The case for assisted dying must be honest – the Leadbeater Bill is not

Labour MP Kim Leadbeater presenting Terminally Ill Adults (End of Life) Bill to Speaker of the House of Commons Sir Lindsay Hoyle
Labour MP Kim Leadbeater presenting Terminally Ill Adults (End of Life) Bill to Sir Lindsay Hoyle - House of Commons/UK Parliament

Maybe my advancing years are drawing them to my attention, but are there more television commercials urging us to prepare for dying – and not just on daytime TV, the usual forum for advertisers to target people of a certain age? They invariably involve a cheerful, healthy-looking couple talking to one another about how they have signed up to an insurance plan that will cover all their funeral expenses “when the time comes”.

They have even picked out the casket and the interment plot. There is one company called Simply Cremations where you can cheerfully book ahead for your final immolation. This all seems eminently sensible if a touch morbid. We are all going to die after all so why not make the arrangements in advance? Many people do so, picking their favourite hymns and Bible readings or seeking out a humanist plot to rest for eternity in a field and a wicker basket.

We were once surrounded by death, and feared it, but now tend to hide it away or treat it as another lifestyle choice, like a holiday, albeit an extended one. Yet while we are increasingly content to plan for what happens after our deaths, many remain distinctly uneasy about making provisions to bring it about.

It is our unfortunate fate as conscious, sentient beings to know that we are going to die, just not when or how. I assume that we all want our own deaths, and those of the people we love, to be “easy, gentle and placid”, preferably at a great age. But life is rarely so kind.

Every now and then we are presented with a way out in the form of assisted suicide, the latest iteration for England and Wales being Kim Leadbeater MP’s Terminally Ill Adults (End of Life) Bill. This is essentially the same measure that the Commons voted on in 2015 and rejected by a substantial majority. Everyone imagines it will be different this time because Labour is now in power and has so many MPs.

But this is not, or should not be, a party political issue even if some are trying to make it one. There are many Labour MPs opposed to assisted dying and quite a few Conservative MPs in favour.

Moreover, polling consistently suggests a majority of the country supports euthanasia in defined circumstances. Some opponents say this is too important to be left to parliamentarians and should be subject to a referendum. If there were to be a nationwide vote it would almost certainly be in favour.

In any case, these are moral matters that we have always left to our elected representatives and so it should remain. However, proponents of assisted dying need to be honest about their intentions.

At the heart of every Bill of this type is a deliberate falsehood. They always stipulate that the measure will apply only to adults with mental capacity and only six months to live. Yet in almost every jurisdiction where it has been introduced the provision is extended, first beyond six months and then to people who aren’t terminally ill.

When you stop to think about it, limiting this to people who are dying within six months is rather pointless since they have not long to live anyway. If they are in pain they should be treated with palliative drugs, preferably in a hospice. But there are too few end-of-life institutions and this sort of legislation places those that do exist at risk.

Moreover, the relief of pain is now more problematic than it used to be. Doctors would once routinely administer high doses of morphine to suffering patients who would die as a result. The practitioner was protected from possible legal action by the Doctrine of Double Effect, a well-established legal principle which states that a morally sound action with an unintended negative side effect is permissible.

However, doctors are much more reluctant to rely on this ever since the Harold Shipman murders. Although his actions were malicious and his motives unclear, GPs since have had to think twice about administering potentially lethal doses of painkillers even if their intentions are benign.

The reality is that in such cases there was an implicit intent to end the patient’s misery. If this had been overt, the doctors would have exposed themselves to serious legal and professional condemnation.

So one argument in favour of Ms Leadbeater’s Bill is to end this pretence and let doctors do openly what they once did covertly.

That would at least restore the opportunities for pain relief to where they were pre-Shipman. A better alternative would be to significantly boost the hospice system and ensure that good palliative care is available to all. But this is simply not going to happen, so why pretend otherwise?

The main lacuna in this Bill is its failure to address what people fear most – not death but a ghastly drawn out twilight of an existence, no longer able to recognise anyone or enjoy anything, sustained for years by medical treatments never available in the past.

When people say they favour assisted dying many have this living limbo in mind because they have witnessed it and yet it is not covered by the legislation. Once the principle is conceded, however, then the next move will be to extend it to people whose lives are miserable and just want out.

Proponents who reject the slippery slope argument are not being straight with themselves or with the rest of us. Look what has happened in Holland, Belgium, Canada and other jurisdictions which all started off with the same protections included in the Leadbeater Bill.

Personally, I don’t have any great ethical objections to this measure provided it does not allow people to be pressured by family members to end their lives or feel they have become a burden, both of which are real possibilities. But many people who support assisted suicide do so because they fear a long, lingering and miserable end to their lives, not one that will be over in six months and can be eased by palliative care or ended by infections like pneumonia, once known as “the old man’s friend”.

A bit like those adverts for funerals we need to have an honest discussion about what we really want. If this Bill becomes law, whatever the safeguards, then within a few years assisted dying will no longer be limited to the terminally ill and everyone knows it.