Revealed: Government’s abandoned 2019 consultation on assisted dying

In 2019, the Ministry of Justice (MoJ) planned to conduct a ‘call for evidence’ on assisted dying, but the plans were abandoned. But now, four years later, Humanists UK is publishing the consultation paper for the first time. It obtained it through the Freedom of Information Act, and after the Information Commissioner’s Office (ICO) ordered the MoJ to deliver the paper after deciding that Humanists UK’s request was incorrectly refused.

Humanists UK recently welcomed the launch of the Health and Social Care Committee’s inquiry on assisted dying. It hopes the inquiry will listen to the voices of dying people, and take into account the enormous weight of international evidence that supports assisted dying. A citizens’ jury has recently concluded in Jersey, and another is just starting in France. A consultation on a Bill in Scotland has concluded.

In 2019, the former Secretary of State for Justice, David Gauke, instructed the Ministry of Justice to draft the paper to better inform parliamentary debate. The paper called for evidence about the positive and negative impacts of the current law in England and Wales, and asked for evidence from other countries and evidence about the potential impact of a change in the law.

Although the paper was completed, it was never released. No agreement was secured within Theresa May’s Government for the consultation to happen. And within a few months, there was a new Prime Minister, a new Government, and a new Justice Secretary.

Humanists UK Assisted Dying Campaigner Nathan Stilwell said:

‘We welcome the current parliamentary inquiry into assisted dying however this paper shows that foundations were laid for this work in 2019 and it is a shame it has taken so long for Parliament to properly examine it.’

‘90% of the public wants a compassionate assisted dying law. The people of England and Wales deserve the right to choice, dignity, and autonomy at the end of their lives.’

Humanists UK supports assisted dying for those of sound mind who are terminally ill or incurably suffering, and have a clear and settled wish to die.

Notes:

For further comment or information, media should contact Humanists UK Director of Public Affairs and Policy Richy Thompson at press@humanists.uk or phone 020 7324 3072 or 07534 248 596.

Humanists UK first requested the consultation paper from the MoJ in early 2020, after the change in Prime Minister/Government. It did so thinking that exemptions from the Freedom of Information Act related to ongoing policy development would by that stage have fallen away. The MoJ disagreed, so Humanists UK took the matter to the ICO. The ICO decided in Humanists UK’s favour last year, leading to the paper being published today.

Read the MoJ’s call for evidence.

Read the ICO’s decision.

Read more about progress on assisted dying over the last ten years.

Read the ONS study on suicides among people diagnosed with severe health conditions.

Read more about our campaign to legalise assisted dying in the UK.

Humanists UK is the national charity working on behalf of non-religious people. Powered by 100,000 members and supporters, we advance free thinking and promote humanism to create a tolerant society where rational thinking and kindness prevail. We provide ceremonies, pastoral care, education, and support services benefitting over a million people every year and our campaigns advance humanist thinking on ethical issues, human rights, and equal treatment for all.

On the anniversary of her death, we salute the legacy of the committed assisted dying campaigner Debbie Purdy

Debbie Purdy led an enviable life before multiple sclerosis changed it forever. As a music journalist Debbie not only had access to music gigs for free, but the venues wouldn’t allow her to pay for drinks. It was on one such occasion in Singapore that she met her husband-to-be, the renowned Cuban jazz musician Omar Puente, who went on to support Debbie tirelessly as she faced the challenging symptoms of her illness with considerable grit.

On the anniversary of her death, we remember Debbie’s powerful legacy in forcing the government, through her legal case in 2009, to issue guidance on the prosecution criteria for those who assist someone to die. She wanted to be sure Omar would not be prosecuted if he accompanied her to an assisted death in Switzerland.

The then Director of Public Prosecutions, Keir Starmer, issued the Crown Prosecution Service guidance to apply in deciding whether a prosecution is in the public interest, even if there is sufficient evidence to prosecute. There are sixteen factors tending in favour of prosecution and six against. You can see the details here: https://www.cps.gov.uk/legal-guidance/suicide-policy-prosecutors-respect-cases-encouraging-or-assisting-suicide

It is worth remembering the title of Debby’s heart-warming memoir, It’s not because I want to die. In choosing that phrase, she echoed what we know to be true: that those with incurable conditions or who are terminally ill simply want the ability to choose when and where their lives end, if they consider that their suffering has become intolerable. But for their suffering, they would want to live on. Our own late patron Paul Lamb, paralysed in a car accident, expressed a similar view in his campaigning.

