Coalition against killing

How might the assisted suicide bill play out in the UK?

It has been a dark week in the UK. On Tuesday 17th June we saw decriminalisation of abortion from 24 weeks up to birth and on Friday the passing of the assisted suicide bill.

There have been unlikely alliances formed in opposition to this bill, for example covid zealot and palliative care consultant, Rachel Clarke has been excellent in vocalising her opposition.

I was at parliament Green protesting on Friday alongside many different people. Those supporting the bill were easily identifiable in their corporate pink matching T-shirts with their expensive professional billboards. Many of them had a picture of a person they knew who had suffered in dying and whose story had motivated them to campaign for dying as a solution to that suffering. Those opposed to the bill were a more diverse group with more than one motivation for opposing the bill. None denied that suffering in death is real even if rare. With good palliative care pain relief is achieved in 73-87% of cases with partial relief of pain in 99.8%. Interestingly, there was a fair amount of mingling and respectful discussion between those for and against the bill.

For both issues there were broadly two camps: the head and the heart. This was true for both the abortion issue and the medicalised suicide issue. The head camp for the former included all sorts of pragmatic problems from risks of female infanticide, incentivising women to postpone treatment to qualify for 52 weeks of paid maternity leave which happens after a stillbirth from 24 weeks gestation and the danger to the mother of medical abortion at home. There were even pro-choice arguments that the delicate compromise that had been accepted for so many years based on the premise that earlier pregnancies were qualitatively different to later ones is being smashed to pieces. The church was neglectfully almost silent on the topic with one spokesman making an argument that could be used to defend any crime: “Some women in desperate circumstances make choices that many of us would struggle to understand. . . Such women need care and support, not criminalisation.”

For the assisted suicide bill, the heart camp were opposed to breaching a moral red line where the deliberate taking of life is considered wrong on principle. Many in that camp are Christian. Others see the danger of crossing a Rubicon where a clear distinction between right and wrong is lost and becomes irretrievable as we descend down a slippery slope as has happened in Canada where 1 in 20 deaths (15,343 out of 326,571 annual deaths) are in 2023 were “medically assisted” or in Belgium where children are now being euthanized. Legalising assisted suicide invites a cultural shift toward utilitarianism. When the worth of a life is measured through only an economic lens the importance of human dignity is lost and our relationship to one another forever changed.

The head camp had a variety of different reasons to oppose the assisted suicide bill.

1. Poor legislation

There were those who can see how poorly written the bill is from a legislative point of view. They are not opposed to assisted suicide in principle but opposed to bad law making. (It surprises me given the strong arguments around how poor the bill is in this regard that opposition parties did not feel they could whip to oppose the bill).

2. NHS is not safe

Blanket Do Not Resuscitate orders were issued in 2020 to, in some cases, anyone over the age of 65, anyone in a care home and all people with learning difficulties. Do not resuscitate should mean just that. Resuscitation is rarely successful and in many cases where it does succeed it is followed by a period on intensive care which not everyone is fit enough to survive. Therefore, for some patients resuscitation is a route to a less dignified and prolonged death rather than a life saving procedure. It is entirely appropriate that a choice be given to patients who are not fit for intensive care to avoid this outcome. It is never appropriate to make these decisions without consent nor to make them based on arbitrary criteria. Worse, it did not just mean DNR or “do not resuscitate”. Unfortunately, DNRs also affect broader healthcare provision and in 2020 the blanket DNRs were issued at the same time as hospitals refused admission to anyone with a DNR. As a result healthcare was denied to those parts of our society that most need it. One consequence was that people with learning difficulties had a mortality rate attributed to covid that was 3.7 times too high for their age. Even after accounting for every physical health problem the rate was too high. Respiratory viruses do not discriminate based on mental capacity but people certainly do.

Covid also saw an escalation in the use of end of life medication. Protocols gave a binary choice that when someone deteriorated if they were not fit to be ventilated then were to be given midazolam and morphine. Both these drugs suppress respiration and could have turned a survivable acute respiratory infection into a lethal one.

With conversations about decisions to resuscitate being common already and with a relaxed attitude about the use of medication that might shorten life patients need stronger protections not weakened ones. In an environment when doctors poison their patients to death, what will those conversations about resuscitation decisions really look like and what will they feel like for patients?

The doctors present were all there to protest the bill.

3. Disabled at risk

Many people are most concerned about the impact of enabling poisoning on the NHS on the most vulnerable in society. Many people already articulate feeling like a burden at times and this bill risks legitimising that fear and framing death as a selfless escape from dependency. In Canada the disabled are frequently pressured to end their lives and poverty has even been given as a reason for a medically assisted death. Numerous disabled groups were present to protest the threat this bill presents to disabled people. Being a burden featured in the reasoning behind more than 45% of Canadian medically induced deaths in 2023.

Table 1: Reasoning given for medically assisted death. Track 1 is where death was “reasonably foreseeable” and Track 2 is where death “was not reasonably foreseeable”. In 2023, 1 in 25 medically assisted deaths were in Track 2. (Also note how pain is conflated with fear of pain to inflate the numbers).

4. NHS at risk

To enable doctors to give poisons to end people’s lives the principles upon which the NHS was founded will need to be breached.

5. Palliative care at risk

Palliative care is already woefully underfunded, dependent on charitable giving to survive and without capacity to reach all in need. The current legislation does not allow for hospices to opt out of providing a death option which will mean the precious supply of this service will be diminished further still as catholic hospices are forced to shut down and other providers resign on ethical principle.

It is possible to agree with all these points - they are not mutually exclusive.

As the day progressed, one by one suggested amendments were almost all defeated.

The changes since its second reading include:

1. Medical practitioners cannot proactively raise assisted dying with people under 18. Open discussion is only allowed if the individual brings it up themselves.

2. Employers will be prevented from penalising staff who assist in delivering assisted suicide.

3. The requirement for high court approval was removed.

4. The establishment of a disability advisory board to uphold safeguards for those with learning disabilities, autism, or mental health conditions.

Amendment NC16 to block access to assisted dying for people whose decision was significantly influenced by feelings of burden, mental illness (including depression), disability, financial issues or lack of treatment. When news of that defeat reached us in the protest, we began to lose optimism about what the end result would be.

At around 2:30pm the result came through and a gleeful cheer erupted from the pink protestors. Something of the spirit of the opposing groups is I hope captured in this video.

The silver linings at the moment are as follows:

1. Because the bill has been so uncompromising the allegiance of head camps remains intact. Not one of those reasons to oppose has been dealt with. The opposition remains as broad as before.

2. The House of Lords has been handed a shoddy piece of legislation. Shockingly those that voted it through admitted this calling it “a mess of a bill”. Politicians had failed to engage with the details. Consequently, the Lords may feel justified in rejecting it outright or in causing substantial delay to its implementation.

3. Even if it passes the intention is that it would not be implemented until 2029. That will make it a key election issue.

4. Six Cabinet ministers, around one-third of the Cabinet opposed the bill. The Health Secretary, Wes Streeting, has been particularly vocal in expressing concerns. The other minister who would be responsible for its implementation, Justice Secretary, Shabana Mahmood was also opposed.

In church today, I came away with part of one verse really resonating “whoever is not against you is for you.” I do wonder if any of the head camp objections are dealt with over the coming years how many of those currently opposed on rational grounds might find themselves joining the heart camp after all.