The briefing below lays out NDYUK’s concerns about the Meacher Bill and was used at the APPG for Dying Well webinar in July 2021
Assisted suicide bills introduced at Westminster and Holyrood
Baroness Molly Meacher, the chair of Dignity in Dying, has introduced a bill in the House of Lords to make assisted suicide legal. The second reading is expected in the autumn.
MSP Liam McArthur has laid a similar bill before the Scottish Parliament.
Not Dead Yet UK’s view
Those who support the Meacher bill and campaigners outside Parliament use the term assisted dying. That is a euphemism. This legislation would give doctors legal powers to help patients kill themselves, to commit suicide.
We don’t claim to speak for all disabled people. Some of our members used to be in favour of changing the law.
But we cannot see how safeguards will work well enough for us to feel confident that a change to the law will ensure disabled people are protected. This includes protection from coercion, from feeling a burden, from limited resources or from professionals subjectively deciding our lives are not worth living.
A review of how assisted suicide legislation is operating – in Oregon, Canada, Holland and Belgium – shows our fears are well-founded.
There are no organisations run by disabled people calling for the law to change.
Disabled people are living in difficult times. Cuts to social care and health services mean we don’t get the support that we need, and the pandemic has hit us harder than any other group. We can see the argument for a change in the law; but the current backdrop means now is not the time to support the Meacher bill.
We need help to live, not help to die. The law should remain as it is and protect the majority, rather than the few who might benefit from this bill.
The issue of ‘choice’
Freedom of choice has limits; such as where choice threatens the life or wellbeing of others. Legalising assisted suicide would pressure some of the most vulnerable people to end their lives. It would set a precedent for extending assisted suicide to other groups.
Society does all it can to prevent suicidal thoughts being enacted amongst the mentally ill and those who (temporarily) feel they cannot face the future.
Those seeking a change to the law say such ideals have no place when considering severely disabled and terminally ill people. If you can take your own life without assistance, society generally strives to protect you; but, if assistance to die is needed, they argue, it should be provided.
A fundamental shift in the relationship between doctors and patients.
The current blanket ban on assisted suicide provides absolute protection for disabled people. Medical staff cannot suggest an assisted suicide because it’s against the law. It makes the bond of trust between patients and doctors strong.
Legalising assisted suicide will irrevocably damage that relationship.
This debate is reinforcing negative perceptions of disability. It feeds into desires for a body beautiful and a perfect life untroubled by illness.
Guilt around being a burden on the family or society
Ill and disabled people may feel that they have a duty to die. Evidence from palliative care specialists shows most people who seek assisted suicide give ‘not wanting to be a burden’ as the main reason for seeking death.[1]
Some 59% of those assisted in their suicides in Oregon in 2019 stated that being a ‘burden on family, friends or caregivers’ was one of their main reasons for requesting it.[2] Some 34% of those who were euthanised in Canada in 2019 cited ‘perceived burden on family, friends or caregivers’ as one of their main reasons.[3]
Other people will face pressure from relatives to seek help to end their lives. Such pressure might be subtle, but it will be there.
This bill raises deep concerns about how disabled people are viewed by society. Many people believe people they do not know would be better off dead because of their perceptions of illness and disability.
The role of good quality palliative and social care
Those who support this bill ignore the evidence from professional medical organisations that the prognosis of date of death is extremely difficult.[4]
There are no concrete rules to determine whether a person is terminally ill and in the last months of life, or whether they are ‘suffering unbearably’.
The choice of people nearing the end of life or who are suffering might be very different if they received the palliative and social care they should get. There is no right in Britain to palliative care.
With modern medicine, the cause of much of the suffering is often not the illness itself – but unmet physical, mental or social care needs.
Nearly 14% of Canadians who requested legal medically assisted suicide in 2019 cited isolation and loneliness as a factor in their ‘choice’.[5]
The vast majority of doctors specialising in palliative and end of life care do not support a change in the current law[6]. We should listen to them.
The experience abroad: Evidence of the slippery slope
The idea that we would be embarking on a slippery slope is borne out by data and experiences from countries that have introduced so-called right-to-die legislation. Most laws abroad have been expanded and restrictions loosened.
The 2002 law in the Netherlands refers to ending ‘unbearable suffering’. However, the legalisation of euthanasia in the Netherlands “has contributed to a normalization of physician-assisted dying and… an expansion of its practice”.[7]
This expansion has involved acts of euthanasia that many would regard as abuses: the expansion of euthanasia from 12-year-old children to severely disabled new-born children[8]; and an expansion from voluntary euthanasia to non-voluntary euthanasia, particularly in cases of dementia where patients are incapable of giving consent[9] and chronic psychiatric patients, from 0 cases in 2009 to 60 cases in 2016[10].
Canada introduced assisted suicide legislation in December 2015. The Canadian Government now proposes that from March 2023 patients with mental illness alone and no other underlying issues can be given medical assistance to die.
Within six years the scope of the assisted suicide legislation in Canada has been amended twice. More people are now eligible and protections weakened.
A study in Belgium found that in only half the cases in Flanders were doctors assisting suicide reporting the death to a review committee as required by the law.[11] Around14% said they didn’t report a case either because they suspected the legal requirements had not been met, or they feared possible legal consequences.
Conclusion
Baroness Meacher’s bill addresses the needs of a small proportion of the population. And the cost is too high. The provisions of the bill, with their inadequate safeguards, open the door to dangers for disabled people which may literally prove fatal.
We don’t believe any parliamentarian will be able to put their hand on their heart and say ‘no disabled people will die because this bill is robust and fully protects everyone from any type of pressure or mistake’.
References
1 Hoffenberg R. Assisted dying. Clin Med 2006672–74. [PMC free article] [PubMed] [Google Scholar]
2 Oregon Health Authority Public Health Division, Center for Health Statistics Date written February 25, 2020
3 First Annual Report on MEDICAL ASSISTANCE IN DYING IN CANADA 2019
4 PMC Journal- A Systematic Review of Predictions of Survival in Palliative Care https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999179/
[5] First Annual Report on Medical Assistance in Dying in Canada 2019
[6] BMA Survey on Physician-Assisted Dying 2020
[7] Koopman J and Boer, T, “Turning Points in the Conception and Regulation of Physician-Assisted Dying in the Netherlands”, American Journal of Medicine Vol 129, No 8, August 2016[7]
[8] https://www.proquest.com/openview/2f5f978f061e5f38e3bf34c2b4e06d50/1?pq-origsite=gscholar&cbl=47659
[9] BMC Medical Ethics https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-019-0401-y
[10] BMC Psychiatry https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1369-0
[11] Reporting of euthanasia in medical practice in Flanders, Belgium: a cross-sectional analysis of reported and unreported casesBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5174 (Published 05 October 2010)
