Deirdre Heenan: There is a better way than making assisted dying legal

A landmark vote on legalising assisted dying is due to be held this Friday.

The term assisted dying is usually thought to include both clinician-assisted methods of dying, and assisted suicide (where drugs are self-administered following a prescription by a doctor).

For many MPs this will be the most important decision they will be asked to make in this parliament. As it is a free vote, they can decide whether to support or oppose it.

Previously, in 2015, an assisted dying bill was rejected by 330 votes to 118. However, in the intervening nine years the landscape has changed dramatically.

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Globally the practice has become more widespread and opinion polls show significant and increasing public support.

It has been legally available in the US state of Oregon for the past 25 years with little controversy and is legal in Australia, New Zealand and a number of European countries. Physician-assisted dying is a legal option for more than 150 million people around the world.

In March 2024, as leader of the opposition, Keir Starmer vowed to hold a vote on legalising assisted dying. In an interview with terminally ill TV personality Ester Rantzen for ITV News, he stated: “I’m personally in favour of changing the law, I think we need time, we will make that commitment”.

Whilst he didn’t give any indication of timings, he stressed that “delays just prolong this agony”. This was taken as a signal that this issue would be raised in his first parliament.

It is worth noting that despite prominent calls to make assisted dying legal, in the general election debates the subject barely merited a mention. The issue was conspicuously absent from the Labour manifesto. Meanwhile, the Conservative party pledged to “respect the will of parliament” on assisted dying, and the Liberal Democrats pledged to allow a free vote.

There are many strongly held views on both sides of this highly charged, emotive debate.

Of course, no-one wants to watch a loved one suffer and die in pain. Where is the dignity in that? If an individual is terminally ill, shouldn’t they be allowed to decide when they depart this life? In an ideal world shouldn’t we be allowed to depart this earth drinking champagne and toasting our loved ones?

We do not, however, live in an ideal world. There are fundamental ethical and moral issues at the heart of this debate that have not been properly considered.

In theory, it might sound like a sensible and humane decision to legalise assisted dying. But this is a complex issue that should not be ushered in through a rushed Private Member’s Bill, subject to insufficient scrutiny.

Laws reflect a country’s principles; they send social messages. Regardless of the intentions, an assisted dying bill would alter how society views and values older people, disabled people and those with poor mental health.

Implicitly it conveys a message that if assisted dying is an option, it should be considered as a course of action. If Covid-19 taught us anything, it is how some groups of people are deemed ‘more worthy’ than others.

Safeguards, no matter how well designed, are an assertion of what should happen in a perfect scenario. It goes without saying that no-one should feel pressured, or undervalued, or a burden, and decisions should always be voluntary.

Alas the reality is coercive control and family dynamics may mean vulnerable people are pressured to end their lives prematurely because of disability, age or a range of other reasons. One in six older people in the UK are believed to be affected by elder abuse. And what of dementia? How would people with dementia express their wishes? Would we be comfortable with someone acting on their behalf?

Evidence from across the world demonstrates that once the principle of assisted dying has been accepted and normalised, the eligibility criteria widen. If it is available to the terminally ill, then why not disabled people, people with poor mental health, or those who are suicidal?

An extensive body of research shows that at the end of life, the majority of people want access to high quality, timely, coordinated palliative care that can mitigate suffering and pain. Yet our ability to deliver this remains elusive.

The provision of palliative care is fragmented, with substantial variation in access to specialist care. A postcode lottery exists for end-of-life care which is neither fair nor equitable. People from less affluent areas are more likely to die in hospital and experience difficulties obtaining pain relief drugs.

Assisted dying legislation would have major implications for the current system of palliative care. Inevitably it would mean that a system that is already underfunded and unable to provide services would be further eroded. We should be calling for universal access to high quality generalist and specialist palliative care, rather than legalising assisted dying.

Finally, in this society the GP-patient relationship is the cornerstone of health and social care. Patients can speak freely to their doctors, expressing fears about their illnesses, vulnerabilities or disabilities, secure in the knowledge that these medics are there to help, support and advise.

Legalising the provision of lethal drugs to patients is fundamentally different from withdrawing life-sustaining treatments.

If doctors had the power to end patients’ lives, would this change the dynamic of the relationship? Undoubtedly.

We should not go gently into a move that represents an existential threat to the marginalised. There is a better way.

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