MPs will be debating whether to legalise assisted suicide on 29 November when Kim Leadbeater's Bill is up for its second reading. We do not yet have the text of the Terminally Ill Adults (End of Life) Bill, though I expect it will be published in the coming weeks.
Nevertheless, however the bill is worded, there are multiple good reasons not to change the law on assisted suicide.
'Assisted suicide' is the right terminology
Kim Leadbeater, assisted by the media, keeps referring to this as her 'assisted dying bill'. This is euphemistic language. The bill will not be about assisting people who are dying. That is the noble and worthy work of hospices. The bill is about assisting people to commit suicide. It will legalise for the first time helping someone to commit suicide by giving them some poison.
The NHS defines 'assisted suicide' as "the act of deliberately assisting another person to kill themselves." Currently this is illegal under the Suicide Act (1961). Kim Leadbeater's bill will change the law to make this legal in certain circumstances.
Here are twelve reasons why we should not legalise assisted suicide as proposed by Kim Leadbeater.
1. Legalising assisted suicide implies that some people are 'better off dead'
Prominent actress, broadcaster, and disability rights activist Liz Carr produced a superb BBC documentary, Better Off Dead?, which aired earlier this year. Carr interviewed multiple disabled people to obtain their views on the subject, as well as doctors who have administered assisted suicide to dozens of patients. The testimony of disabled people is that, sadly, people in our society already frequently speak to disabled people in ways that imply they would be 'better off dead'.
Should the law really be changed to lend legal legitimacy to the idea that suicide is the right option for some people? Once you legalise assisted suicide you have crossed a Rubicon. The state would then support aiding some people to end their lives. The law would therefore imply that some lives are not worth living. The only way to avoid this is to keep the law as it is and not legalise assisted suicide.
2. Legalising assisted suicide will put pressure on vulnerable people to end their lives
Health Secretary Wes Streeting has said that the state of end-of-life care in the UK means that the country is not ready for assisted suicide. He shares our concerns that people will feel coerced into requesting assisted suicide because of a lack of end-of-life support, or because they believe that they are a burden on others.
The Archbishop of Canterbury has also warned of the danger that "permission slips into being duty". The latest statistics from Canada show that over a third (35.3%) of patients who received Medical Assistance in Dying (MAiD), which is how they refer to assisted suicide, cited "perceived burden on family, friends or caregivers" as a reason for requesting MAiD. In Oregon, 43.3% cited being a burden as a reason for requesting assisted suicide.
Lord Walton of Detchant was an eminent neurologist who authored a Select Committee Report on euthanasia in 1994 that is still regarded as a gold standard. In his oral remarks to the House of Lords summarising the report he said:
"We concluded that it would be virtually impossible to ensure that all acts of euthanasia were truly voluntary and that any liberalisation of the law in the United Kingdom could not be abused. We were also concerned that vulnerable people—the elderly, lonely, sick or distressed—would feel pressure, whether real or imagined, to request early death."
Shockingly, respected commentator Matthew Parris argued in The Times earlier this year that it would be a good thing for vulnerable people to feel pressure to end their lives rather than be a burden on society! That is the very opposite of a caring and compassionate society.
3. Safeguards on assisted suicide do not hold
The experience of overseas countries that have legalised assisted suicide shows that promised safeguards do not withstand pressure for extension.
Once a society has decided to facilitate suicide for some people, a slippery slope ensues whereby more and more people are allowed to qualify as 'better off dead'.
In 2022, Canadian Paralympian and armed forces veteran Christine Gauthier requested a new wheelchair ramp to her house. She was instead asked if she had ever considered Medical Assistance in Dying (MAiD). Other veterans seeking support for their PTSD have also been offered MAiD unprompted.
Last year 2023, Kathrin Mentler, a 37-year-old Canadian from Vancouver, visited a hospital seeking help for her suicidal thoughts. Instead of support, she was asked "have you considered MAiD?". There are many other examples from other countries too where people without any form of terminal illness have been offered or received assistance in suicide. This is exactly what happens when society opens the door to facilitating suicides.
