Choosing Dignity: The Case For Assisted Dying
Written By Adiyat Zahir
November 29th, 2024, 2:15pm. Hundreds of individuals gather in Westminster, flaunting placards, banners, and even an effigy of a grim-faced High Court Judge. On the west side of Parliament Square is a tide of pink jumpers and pink beanies, provided by the Dignity in Dying organisation, swelling against the statue of suffragist leader Millicent Fawcett. Less than a minute’s walk away, around the corner, stand their opponents, wrapped up in woolly scarves, some wearing expressionless masks or rosary necklaces, chanting “Kill the Bill, not the Ill”. In the House of Commons, MPs have been debating Kim Leadbeater’s assisted dying bill, and are now filing out of the chamber to vote. All the campaigners outside Parliament are glued to their screens. Less than fifteen minutes later, the news reaches the first phones. A quiet murmur in the crowd gives way to a loud roar. There are cheers and hugs on the supporters’ side, as some break down smiling and teary-eyed. On the other side of the square, the opponents of the bill pack away the bits and pieces of their campaign, quiet and solemn. The ten foot puppet of the judge lies crumpled on the road.
In its current form, the bill proposes to legalise assisted dying as a choice for terminally ill, mentally competent adults with six months to live or less. This decision would have to be approved by two independent doctors and what was formerly a High Court Judge, which has since been amended to an expert panel consisting of a legal chair, a psychiatrist and a social worker. The bill is still a long way from becoming law – it currently remains under the scrutiny of a parliamentary committee, and is yet to progress through the House of Lords, which itself will present various hurdles and possible amendments to pass. In practice, it will likely be at least three years before any form of assisted dying becomes available to the public. However, even at its current committee stage, it remains a highly contentious debate, with each amendment garnering significant attention from both sides. We must listen to voices for and against the bill to reach a balanced and compassionate outcome. However, we cannot let our emotions and fears cloud our reason. It is imperative that we do not let voices of dissent deprive terminally ill individuals of a humane and dignified choice to avoid unnecessary suffering at the end of life.
Relentless Rebuttal from the Right
The decision to replace the High Court Judge with an expert panel has already stoked a great deal of concern, particularly among rightwing media – “Social workers to sit on 'death panels' in Labour MPs watered-down assisted dying Bill”, reads the Daily Mail, insinuating that the experts sitting on the panel are somehow eager executioners rather than qualified professionals committed to upholding patient autonomy. Another headline from the Telegraph affords particular umbrage – “The vile assisted suicide bill is on its last legs. Now let’s kill it off.” Such headlines are not only grossly disrespectful, but reveal the contempt with which certain opponents of the bill regard a highly sensitive issue which has caused grief and anguish to countless families on both sides of the debate. These articles do not reflect the nuanced discussion with which democratic debate should be characterised – rather, they seek to dehumanise, mock and vilify the very people this bill seeks to protect and empower. If the best argument against assisted dying is a crass pun about death, then the moral case of the opposition discredits itself through its own cynicism, lack of human decency and refusal to engage maturely with the issue at hand.
The Sunday Times, in particular, has been the champion in rightwing media of relentlessly opposing the assisted dying bill. According to one of its reports, medical experts have warned against changes to the bill, with one calling it a ‘slippery slope’. This same expert recently posted on X, “If this bill is legalised, as a doctor, I will not refer people onwards for lethal medications – this act of refusal to refer is illegal under this bill. Please could you tell me what will be my penalty? Will it effect [sic] my gmc?”
Refusing to Act – Conscientious Objection
The fifth clause of Leadbeater’s bill clearly outlines that any medical professional can opt to be a conscientious objector of assisted dying. What exactly is meant by ‘conscientious objection’? Put simply, conscientious objectors under no statutory or legal duty to participate in a medical procedure. This same system exists to protect doctors morally opposed to abortion and allows them to refuse reproductive advice to gay couples. However, a conscientious objector is required to refer the patient to another medic who can deliver them the treatment to which they are entitled. This ensures equitable delivery of services to all patients. If a doctor not only objects but then refuses to refer a competent patient to another medical professional despite the patient’s legal right to such treatment, then they are putting their own interests above the patient’s.
