Do not believe the promises of assisted suicide 'safeguards'

(Photo: Unsplash/Kristina Tripkovic)

Assisted suicide is now back on the Parliamentary agenda again, with Baroness Meacher's Assisted Dying Bill awaiting a possible second reading in the House of Lords.

Campaign group Dignity in Dying cites the results of a public survey, commissioned by themselves, apparently in support of assisted suicide.

Needless to say, surveys in search of a predefined result should be treated with caution. As Not Dead Yet said, "Everyone, including disabled people, would prefer a death that is free from pain and other distressing symptoms. ... If the poll said, 'Should people who are lonely or depressed be assisted to poison themselves, we imagine the vast majority would say 'no'."

The danger is that this Dignity in Dying survey may reflect people's fears that palliative care will either not be available when the time comes, or won't enable the death with dignity for which we they would hope.

In their 2015 report, Ambitions for Palliative and End of life Care, the National Palliative and End of Life Care Partnership noted, "We know that distress from pain and symptoms can be relieved with expert palliative care, and that inadequate and misguided clinical interventions are features of patients' and their families' poor experiences."

But fears surrounding palliative care provision would immediately become justified, by way of a self-fulfilling prophecy, if assisted suicide were ever to be made lawful. Those working to bring about guaranteed access to high-quality palliative care would then have to contend with the availability of a cheap alternative quick-fix "solution".

The last parliamentary debate on this "solution" was in 2015, when the Private Member's Bill sponsored by Rob Marris MP was decisively defeated in the Commons, by 330 votes to 118.

The supposed safeguards against abuse included in that Bill were dismissed by MPs as "deeply flawed", "delusory", "laughable", as "so-called safeguards" or a "lack of safeguards", and as creating "gaping holes" and "a blank cheque".

And this time round?

The safeguarding provisions in Baroness Meacher's Bill are essentially identical - almost word for word - to those ridiculed in the House of Commons in 2015.

In fact, the only difference is that a doctor who has been providing their patient with palliative care is no longer explicitly identified as - but is still not prevented from being - one of the doctors who is allowed to deliver the lethal substance referred to in the Bill as "medicine".

These safeguarding provisions are based on a requirement for High Court approval before each suicide can go ahead. The High Court would have before it a signed and witnessed declaration that someone had a "voluntary, clear, settled and informed wish to end his or her life", as required by clause 3 and the Schedule to the Bill.

Two doctors would need to have countersigned the declaration form to certify that the person's wish was free from "coercion or duress".

A declaration of this kind would clearly be powerless to counteract, or even to identify, the kind of subtle and insidious - but nonetheless powerful - pressure which the mere existence of a legalised suicide service within the heathcare system would inevitably bring about, through the remoulding of public attitudes.

If our natural demise is inconveniently delayed under this regime, we can expect to hear the kindly but solemnly pressing enquiry, "Have you considered assisted dying?"

This question may not actually be vocalised.

It will not need to be.

It will be there in the background.

We'll be aware that "assistance" to die would eliminate the costs of our treatment and care, relieve our family of future anxiety and distress, and sometimes free up a hospital bed.

In short, it would enable us to stop lingering around guiltily as a selfish "burden" to all concerned.

Many families will say they don't look on their loved one as a burden. But we would still know that this is precisely what we are, against the backdrop of a practical, officially available and virtually zero-cost alternative.

Why wouldn't people just to do what will inevitably become the "decent thing"?

Other families, unfortunately, do not have the sick person's interests at heart. Former Court of Protection judge Denzil Lush has estimated that one in eight Lasting Powers of Attorney may involve financial abuse. According to a 2015 report by Age UK, 50% of financial abuse of elderly people in the UK is perpetrated by adult children. A sense of entitlement to an older person's money is expressed by relatives who "feel they will inherit it anyway" (page 8 of the report).

Concerns expressed by the Church of England are surely not exaggerated: "It would be negligent to believe that such people would not seek to exploit a change in the law in order to pursue their goals" (page 2).

Insistent moral pressure on people to solve the problem of their continuing lives would affect not just those conventionally thought of as "vulnerable", but anyone who is unable to stand out against society's new-found values when at their weakest, and who may even face dependency on those suggesting their early death, should they opt to survive.

Parliament has just legislated against controlling or coercive behaviour, including between different generations of the same family, in the Domestic Abuse Act 2021 (sections 1, 2 and 68).

Baroness Meacher's Bill is a charter for coercive and controlling behaviour, as well as toxic moral blackmail.

The idea that doctors could enquire into family circumstances and relationships in such a way as to verify, in any meaningful way, that a person's decision had been made "without coercion or duress", is of course ludicrous.

The thin end of a wedge?

Much has been written about the likelihood, if this Bill is passed, of a "slippery slope" towards increasingly wider criteria for assisted death. These concerns are surely justified, based on the alarming and much-publicised trends witnessed in other countries.

Probably a first step would be to remove the restriction, in section 2 of the Bill, to terminally ill people who are expected to die within six months. As the Church of England's position statement points out, "Beyond making an estimation of 'hours or days' towards the very end of life, it is simply not possible for doctors to state how long anyone will live; it would be wrong to place doctors in the position of having to estimate a person's life expectancy for the purposes of them accessing any proposed assisted suicide services" (page 3).

And yet this is exactly what the countersigning doctors are required to do under the Meacher Bill.

But there is another "slippery slope" here that won't have escaped our attention.

The time may well come when the High Court's review of statements opting for assisted death is recognised as just a rubber stamp. This scenario is far from speculative, given that the role apparently envisaged for the Court is the essentially administrative one of checking that a declaration form has been filled in properly.

The Court would remain blind to the more insidious forms of psychological pressure that could have prompted a declaration in the first place.

In that case, the obvious development would be to dispense with Court proceedings and hand the decisions over to NHS management.

An inauspicious precedent

We've been here before ...

As we have seen in relation to withdrawals of artificial nutrition and hydration from those in "vegetative states", a previous requirement for judicial oversight was discarded three years ago by the Supreme Court, on the assumption that a "regulatory framework" was in place to govern the withdrawal process.

We now know, following the research published recently in Clinical Medicine, that there is in reality no such "regulatory framework".

Certainly, there exists detailed practice guidance from the medical profession, containing expectations about internal and external scrutiny over withdrawal decisions, to guard against malpractice including unlawful 'life-shortening'.

But the absence of any such scrutiny in practice, as revealed by the Clinical Medicine article, means that standards of decision making laid down by this medical guidance are no more than aspirational, and come nowhere near a "regulatory framework".

So, who would the Bill really help?

The Meacher Bill's proposals would benefit the probably small number of those genuinely wishing to end their lives at a precise time of their own choosing, when they're no longer able to do so without enlisting an accomplice.

There are also some family members who could be relieved of anxiety or of caring responsibilities, and who in some cases would stand to inherit their relative's property.

An overstretched health service may welcome the cost savings involved, purely on pragmatic grounds.

Are these sufficient reasons for overturning the respect universally due to disabled, suicidal and vulnerable people, whom this dystopian scheme would put at particular risk of being cajoled into premature death through an ambient moral pressure?

We are liable to find ourselves in a society where the concept of human dignity had been decisively transformed: from an innate quality which grounded all human rights - as well as involving responsibilities towards others sharing the same dignity - into a subjective evaluation of personal experiences and fears.

In that society, suicidal thoughts would no longer automatically be seen as calling for urgent, empathetic support in response to mental anguish.

It would be a society in which any effective right to a natural death without fear of question or challenge would have been quietly put to sleep.