4. Judges cannot be trusted to protect life
It has been reported that the safeguards in Kim Leadbeater's bill will include requiring a judge to agree that the patient can be helped to commit suicide. Christian Concern and the Christian Legal Centre have worked on several end-of-life cases where a judge has decided that it is in the 'best interests' of the patient to die. This includes the lives of young children such as Alfie Evans, Archie Battersbee, and Indi Gregory, in all of whose cases judges ruled, against the wishes of the family, that it was in their 'best interests' to die.
Sudiksha Thirumalesh, by contrast, was not a child. She was 19 years old and had been determined by experts to be of sound mind. Sudiksha stated clearly that she "wanted to die trying to live" rather than have life-sustaining treatment removed from her. The Court of Protection declared that she nevertheless lacked mental capacity to make decisions about her treatment, while doctors argued that it was in her best interests for life sustaining treatment to be removed.
Earlier this year, the Court of Appeal overturned this ruling, declaring that she did have mental capacity after all. Nevertheless, her case had to come before Court of Appeal judges before sensible enough judges could be found who would not ignore her explicitly-stated wishes. We know from bitter experience then, that judges cannot be relied upon to provide a safeguard in end-of-life cases.
5. Autonomy is no justification for legalising assisted suicide
Proponents of legalising assisted suicide emphasise choice and autonomy at the end of life as a reason to justify changing the law. But we do not give people autonomy over life and death decisions.
Should we allow duelling because some people want the autonomy to settle disputes this way? Should we allow anyone to assist the suicide of another person no matter how old or healthy they are? Autonomy does not justify changing the law in such a significant way.
6. People change their minds
Related to the autonomy argument above, what happens when people change their minds? There are many people who have requested assisted suicide, or thought that they would want assisted suicide, only to change their minds. But death is final. There is no opportunity to reverse the decision once you are dead. The only way to protect people from a decision they may come to regret is not to legalise assisted suicide.
Palliative care clinician Dr Kathryn Mannix authored a revealing book, "With the End in Mind" in which she tells the story of former head teacher Eric who developed motor neurone disease. Being a man who was used to getting things done and being in control, he wanted to control his death and thought seriously about committing suicide in order to spare his family.
He then became frustrated that he couldn't demand assisted suicide in the UK. It turned out that as he faced his fears or realised that they were misplaced, he slowly changed his mind and became more determined to live. Some days before he finally died, he said this to Dr Mannix:
"This is important. People need to understand this. You need to understand this. I wanted to die before something happened that I couldn't bear. But I didn't die, and the thing I dreaded happened. But I found that I could bear it. I wanted euthanasia, and no one could do it. But if they had, then when would I have asked for it? Chances are I would have asked too soon, and I would have missed Christmas. So I'm glad you couldn't do it. I've changed my mind, and I wanted to tell you. I was angry with you because you're part of the System that says no to assisting with dying. But you weren't saying no to dying, you were saying yes to living. I get that now. I'm a teacher, and you need to tell other people this for me, because I won't be here to tell them."
Campaigner Nikki Kenward tells a similar story of previously supporting assisted suicide and then contracting a serious illness which left her bedridden and paralysed. Had the law allowed assisted suicide she believes she would have been killed. She is now a powerful advocate against changing the law. We need to listen to stories like this. Very often the fear is worse than the reality. Assisting suicide is a one-way street.
7. The patient-doctor relationship is compromised
If assisted suicide is legalised, then carers or medics could suggest assisted suicide to patients. This turns carers or medics into agents of death rather than trusted providers of care and medicine.
Can you imagine your doctor suggesting that they could help you kill yourself? This does happen in countries where assisted suicide is legal. Financial pressures on medical professionals would incentivise them to offer death over life. This would fundamentally undermine the trust that we should be able to place in carers and medics.
8. Medics do not support legalising assisted suicide
Related to this, recent polling shows that 80% of palliative care physicians are opposed to a change in the law. These are the doctors with the most experience of end of life care, whose voice should be loudest in this debate.
