Assisted Dying Bill: What you need to know

MPs have voted in favour of the highly anticipated ‘Terminally Ill Adults (End of Life) Bill’ (the Bill) following debate on 29 November. The vote was held on a free basis, enabling MPs to vote with their conscience rather than being confined to vote with their party whip. 

The discussion around assisted dying is inevitably highly polarising and emotive, with both those in support and in opposition of change to the status quo as equally vocal and steadfast in their viewpoints as the others. Successive UK governments have erred on the side of caution, reluctant to make changes, with the last time the matter was formally debated by Parliament being in 2015. But legislative change may now be coming. 

The Assisted Dying Bill

The Bill was introduced in the House of Commons by MP, Kim Leadbeater. If the Bill receives sufficient votes to become law, it'll legalise assisted dying provided that the following requirements are first met:

• The individual must have the capacity to make the choice. They must be deemed to have expressed a clear, settled and informed wish, without having been subjected to any coercion or pressure.
• They must be expected to die within six months.
• Two independent doctors must assess the person at least seven days apart and be satisfied that they are eligible.
• A High Court judge must hear from one or both of the doctors. The judge can also ask questions of the dying person before making a ruling.

Following the vote in favour of the Bill at the second reading, it'll now proceed to committee stage.

Why do people want the law on assisted dying to change?

Whilst most agree that everyone should have the autonomy to make choices about their own bodies and healthcare, the key question is whether this freedom should stop short of the right to access life-ending medications, even where this is in a highly controlled and regulated manner and environment.

The main argument in favour of legalising assisted dying is to give people who are suffering the choice to die in a more dignified and comfortable manner than the current systems allow. The current best option for terminally ill patients is to rely upon palliative medicine; the aim of which is to help very sick people to be as comfortable as possible towards the end of their lives without hastening (nor postponing), their death. 

Why are people opposed to the Assisted Dying Bill?

Primarily, people are concerned that legalising assisted dying opens up new possibilities for abuse and exploitation of sick and elderly people who are some of the most vulnerable in our society. Though the Bill contains safeguards against people being coerced and pressured into opting to end their lives prematurely, there will inevitably be cases which slip through the net. This is of particular concern because the plans as currently outlined place so much weight on the determinations of doctors and judges who, though experts in their respective fields, are of course not immune from making human errors. And in the context of ending a life, there’s no coming back from any mistake.

There are also questions around how pressure and coercion might be identified and assessed. Encouraging a relative with a poor quality of life to consider assisted dying may be well meaning and in their apparent best interests, but at what point does suggestion become pressure? Additionally, how can the needs of the individual be safeguarded against relatives with concerns about increasing care costs eroding potential inheritance or the “burden” of providing physical care is becoming too much for them? With so many potential “risk” scenarios, this deceptively straightforward issue takes on a different complexion.

What’s more, there have been questions raised about how equitable the proposals are, as it's likely that those who can't access good health and social care are more likely to turn to assisted dying, when compared with those who have the resources to afford to explore the alternatives.

From a procedural perspective, prominent political figures, such as Labour MP Dianne Abbott and Conservative MP Sir Edward Leigh have expressed concerns over the pace at which the Bill has moved from initial publication to its second reading, as they believe that it hasn't given adequate time for scrutiny and debate. Additionally, they are uneasy at the experience-levels of the MPs who'll carry the responsibility for making this landmark decision. There are more new MPs in the Commons than ever before, many who have been in their new roles only a matter of months. This is also the first private members bill of the current parliamentary session, meaning that many MPs are engaging with this process for the first time.

Assisted dying globally

As the first country to permit any kind of assisted dying, Switzerland is frequently cited as the example of how this can work in practice.

 Assisted suicide has been legal in Switzerland since 1941 and the country is home to Dignitas, a non-profit organisation which provides physician-assisted dying, including for non-Swiss nationals visiting the country specifically to end their life.

The US state Oregon has had legal assisted dying since 1997, whilst various other states have subsequently brought in law based on Oregon’s model, including Washington in 2008 and California in 2015. More recently Canada, Australia and New Zealand have all legalised assisted dying.

Is the UK now ready to follow suit? Watch this space.

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