: formally correct with no spelling mistakes but lacking in thought or understanding of the existing law and court cases. It has disregarded relevant court cases or the current CPS guidance. It fails to consider what the role of the judges should be – see here for a thoughtful considered assessment on this aspect by Sir James Munby, former President of the Family Division. It fails to consider that if you create a legal right you inevitably create the possibility for a discrimination claim for those excluded from the law’s ambit (why should assisted suicide not be granted to those who are not terminally ill? Why permit one and not the other?). It fails to consider the evidence that whereas suicide is far more prevalent among men than women, coercive behaviour is more likely to be directed towards women and may be a particular problem for older women. It fails to take into account the views of those working in the palliative care sector or the disabled (both of whom have expressed serious concerns). It does not require a person’s family to be told nor is there a right of appeal against a judge’s decision in favour of death, even with evidence of coercion; (there is a right of appeal against a decision not to permit assistance). The whole Bill is skewed to pushing a patient along only one path.

Above all, it fails to appreciate that imposing a duty on the NHS to offer killing as an option fundamentally changes the ethical universe within which medical practitioners work, how patients and the vulnerable will be viewed and how they will feel themselves to be viewed by a state and its functionaries who have given ample evidence over decades that they will happily place financial considerations over what is in patients’ best interests and lie about this, no matter what might be said in public. If you want proof of this, read the Langstaff Report on the Blood Contamination Scandal: that scandal happened because the NHS wanted to save money when it came to blood transfusions and blood products. Having embarked on such a course it – and, bluntly, many of the medical professionals and others – then lied repeatedly about the consequences and deliberately chose not to scrutinise what they had done.  

How to treat people who are suffering and/or close to death is a difficult, sensitive topic. It deserves the greatest thought, analysis, consideration of all the potential consequences, ethical, legal, practical and emotional considerations and proper, extensive consultation and consideration of all relevant evidence. It merits something far better than a poorly drafted, ill-thought out bill lacking this pushed through on a Friday afternoon in limited time when many MPs are in their constituencies and at the apparent behest of a retired TV presenter.

Cyclefree