Experience since the CPS issued its policy on prosecution, following Debby’s legal case, shows that it is not being applied in a consistent manner. Only this year, My Death, My Decision member Sue Lawford was arrested on her return to the UK, after she accompanied Sharon Johnston, a tetraplegic, to Dignitas.

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Assisted Dying inquiry launched

The Health and Social Care Committee has launched an inquiry into assisted dying in England and Wales. My Death, My Decision has strongly welcomed the news and hopes to work constructively with the Committee.

My Death, My Decision is campaigning for an assisted dying law that will allow adults of sound mind who are either incurably, intolerably suffering, or terminally ill, the right to have an assisted death. We hope the inquiry will examine jurisdictions like Spain, Austria and Canada that have laws that are not restricted to only people who are terminally ill. 

Assisted dying has not been properly examined by parliament since the House of Lords’ committees in 2004. In the 18 years since Parliament last investigated the matter, public and professional opinion have changed considerably. A poll by the National Centre for Social Research (NatCen) found that around 90 per cent of the British public favours a change in the current law. The British Medical Association (BMA) and the Royal College of Nursing (RCN), opposed a change in the law during the 2004 parliamentary inquiry but both have since re-evaluated their stance and changed their position to neutrality – as has The Royal College of Physicians. 

In the last two decades global opinion has shifted in favour of the option of assisted death. In 2004, only 38 million people around the world lived in jurisdictions where assisted dying was legal, whereas currently it has increased ninefold to more than 360 million people worldwide.

My Death, My Decision Chair Trevor Moore said:

‘I am so glad that parliament is at last examining assisted dying – something for which we have been campaigning for years. We know that many of the people we support, people who are incurably suffering and people who have witnessed a loved-one’s painful death, will welcome this news. We look forward to working with the committee and I hope they look at all the international evidence that shows that safe, compassionate assisted dying laws are possible.

‘Parliament will be following in the footsteps of Jersey, the Isle of Man, Scotland, Ireland and now France in finally tackling this issue. People who are incurably suffering deserve the right and freedom to make decisions about the end of their lives.’

Notes:

For further comment or information, media should contact Nathan Stilwell at nathan.stilwell@mydeath-mydecision.org.uk or phone 07456200033.

My Death, My Decision is a grassroots non-profit organisation that campaigns for a balanced and compassionate approach to assisted dying in England and Wales. As a growing movement, we are at the forefront of social change: nearly 90% of the public now favours a change in the law to allow adults of sound mind, who are either terminally ill or facing incurable suffering, the option of a peaceful, painless, and dignified death.

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Ireland to consider assisted dying law

Pictured: Department of the Taoiseach, Dublin, Ireland

Yesterday, the Republic of Ireland announced that it will examine the issue of assisted dying. A special committee of the Oireachtas (Irish Parliament), made up of nine deputies and five senators, will be tasked to carry out an in-depth study. Humanists UK welcomes this news and hopes that Westminster follows suit.

The committee will explore eligibility criteria, safeguards, and processes and will be capable of recommending legislative change.

In 2020, the Dying with Dignity Bill was submitted to the Dáil, the lower house of the Oireachtas. The Bill would allow people with terminal illnesses the option of an assisted death. It received widespread public support and passed its second stage by 81 to 71 votes. However, in 2021, during the next stage, the Justice Committee chose not to proceed, instead suggesting a special committee look at the issue in depth. That is what is now happening.

The committee will aim to complete its report within nine months of its first public meeting, the date of which has yet to be announced. The UK Health and Social Care Committee is expected to launch an inquiry into assisted dying in England and Wales in early 2023.

Assisted Dying Campaigner Nathan Stilwell said:

‘We are very pleased that the Republic of Ireland is moving forward in examining assisted dying. Jersey, the Isle of Man, Scotland, France, and now Ireland are all looking into this issue right now and Westminster looks poised to set up an inquiry in the new year. People who are suffering at the end of their lives desperately want to see progress.

‘People who are terminally ill or incurably suffering deserve the right to make choices at the end of their lives. Assisted dying has always been an issue of freedom and autonomy. But politicians need to examine the evidence, from at home and abroad, in order to make an informed decision on this vital issue.’

