Well, it’s happened. The Terminally Ill Adults (End of Life) Bill has passed by a substantial margin of 55 votes. A win for Kim Leadbeater and the new intake of MPs, who were twice as likely to vote for the measure than those who’ve been around for some time. The debate was respectful and impassioned, an unusual combination. But it was also an insight into the thinking of British parliamentarians.
The word and the concept invoked by the Bill’s proponents was choice. “This is about choice”, said Kit Malthouse, the Conservative co-chair of the All-Party Parliamentary Group for Choice at the End of Life. Kim Leadbeater declared that “the right to choose does not take away the right not to choose”. Except it almost certainly will in the case of those who will be made to feel a burden. As Labour’s Rachel Maskell pointed out in what was among the best speeches of the debate, this is a measure for the strong, not the weak.
It will be the vulnerable, not the celebrities who have noisily backed the measure, who will bear the brunt of the choice of whether selfishly to continue to exist at the expense of their needy family and an overburdened health service, or whether to relieve everyone of that burden by asking to die. There will be victims of this Bill, and they will almost all be hidden. We shall be a more atomised society once we facilitate suicide; the old culture in which suicide was a criminal act may have been seen by some as cruel, but it did at least have a healthy regard for the sanctity of human life.
What was remarkable was the extent of sheer wishful thinking in the debate. Mr Malthouse declared that desperate people were right now committing suicide by refusing to take medication or refusing sustenance in the nearby hospital of St Thomas’s across the river from Westminster. Maybe so. But has it crossed his mind that some troubled anorexics will already have worked out that the way to obtain suicide on the NHS is to avoid eating until their condition is diagnosed as terminal; some of them will be vulnerable young women. And did anyone among the proponents bother to scrutinise the notion of “terminal illness”? Most serious conditions, if not addressed, are terminal. Diabetes can be a fatal condition if those who have it do not take insulin. Not all of those who take advantage of assisted suicide will be suffering from advanced multiple sclerosis or cancer. We shall, unfortunately, have the chance to find out.
And, as many MPs pointed out, the restriction to those with six months or less to live is illusory; there are rarely secure diagnoses in these circumstances. Many people given only a short time to live defy their doctors’ expectations and live for months and sometimes years more. Yet the Bill proposes this criterion with apparent confidence.
It was remarkable, and in other circumstances, would be heartening, to see so many MPs line up to support palliative care. Practically every proponent of the Bill, including Ms Leadbeater, declared that this wasn’t either/or, that the provision of assisted suicide was perfectly compatible with more and better palliative care. Two things. We should be providing excellent palliative care uniformly and proactively before we propose this death option; the first choice should be in the kind of care we receive at the end of life, not the choice of suffering or suicide. Second, the reality is that countries which introduce assisted suicide or euthanasia have slipped substantially down the global league of palliative care provision. As for the assurances that this service will be properly funded, as will hospices, do the proponents of the Bill think we are stupid? The Government’s recent increase in employers’ National Insurance contribution has fallen hard on hospices; keeping the provision we have will be a challenge, let alone expanding provision. The NHS has trouble providing a health service, let alone a death service.
As several MPs pointed out, this will fundamentally alter the relationship between doctor and patient. Doctors will be allowed to raise and discuss the possibility of assisted suicide with their patient; if they are opposed to it in principle, they will be obliged to pass the patient on to a more accommodating practitioner. The fundamental medical ethic, Do No Harm, will not survive this measure.
There are any number of holes in what are billed as the strongest safeguards in the world – the fact that the “medical practitioners” or people of good standing, who will sign off the request may not know the patient; the existing strains on the criminal justice system which mean there will be too few High Court judges adequately to supervise it; the likelihood of a court challenge from those with debilitating but not terminal conditions (including mental health issues) demanding equal access; the reality that very few doctors are expert in identifying coercive control of vulnerable patients, a difficult matter to reveal at the best of times.
Fundamentally, the issue is one of principle. The principle of the sanctity of human life has been undermined. We shall be allowed to kill the vulnerable, and that will change the common culture not just for those who ask for assisted suicide but for everyone.
However, what can be introduced by a private member’s Bill can be rolled back by a private member’s Bill. The MPs who voted for this Bill can be rejected at the next election; and indeed many of the new intake will be. The struggle starts now, to hold MPs to account for their vote today, and to work on reversing this appalling piece of legislation. Before the next election there should be an audit of how it works in practice, and those who voted for it must be required to stand behind it. We would say to our readers in England and Wales: look at the debate online if possible, find out how your MP voted, and let them know exactly what you think.
<em>(Photo by Leon Neal/Getty Images)</em>