Herein lies the problem with our Sunday Times expert who would refuse to refer his patients to receive assisted dying. If refusal to refer to another practitioner were permissible in the case of assisted dying, why should it not be in other scenarios? If a doctor religiously objected to homosexuality, why could they too not deny them reproductive advice outright? Could a doctor not refuse emergency contraception to victims of rape? If we are to argue on the grounds of so-called ‘slippery slopes’, it seems the real slippery slope is that of the doctor who refuses to see past their personal values. To be a doctor is to be willing and able to offer the medical treatment which are beneficial and desired by the patient as part of a just healthcare system. We must view the case for assisted dying as any other case for potentially contentious medical procedures – with a nuanced and balanced approach, but ultimately as a part of a healthcare system bigger than any one individual. Rather than denying them their treatment, doctors could instead ensure their patients are fully informed of the alternatives to assisted dying: guiding them to access high-quality palliative care, informing them of the benefits and drawbacks of assisted dying, and making sure the patient does not feel rushed or pressured to make a decision. This ensures that the ultimate decision lies with the patient and protects them from having the doctor’s interests eclipse their own. We cannot, therefore, allow moral values or self-interests to corrupt the equitable delivery of health services.
Buried Beneath Bureaucracy
This is not to say that voices of dissent are to be disregarded entirely in the name of the greater good; it is crucial we hear all sides of the debate during the amendment process to make sure all the proper checks and safeguards are in place. The crux of the disagreement lies in whether there are enough safeguards to protect those who are vulnerable from coercion or ending their lives too soon. Those who most strongly oppose it rest heavily on the argument that, without proper protections in place, more and more people will die ‘before their time’, and that stringent legislation must therefore dictate each and every step of the process. But even in its current state, the UK assisted dying bill is far more robust than any other country with legalised assisted dying – no other country requires judicial approval for every case, for example. Furthermore, the bill only legalises assisted dying, which is categorically different to euthanasia. Assisted dying allows the doctor to prescribe a lethal drug which the patient must take themselves – fundamentally, the doctor cannot administer the drug themselves, unlike in euthanasia, where the doctor administers a treatment that induces death, such as a lethal injection. Therefore, a person suffering from a terminal illness which will increasingly deprive them of their motor functions may feel pressured to seek an assisted death elsewhere while they still have the ability to do so.
This is often cited by many Britons who travel to Dignitas, an assisted dying clinic in Switzerland, to end their lives – they say that they felt they had to go to the clinic while they were still able to travel, before their pain became too great for this to be an option. Paolo Marra, who travelled to Dignitas after developing terminal cancer said in a video left after her death, “I could have had more time with my friends and people who love me [if assisted dying was legal]. But instead, I will have to go to Dignitas on my own because I don't want them to be questioned by the police or get into trouble.” For her, “assisted dying is not about giving up. In fact, it’s about reclaiming control. It’s not about death. It’s about dignity.”
No-one disagrees that we should take the time to make sure critical safeguards are in place to create a robust bill which protects those who are vulnerable. But if such protections come at the cost of ever-increasing bureaucratic processes and legislative delays, we threaten to rob the option of assisted dying from the people who want it most. How much more pain and suffering can we justify as the assisted dying bill becomes further entangled in red tape? How many more people must experience their dignity and independence erode away before the bill is even passed into law?
Palliative Care & Assisted Dying – Are They Really At Odds?
Many opponents of the bill often argue that instead of legalising assisted dying, we should move our focus to improving palliative care. They contend that investing in high-quality end-of-life care can alleviate suffering without resorting to taking one’s own life. They may be concerned that the passing of this bill could undermine the investment in palliative care, shifting focus away from improving pain management for the terminally ill. Further still, they may fear that assisted dying is fundamentally conflicting with their medical values of compassion and beneficence. But this does not have to be the case. Presenting palliative care and assisted dying as completely morally opposed is a false dichotomy some of the bill’s opponents seem keen to proclaim. Leadbeater’s bill seeks to complement palliative care by recognising that even the best palliative care cannot always relieve every form of suffering. Supporting assisted dying does not mean abandoning palliative care; in fact, both can and should coexist to offer a full spectrum of compassionate treatment options.