Notes:

For further comment or information, media should contact Humanists UK Director of Public Affairs and Policy Richy Thompson at press@humanists.uk or phone 020 7324 3072 or 07534 248 596.

Read more about a decade of campaigning for the legal right to die – at home and abroad.

Read more about our campaign to legalise assisted dying in the UK.

Humanists UK is the national charity working on behalf of non-religious people. Powered by 100,000 members and supporters, we advance free thinking and promote humanism to create a tolerant society where rational thinking and kindness prevail. We provide ceremonies, pastoral care, education, and support services benefitting over a million people every year and our campaigns advance humanist thinking on ethical issues, human rights, and equal treatment for all.

Retired NHS manager arrested, subjected to six-month investigation over assisted death

Sharon Johnston (left) with Sue Lawford (right) at Dignitas, Switzerland

My Death, My Decision can now disclose that one of our members was earlier this year arrested at 5.30 am, put in a cell and held for 19 hours, and then subjected to a six-month police investigation, for escorting a woman to receive a medically assisted death in Switzerland.

The person she assisted was 60-year-old Sharon Johnston from Cardigan, who became tetraplegic following a fall at her previous home in Aberystwyth. Sharon spoke publicly about her wish to have an assisted death in 2021 BBC documentary When Would You Want to Die?

Sue Lawford, Co-chair of My Death My Decision Wales, originally from London and now living in Cardiff, says that the saga shows the urgent need to reform the UK’s assisted dying laws. Sue will be talking to MPs and Lords about her experience today at My Death, My Decision’s event in parliament.

Sue accompanied Sharon on 14 February to Heathrow Airport, en route to Dignitas in Switzerland. On the way to the airport Sharon was contacted by Dyfed Powys Police and Social Services several times; she reassured both that she was okay.

Sue accompanied Sharon to Dignitas to provide support. When Swiss Police arrived at Dignitas, Sue and Sharon reassured them and they were satisfied there was no illegal activity.  They left without taking any action. Sharon then had a calm, peaceful death early on the morning of 15 February. Her last words were: ‘This is a lovely feeling.’

The same day, Sue returned home to Cardiff. On 16 February at 5.30 am she was woken by the Police. Sue was arrested for assisting a suicide and was placed in the back of a police van and driven to Cardiff Bay Police Station. Meanwhile, police officers searched her house for over four hours. They seized her phone, electronic devices, passport, and documents relating to her work. They also took away electronic devices belonging to her husband, who had no connection whatsoever with the case.

Sue was kept in a police cell for 16 hours, before being interrogated by Dyfed Powys Police, with a duty solicitor in attendance. After over 19 hours in custody, she was released ‘pending investigation’. That investigation was dropped after six and a half months, due to ‘evidential difficulties’. Sue says being under arrest for such a long time was detrimental to her mental health.

Her possessions, and those of her husband, were only returned at the end of the investigation. 

According to data from YouGov, 79% of people in the UK believe that people who provide practical help to someone to obtain a medically assisted death abroad should not face prosecution.(1)

My Death, My Decision supports the right to die for individuals who are of sound mind, have a clear and settled wish to end their life, and who are terminally ill or incurably suffering. Sharon was not terminally ill as a result of her tetraplegia. Swiss law allows both groups the right to die.

Sue Lawford said:

‘The entire situation caused immense stress and heartache for Sharon on an already difficult journey. It has caused me immense stress and anxiety since our return. The BBC had filmed an entire documentary on Sharon, whose decision was as clear as day. 

‘A change in the law in the UK is long overdue. And it shouldn’t be limited to the terminally ill. Sharon’s situation was intolerable, yet could have continued for many years, and there are countless others like her without the means to end their lives on their own terms.’

Trevor Moore, Chair of My Death, My Decision, said:

‘Sharon’s and Sue’s stories show why our current laws are completely broken. The lack of compassion they show in forcing an incurably suffering person to travel abroad for an assisted death, in the most difficult of circumstances, is shameful. For that to be followed by a heavy-handed criminal investigation of someone who acts out of the best of motives in providing help is appalling. That is why we urgently need a compassionate assisted dying law for England and Wales.’

Notes

For further comment or information, media should contact Nathan Stilwell at nathan.stilwell@mydeath-mydecision.org.uk or phone 07456200033.

