Assisted dying in the UK: compassion or manslaughter?
On Friday 29 November, MPs voted in support of Kim Leadbeater’s private members’ Assisted Dying Bill. This historic vote to legalise assisted dying in England and Wales potentially paves the way for a dramatic change in the law.
What is assisted dying?
A controversial topic; assisted dying is complicated and divisive, with supporters and opponents holding intractable positions.
Assisted dying is the act of deliberately assisting another person to kill themselves. This isn’t quite the same as euthanasia, which is the act of deliberately ending a person's life to relieve suffering.
For example, if a doctor were to administer an unnecessary drug to a patient with a terminal illness with the aim of ending their life due to excessive, or soon to be, excessive suffering, this would be euthanasia. But, if a family member were to provide someone who was dying with drugs that could end their life, knowing that is how they would be used, this would be classed as assisted dying.
There are two classifications of euthanasia:
Voluntary euthanasia – where a person makes a conscious decision and asks for help to die
Non-voluntary euthanasia – where a person is unable to make their wishes known (i.e. they're in a coma) and another person makes that decision for them
The law in the UK and abroad
Assisted suicide is illegal under the terms of the Suicide Act (1961) and is punishable by up to 14 years' imprisonment. Depending on the circumstances, euthanasia may be considered either manslaughter or murder. The maximum penalty is life imprisonment.
In the rest of the world, ten US states, Australia, New Zealand, Canada, Switzerland, Spain, Austria, the Netherlands and Belgium permit assisted dying. It looks likely that France will soon join the list, as President Emmanuel Macron announced recently that a new Bill on assisted dying has been drafted. In a French Citizen’s Assembly 2023 survey, 75.6% of participants voted in favour of assisted dying.
In Canada, its law on assisted dying was updated in 2021 to allow people with “grievous and irremediable” mental illness to request medical assistance to die. On February 29, 2024, legislation to extend the temporary exclusion of eligibility to receive medical assistance in dying (MAID) in circumstances where a person's sole underlying medical condition is a mental illness received royal assent and immediately came into effect.
Switzerland is famous for ‘suicide tourism,’ with people from other countries traveling there to end their lives with legal medical assistance. Assisted suicide is legal in Switzerland, as long as it is of the person’s free will and they are not influenced or pressured by the motives of family or friends. According to Dignity in Dying:
“Every eight days a Briton travels to Dignitas for help to die” and “Nearly 350 Britons have now ended their lives at Dignitas”.
The arguments for and against assisted dying
Reverend Giles Fraser is a strong opponent of assisted dying due to his personal experiences of depression and suicidal thoughts. This has caused him deep concerns about how the assisted dying law could be watered down to allow those who are otherwise physically well to end their own lives.
Credit: Photo: JANE MINGAY
Reverend Fraser knows that watching a loved one die is very hard for family members, and that a dying person might try to ease their suffering by choosing to end their life under that pressure. He is also concerned about how the government could perceive assisted dying as a method of making large healthcare savings. Finally, he believes that:
“Wrapped up in all of this is an assumption that, if you are old, or suffering, or mentally distressed, or disabled, your life is somehow of lesser value.”
Paralympian Baroness Tanni Grey-Thompson is also against a change in the law, arguing that nobody needs to die a "terrible death" if they have access to specialist palliative care. She told Sky's Sunday Morning with Trevor Phillips.:
"There are really big consequences if you change the law and the relationship between an individual and society fundamentally changes."
Baroness Grey-Thompson believes changes to assisted dying laws, such as those seen in countries including Canada, could risk stripping disabled people of the choice.
Rabbi Jonathan Romain is a strong supporter of legalising assisted suicide as an act of compassion. In 2014 he established Inter-faith Leaders for Dignity in Dying (IFDiD), an inter-faith group of clergy, now numbering 50 leaders, of many religious affiliations, who support the aims of Dignity in Dying.
A 2019 Populus poll, commissioned by Dignity in Dying, found that 80% of religious people – and 84% of the general public – supported a change in the law. On a recent episode of podcast The Moral Maze, Rabbi Romain stated his position:
“When you see [people] in trouble…you try and help them. That applies to life and it should also apply when approaching the end of life…It’s not about shortening life, it’s about shortening death.”
While many opponents are concerned about the potential for any possible assisted suicide law to be watered down, citing Canada as an example of subsequent updates to the law, he believes there are three criterion that will prevent this from happening:
“Terminally ill, mentally competent and of their own free will – it’s the three red lines.”
Jonathan is also concerned about the outsourcing of death to Dignitas – the assisted dying organisation in Switzerland – which many would consider financially prohibitive. A Dignity in Death study found that while more than half of Britons would consider travelling abroad for an assisted death, only a quarter said they could afford the average £10,000 cost, allowing only those in a fortunate financial position to end their lives at Dignitas. This provokes further concern about the lack of parity of access to assisted dying.
Dame Esther Rantzen, who has stage four lung cancer, has chosen to join Dignitas. She decided that if treatment for her illness is unsuccessful she would like to have the option to end her life there. She said her decision was driven in part by her wish that her family's last memories of her are not:
"painful because if you watch someone you love having a bad death, that memory obliterates all the happy times."
She said she believed people should be given the choice about:
"how you want to go and when you want to go."
The postcode lottery of palliative care
In the UK, expert palliative care is provided by hospices across the country. However, hospices are only partially funded by the NHS, and it is mostly through their own fundraising efforts that they are able to provide their services to the community. The disparity in funds has created a postcode lottery, meaning that depending on where a dying person resides, they may or may not have access to high quality end of life care.
Hospice UK, the national charity for hospice and end of life care estimates that:
“…one in four people currently do not receive the specialist palliative care they need because of marginalisation and exclusion, exacerbated by a postcode lottery of patchy, uneven services and funding. We believe that the assisted dying debate must include discussion about how we can make good palliative care available and accessible to everyone, whoever they are and wherever they live.”
While the World Health Organisation does not hold a view on assisted dying, it also supports the increased access to high quality palliative care, saying:
“Adequate national policies, programmes, resources, and training on palliative care among health professionals are urgently needed in order to improve access. The global need for palliative care will continue to grow as a result of the ageing of populations and the rising burden of non-communicable diseases and some communicable diseases.”
Hospice UK also makes clear the politically difficult position in which UK hospices find themselves on the subject of assisted dying:
“Hospice UK recognises that the views of staff, volunteers and trustees of our members will reflect the full spectrum of views on assisted dying that exist in society. We understand that people and organisations have strong opinions on this sensitive and emotive issue…It’s not our role as Hospice UK to either support or oppose a change in the law. Rather, our aim is to ensure our members have the opportunity to contribute their views, experience and expertise to this national conversation.”
Will the assisted dying law change?
The Assisted Dying Bill aims to legalise assisted dying for those who chose to, were terminally ill and mentally competent adults in their final six months of life.
The Bill requires that two independent doctors and a High Court judge be satisfied that any individuals requesting assisted dying were:
Over 18 years old
Terminally ill with six months or less to live
Fully mentally competent
Making the decision of their own free will
If they were satisfied that the criteria had been met, the individual would then be provided with a prescription for life-ending medication which they could then take when and where they chose.
MPs made history by voting in favour of the Assisted Dying for Terminally Ill Adults Bill on 29 November 2024. However, as it is a private member’s bill, brought by the Labour MP Kim Leadbeater, the government is technically neutral on the issue. Now departments are ready to begin assessments into the impact and workability of the bill in preparation for the next parliamentary stage. It could take up to two years for it to become law, with more than 200 amendments already tabled in the Commons and the House of Lords.