In Canada, where voluntary euthanasia and assisted death has been legal since 2016, 78% of people who requested assisted deaths had already been in palliative care. Furthermore, it is naive to assume that palliative care is able to alleviate all suffering, no matter how good it may be. According to the Office of Health Economics, in the UK, even if every dying person had access to good quality palliative care when they needed it, 6,394 people per year would still have no effective pain relief in the final three months of their life. One palliative care nurse said that she changed her stance on assisted dying when she realised that some patients could ‘never be as free from suffering as they, or we, would have wanted’.
Elise Burns is one such patient, living in constant pain with terminal breast cancer, relying on two different forms of morphine and a high-strength co-codamol to manage the pain. Some days “they don’t touch the sides”, leaving her barely able to move. She says that she is “not scared to die but I am scared of a bad death – a long, drawn-out, brutal, horrific death. That terrifies me.” Who are we to deny the pain of individuals like Elise, who suffer such relentless suffering despite the best available palliative care? And when people suffer so horribly in the final months of their lives due to their illness, can we really stand by in the name of our moral values when providing help to end their agony is conspicuously the most compassionate course of action?
Facts, Not Fear-Mongering
Public support for the assisted dying bill is unwavering. YouGov polling holds firm - 68% of the public is in favour of legalising assisted dying. Protecting against the ‘slippery slope’ of assisted dying does not need to come at the expense of needlessly making it harder to access by introducing stricter regulations. Nor does it need to come at the expense of other parts of healthcare, such as by undermining palliative care. The whole point of the parliamentary committee debating the bill is to pay careful attention to the evidence and make informed decisions based on both medical opinion and empirical data.
Unsubstantiated claims such as the slippery slope only breed fear and antagonism, instead of reasoned concern. Where is the evidence that the passing of this bill will lead to coercion or needless death? In fact, the evidence is to the contrary, as evidenced by a significant number of countries which have already legalised assisted dying for the terminally ill. In the UK, we are fortunate to be able to study these existing frameworks, allowing us to adapt and integrate the best practices into our own legal framework. Where those laws start with provide only to those with terminal illnesses, that is where they stick. There is no slippery slope. That slippery slope only occurs where the law permits assisted dying in the case of ‘unbearable suffering’, and what constitutes unbearable suffering becomes a difficult line to draw.
But that is not the case here. Leadbeater’s bill is already more robust than in any other country with legalised assisted dying. There is no evidence in any of these countries that people are being coerced. In Oregon, where assisted dying has been embedded in clinical practice for more than a quarter of a century, not only has the law worked well and won over many of its opponents, including religious leaders, but palliative care has flourished alongside it (in 2024, Oregon was awarded the highest rating of all the US states in its capacity to deliver high-quality palliative care). Support for better palliative care and assisted dying should not and does not need to be mutually exclusive. The evidence is there. We just have to listen to it.
Conclusion (does this subtitle need changing?)
Even as you read this, it is likely that the legislation of the assisted dying bill is still undergoing line-by-line scrutiny. There is no disagreement that the current legal framework causes profound suffering for many people and those that they love, due to the lack of sufficient assistance. Who knows how many hundreds more people will suffer before the first assisted death takes place in the UK? However, there is also profound unity in calls for protecting those who are vulnerable and put at risk by this bill. If we do not become too entrenched in our own positions, we can create a nuanced, evidence-based framework which respects both individual autonomy and the need for oversight. If, and hopefully when, Leadbeater’s assisted dying bill is passed, it will provide individuals with access to a dignified death surrounded by their loved ones, where they may be remembered not by the final disease-stricken months of their life, but by the life they have led with pride. Even in the terminally ill who may not be sure of assisted dying, it will provide reassurance that if they were to experience a relapse, they are able to deal with it in a dignified way. Above all, Leadbeater’s assisted dying bill is a testament to every individual’s right to choice – the choice on how to live one’s life, and to die one’s death.
Read the rest of the edition here