Sue Lawford is available for interview upon request.

(1) All figures are from YouGov Plc. Total sample size was 1,731 adults. Fieldwork was undertaken between 17th – 18th March 2022. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).

Read more about My Death, My Decision’s campaign.

My Death, My Decision is a grassroots campaign group that wants the law in England and Wales to allow those who are terminally ill or intolerably suffering the option of a legal, safe, and compassionate assisted death. With the support of over 3,000 members, we advocate for an evidence-based law that would balance individual choice alongside robust safeguards and finally give the people of England and Wales choice at the end of their lives.

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Macron announces assisted dying citizens assembly

President Emmanuel Macron announced he will launch a citizens’ assembly on assisted dying. The French President showed his support for assisted dying while campaigning in the presidential election. Further details about the ‘convention citoyenne’ will be announced on Tuesday 13th September. Macron called it a move towards “more humanity.”

Macron had previously said he  would support having the Belgium model of assisted dying in France. Belgium legalised assisted dying in 2002 by allowing it for adults who experience ‘constant and unbearable physical or mental suffering that cannot be alleviated’. This is broadly similar to the law that we are advocating for, along with the Assisted Dying Coalition.

In 2021, a citizens’ jury on the island of Jersey overwhelmingly supported the introduction of assisted legislation, with 78% voting in favour. This led to Jersey’s States Assembly approving assisted dying ‘in principle’ and official legislation is expected to be introduced in 2023.

The Scottish Parliament has just released a report showing strong support for assisted dying. 78% of the respondents to a consultation in 2021 supported a proposed Assisted Dying Bill by Liam McArthur MSP. 

According to France Info, Macron told Jean-Luc Romero, honorary President of the Association for the Right to Die with Dignity ( l’Association pour le Droit de Mourir dans la Dignité – ADMD), that he is committed to passing an assisted law before the end of 2023.

Chair of My Death, My Decision, Trevor Moore said:

“The welcome announcement by Emmanuel Macron of a citizens’ jury on assisted dying for France holds a mirror up to the inaction of our government in addressing this fundamental human rights issue. His commitment to put political weight behind it should shame our politicians into respecting the opinion of the vast majority of the UK population who want a compassionate assisted dying law.

The time for procrastination is over and we call on the new Justice Secretary to instigate a Parliamentary inquiry or to set up a citizens’ jury, following the examples of Jersey, and now France.”

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Success! Assisted Dying Bill introduced on the Isle Of Man

In a great victory for campaigners, an assisted dying bill has been introduced by Dr Alex Allinson in the Isle of Man today. Members of the island’s parliament voted 22 to 2 for the Bill to be introduced. We have supported our friends “Let Me Choose”, a grassroots organisation in the Isle of Man who have been pushing for a compassionate assisted dying law. We have partnered with Let Me Choose through the assisted dying coalition.

The Bill would allow terminally ill, mentally competent adults the choice of an assisted death. A Citizen’s Jury in Jersey voted for a broader bill that would include the incurably and intolerably suffering. In December 2021, Jersey’s States Assembly voted to support assisted dying ‘in principle’.

A public consultation in the Isle of Man is expected to be held over the summer and a draft bill should be available by the end of the year. This will then be reviewed by a committee of the Tynwald (Isle of Man’s parliament).

Trevor Moore, Chair of My Death, My Decision, said:

“With Jersey, Isle of Man and Scotland having now taken significant steps on the road to an assisted dying law in their jurisdictions, Parliament at Westminster is lagging woefully behind. We know that public opinion is overwhelmingly in favour of a compassionate law for England and Wales, which is why we continue to call for an inquiry. That way, politicians can hear and scrutinise the evidence brought forward from all sides of the debate.

Our current laws are broken, protracting the suffering of the terminally ill and those with painful and incurable conditions. We call upon Parliament to do the right thing and give people the choice to end their intolerable suffering when they decide.”

Notes:

For any more information or comment please contact My Death, My Decision at: campaigns@mydeath-mydecision.org.uk.

Read more about My Death, My Decision’s campaign for an inclusive change in the law: https://www.mydeath-mydecision.org.uk/

My Death, My Decision is a grassroots non-profit organisation that campaigns for a balanced and compassionate approach to assisted dying in England and Wales. As a growing movement, we are at the forefront of social change: nearly 90% of the public now favours a change in the law to allow adults of sound mind, who are either terminally ill or facing incurable suffering, the option of a peaceful, painless, and dignified death.