Many of these doctors would refuse to participate in assisted suicide. The Royal College of General Practitioners remains opposed to changing the law on assisted suicide. The British Geriatrics Society is also opposed to a change in the law. The World Medical Association is firmly opposed to assisted suicide and states that: "No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end."
Legalising assisted suicide would put additional pressure on an already stretched NHS to add yet another service with the added complexity of it being a service that many NHS doctors would object to on conscientious grounds. The vast majority of doctors want to provide care, not killing.
9. Numbers of suicides increase
In every country where assisted suicide has been legalised, the number of lives ended in this way has steadily increased every year. In the Netherlands in 2023, 5.4% of all deaths were by euthanasia. In Canada, the most recent statistics from 2022 show that 4.1% of all deaths were by euthanasia which makes it the most common cause of death after cancer, heart disease and accidental injuries.
Over 60,000 people have died from MAiD since the programme was launched in 2016. At these rates, suicide becomes normalised and therefore accepted in society for the most vulnerable people. This acts to increase the pressure on vulnerable people to end their lives.
In Australia, research published last year found that legalising assisted suicide failed to reduce rates of 'unassisted' suicide in the State of Victoria. In fact, since the law came into force, suicide among older people in Victoria has increased by more than 50%. Far from reducing 'unassisted' suicide rates, legalising assisted suicide leads to increased suicides overall.
10. Assisted suicide is against all major codes of ethics
The Hippocratic Oath taken by physicians for centuries promises: "Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course." The World Medical Association Declaration of Geneva pledges to "maintain the utmost respect for human life." All major religions are strongly opposed to assisted suicide. In 2005, faith leaders representing Christianity, Judaism, Hinduism, Buddhism, and Sikhism wrote an open letter to all Members of Parliament and of the House of Lords arguing strongly against any change in the law. Such universal agreement on the ethics of life and death should not be disregarded.
11. Legalising assisted suicide devalues human life
Campaigners for assisted suicide frequently argue that they want to be able to 'die like a dog'. Dogs and other animals are often euphemistically 'put down' when they become sick to 'put them out of their misery' – not that we really know how miserable they are or what they would want if able to express it. There are also costly veterinary bills to consider. The law, of course, distinguishes killing animals from killing humans. Killing a human is a serious crime. Killing an animal is not. This is for good reason. Humans are not mere animals. Human life is widely regarded as sacred. As Christians we believe that all human life is in the image of God – no matter how old or sick the person may be. The comparison with dogs reveals the underlying assumption that human life is no more valuable than animal life. Flourishing societies have the greatest respect for human life. Legalising assisted suicide devalues human life.
12. End-of-life diagnoses are not reliable
With the best expertise and experience in the world, end-of-life prognoses are notoriously unreliable.
Professor John Wyatt, who worked as an NHS consultant for more than 20 years, says: "there were many times when I and my colleagues were hopelessly inaccurate in predicting how many months or years a person had to live. In reality it is not uncommon for a person who is diagnosed with a 'terminal illness' to live on for years or to die within days. Diagnostic errors, spontaneous remission, new treatments, random events, all conspire to make the prediction of death a foolhardy business."
Baroness Finlay, who worked as a palliative care consultant for nearly 40 years adds: "Saying someone has a prognosis of six months is impossible, a year is even more impossible. I've had people who I thought were going to die really soon, and I met them in Marks and Spencer many months later." The reality is that we don't know the future. If assisted suicide is legalised there will be people who would have lived for years had they not been poisoned prematurely.
Conclusion
The above reasons are all strong and they are all good reasons not to change the law on assisted suicide. They apply no matter how the bill is worded. Most people have not really thought through the issues and the implications of legalising assisted suicide. This will include many of the new MPs in Parliament. We need to have a full national debate on the subject where all these arguments are aired. The consequences of legalising assisted suicide are plain to see from the experience of other countries. Britain must not follow their example.
Tim Dieppe is Head of Public Policy at Christian Concern.