The post Success! Assisted Dying Bill introduced on the Isle Of Man appeared first on My Death, My Decision.

Queen’s Speech: Assisted dying and inclusive assemblies bills fall

Baroness Meacher’s Assisted Dying Bill and Baroness Burt’s Inclusive Assemblies Bill have both fallen. This has happened because any private members’ bills that are still outstanding on the day of a Queen’s Speech have their progress halted. Humanists UK has expressed its dismay at the outcome.

The Assisted Dying Bill related to England and Wales, and reached the Committee Stage in the House of Lords. The Inclusive Assemblies Bill focused on England, and was brought by All-Party Parliamentary Humanist Group (APPHG) Vice-Chair Baroness Burt. It completed its passage through the Lords but ran out of time in the Commons, where it had been taken over by APPHG Chair Crispin Blunt MP.

A recent ONS study revealed that serious health conditions more than double the suicide rate, further showing the need for a compassionate, safeguarded assisted dying law.

Humanists UK Assisted Dying Campaigner Nathan Stilwell said:

‘The Government claims to take a neutral position on assisted dying, but simultaneously refused to give enough time for this important bill to be fully debated and voted on. This is a de-facto opposition to assisted dying and keeps our broken current law in place.’

‘We’re now calling for an assisted dying inquiry, as that would equip parliamentarians with the necessary knowledge to conduct an informed debate and vote on this important issue. The clear majority of the public wants a compassionate assisted dying law and for the Government to respect their autonomy.’

Meanwhile, the UK is the only sovereign state in the world to mandate Christian worship in state schools as standard – a bizarre and unfair anachronism in a society where surveys suggest that approximately 50% of the population are now non-religious.

Humanists UK Education Campaigns Manager Robert Cann said:

‘We know that the public is in favour of abolishing compulsory collective worship but by allowing the Inclusive Assemblies Bill to fall, the Government has failed to enable schools to keep pace with modern Britain. We would like to thank Baroness Burt and Crispin Blunt MP, the Bill’s sponsors in the Lords and Commons respectively. This issue will not go away – Humanists UK will ensure it is kept high on the agenda.’

Notes:

For further comment or information, media should contact Humanists UK Director of Public Affairs and Policy Richy Thompson at press@humanists.uk or phone 020 7324 3072 or 07534 248 596.

Read our amendment to the assisted dying bill.

Read the ONS study on suicides among people diagnosed with severe health conditions.

Read more about our campaign to legalise assisted dying in the UK.

Read our article on the Inclusive Assemblies Bill completing its passage through the House of Lords.

Read our article on the poll finding the majority of parents don’t think the collective worship law should be enforced.

Read our article on the Government saying it will ‘remind schools of their duty’ to carry out Christian collective worship.

Read our article on the UN Committee pressing the UK to repeal collective worship laws.

Read more about our work on collective worship.

In 2019, Humanists UK launched a groundbreaking resource hub called Assemblies for All, providing hundreds of free inclusive assemblies for schools.

Humanists UK is the national charity working on behalf of non-religious people. Powered by 100,000 members and supporters, we advance free thinking and promote humanism to create a tolerant society where rational thinking and kindness prevail. We provide ceremonies, pastoral care, education, and support services benefitting over a million people every year and our campaigns advance humanist thinking on ethical issues, human rights, and equal treatment for all.

Baroness Meacher’s Assisted Dying Bill Fails

Baroness Meacher’s Assisted Dying Bill has failed. This leaves the frustrating prospect of no debates, votes or upcoming legislation in parliament on assisted dying. A recent ONS study revealed that serious health conditions more than double the suicide rate, further showing the need for a compassionate, safeguarded assisted dying law.

The assisted dying bill in the House of Lords has fallen because the Government would not allow parliamentary time to debate it. The bill received over 200 amendments at the Committee Stage, and as it will not be included in the next parliamentary session the bill automatically falls. My Death, My Decision, along with Humanist UK, submitted an amendment calling for the creation of an inquiry into the impact of this proposed assisted dying legislation for people who are of sound mind and not terminally ill but suffering intolerably with an irreversible physical condition.

The Government claims to take a neutral position on assisted dying, but simultaneously refuses to give enough time for this important issue to be debated and voted on. This is a de-facto opposition to assisted dying and keeps our broken law in place.

An assisted dying inquiry would equip parliamentarians with the necessary knowledge to conduct an informed debate and vote on this important issue. The clear majority of the public wants a compassionate assisted dying law and for the government to respect their autonomy.

Trevor Moore, Chair of My Death, My Decision, said:

“The failure of the Meacher Bill is a reflection of the government’s refusal to engage with the critical social justice issue of assisted dying. If the government will not introduce legislation in Parliament, we call upon it instead to establish a parliamentary inquiry and implement its recommendations. That way, it can remain neutral.

An inquiry would enable expert evidence to be heard from other countries that have assisted dying, providing also the opportunity to test the often alarmist claims of opponents. With multiple jurisdictions now considering or about to implement an assisted dying law, England and Wales is being left behind. This needs to be remedied without delay, because inaction protracts unnecessary suffering.”

Notes:

For any more information or comment please contact My Death, My Decision at: campaigns@mydeath-mydecision.org.uk.

Read more about My Death, My Decision’s campaign for an inclusive change in the law: https://www.mydeath-mydecision.org.uk/

My Death, My Decision is a grassroots non-profit organisation that campaigns for a balanced and compassionate approach to assisted dying in England and Wales. As a growing movement, we are at the forefront of social change: nearly 90% of the public now favours a change in the law to allow adults of sound mind, who are either terminally ill or facing incurable suffering, the option of a peaceful, painless, and dignified death.

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Dr Henry Marsh: Why the opponents to assisted dying are wrong

I must start with a declaration of interest. I have advanced prostate cancer. I am currently in remission. I have operated on hundreds of  men who were becoming paralysed from prostatic  metastases in the spine, so I am what you might call an informed consumer.

Surgery only postpones paralysis in most cases – many of my patients would eventually have died bed bound, paralysed and doubly incontinent. This quite probably – though not inevitably – will be my fate. Metastatic disease in the bones can be very painful, but this possibility troubles me less than the loss of autonomy and dignity that comes with irreversible paralysis leading to death. Pain can be treated – although it should be remembered that the treatment can have very distressing side effects.  I accept that I might not opt for Assisted Dying (AD) in the event, were it to be available, but don’t we all want, if possible, to die peacefully, ideally in our own bed, surrounded by our family, without prolonged indignity and suffering beforehand? Legalizing AD is simply about fulfilling this fundamental human wish. It is also, after all, the aim of all palliative care.  Why are a small number of people so implacably opposed to AD, when opinion polls in the UK show an overwhelming majority in favour of it?

The opponents to AD produce little, if any, convincing evidence to justify their opposition. We might reply, quoting Bertrand Russell, that if you produce no evidence in support of your argument, we don’t need to produce any evidence to disagree with you. But it is important to understand that there is now evidence about how AD works in practice, as it has been legalized in so many countries.  As John Maynard Keynes is said to have asked: “When the facts change, I change my mind. What do you do?” 

I am not going to spend time going over the arguments in favour of AD in any detail as I want to concentrate on the arguments against it, but would make two points:

Firstly: There is what the lawyers call an a priori case for AD – suicide is not against the law, so you must produce good reasons as to why it should be illegal to help somebody do something that is not illegal.  It is worth pointing out that there is all the difference between assisting suicide for somebody who has made a considered request for it, and actively encouraging it. The 1961 Suicide Act, absurdly, fails to recognize this difference. The Serious Crime Act of 2015 has no problem with recognizing coercive behaviour in other areas of life. Encouraging suicide could easily be legislated against.

Secondly: There is clear evidence that there is an unmet demand for AD in this country despite good palliative care, as is shown by the fact that many people (who can afford it) go to Switzerland for an assisted death. The book Last Rights, produced by Dignity in Dying, has many stories of people suffering dreadful deaths despite good palliative care. Besides, as I argued earlier, the loss of autonomy and dignity that dying can so often involve is the commonest reason for opting for AD in surveys of people who have asked for it, rather than just “physical” suffering.

The UK Association of Palliative Medicine is implacably opposed to AD, but it is curious that in the increasing number of jurisdictions where AD is legal, most palliative care doctors have no problem with it. In none of these jurisdictions has there been any move to reverse the legislation – which suggests it is working well.

In most jurisdictions allowing AD, the people opting for it do not fall into “vulnerable” categories ( ie. poor, disabled, socially isolated or depressed, and without good palliative care available to them). The uptake of AD varies from country to country – but the numbers are small.  For instance, in the Netherlands,  about 4% of deaths are assisted, in the state of Oregon in the USA about 0.3%. Different jurisdictions have different criteria for permitting AD, different ways of administering it and different safeguards. The essential feature of the safeguards is to identify coercion, depression and lack of palliative care, and to establish that the patient has mental capacity. All jurisdictions impose a delay and time for patients to change their minds, before any request for AD is granted.

Given the a priori argument, and the evidence that a small, but significant number of people in the UK would opt for AD if it was legalized, why should their wishes be refused? 

The arguments against AD are principally that  people other than those who might currently  request it will suffer if it is permitted. These seemingly pragmatic arguments are used as a smokescreen for a deeper objection to AD as a matter of principle, rather than of practice. The aim is to sow doubt, which is something you do when you have little evidence, or the evidence is against you.

There are several “practical” arguments against AD:

  1. It will be abused, with people being coerced or pressurised into killing themselves.
  2.  It will be a “slippery slope”, making it too easy for “vulnerable” people to kill themselves. It is important, in other words, that suicide remains a difficult and distressing business for all concerned. (It is worth noting the recent ONS Survey that showed that people with non-survivable cancers have a suicide rate 2.6 times higher than matched controls). AD will become a cheap substitute for proper palliative care. Vulnerable people will be made to feel a burden and will kill themselves. There is a glib sound bite for this: “Right to die will become duty to die”.
  3. It will be impossible to design safeguards that will prevent these problems with any certainty.
  4. I will not waste time on certain opponents who are on record as invoking the shades of  Dr Mengele and Harold Shipman, or who claim that emotions are more important than rationality. AD is about patient autonomy, not about licensing doctors to kill patients, nor is it about paternalistic doctors knowing better than their patients as to what is in their best interests.

In England we are entitled to refuse lifesaving treatment, provided we have mental capacity. If there is a risk of coercion with AD, why is there no evidence that vulnerable people are being coerced into refusing treatment at the moment – to clear a hospital bed, for instance, or because relatives are eyeing up the family silver? Nor is there any evidence that significant abuse and coercion are taking place in jurisdictions where AD is permitted. The safeguards prevent it. Likewise, it is legal in the UK to administer “terminal sedation” if a dying patient is suffering intractably, even though the sedation will hasten death, on the grounds that the intent is to treat suffering and not to kill the patient. I am told that in modern palliative care if this is used, it is only after discussion with the patient and family, who make the final decision. In which case, you might ask, why cannot the patient ask for a quick end ( i.e. AD), rather than a slow one?

 There is no evidence that “right to die will become duty to die”. AD is not resulting in queues of people asking for it because they feel they have become a burden.  What is clear is that the current legal situation in the UK means that no right to die is a duty to suffer

There is no evidence that AD has resulted in declining levels of palliative care – AD should be seen as complementary to palliative care, and not in opposition to it.

All medicine is about making decisions in the face of uncertainty, using evidence to balance risks against benefits. We can never be entirely certain. None of the arguments against AD are being borne out in practice. The “slippery slope” is a deeply discriminatory argument that prioritises a small, hypothetical group of patients against a much greater number of real people whose suffering in their final illness could be lessened if their freely made request for AD was granted. Medicine is about preventing suffering as well as about prolonging life.

Medicine is all about evidence – surely the rational solution to the AD problem is to review the evidence and then legislate to permit it, subject to safeguards. As with any medical treatment, the evidence should be carefully collected and analysed, and the legislation changed accordingly if necessary.

The opponents to AH should be challenged to answer two key questions:

  1. Are there any safeguards which in your opinion would make AD acceptable?
  2. Given the strength of feelings on both sides of the argument, would you support an Official Inquiry ( for instance by the House of Commons Health and Social Welfare Committee ) into the matter?

I have little doubt that Assisted Dying will eventually be permitted in England – the evidence in its favour is so strong. I just hope that it is in time for me.

This script is a condensed version of Dr Henry Marsh’s speech at the Doran Lecture, 24th April 2022.

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