The Assisted Dying Bill [HL] has been introduced by Baroness Meacher (Crossbench) and would apply to England and Wales only.
What terms are being used?
Many different terms are used in the assisted dying debate. As the British Medical Journal (BMJ) notes, “proponents and opponents of assisted dying do not all agree on the terminology used to describe the process”. The BMJ website provides the following guide:
- Assisted dying: Proponents of the Assisted Dying Bill 2015 in England and Wales argue that this term best describes prescribing life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting strict legal safeguards.
- Assisted suicide: This term is often intended to describe giving assistance to die to people with long term progressive conditions and other people who are not dying, in addition to patients with a terminal illness. The drugs are self administered. Some opponents of assisted dying do not accept that it is different from assisted suicide.
- Voluntary euthanasia: This term describes a doctor directly administering life ending drugs to a patient who has given consent.
What is the current law on assisted dying?
Assisted dying is illegal in England and Wales under section two of the Suicide Act 1961. Under this act, a person judged to have assisted the suicide or attempted suicide of another person is liable to imprisonment for up to 14 years. The Coroners and Justice Act 2009 provided an exemption on bringing charges under section 2 of the 1961 act. This was clarified in a February 2010 policy on assisted suicide from the Director of Public Prosecutions and the Crown Prosecution Service (CPS). These guidelines advised against prosecution if “the victim had reached a voluntary, clear, settled and informed decision to commit suicide”, and any person assisting was “wholly motivated by compassion”.
A government answer to a written question in May 2021 showed that between 1 April 2009 and 31 January 2021, there had been 167 cases referred to the CPS by the police and recorded as assisted suicide. The written answer provided the following details:
Of these 167 cases:
- 110 were not proceeded with by the CPS;
- 32 cases were withdrawn by the police;
- eight are currently ongoing cases;
- three cases of encouraging or assisting suicide have resulted in a conviction;
- one case of assisted suicide was charged and acquitted after trial in May 2015; and
- eight cases were referred onwards for prosecution for homicide or other serious crime.
The answer stated that in the 110 cases the CPS did not proceed with, 29 did not meet the evidential stage and 45 were not in the public interest. There were 30 cases where information on either the evidential test or the public interest test was not recorded. Additionally, six cases were recorded with more than one suspect in the same case. The answer notes “these resulted in a mixed outcome where the evidential stage was not met for some suspects and the public interest test was not met for the others”.
Which countries have legalised assisted dying?
Assisted dying (prescribing life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting legal safeguards) “is legal and regulated in the US states of California, Colorado, Hawaii, Montana, Oregon, Vermont, and Washington, and in Washington, DC. In 2017, similar legislation was passed in Victoria, Australia”.
Assisted suicide (giving assistance to die to people with long term progressive conditions and other people who are not dying, in addition to patients with a terminal illness) is allowed in Switzerland.
Voluntary euthanasia (a doctor directly administering life ending drugs to a patient who has given consent) is allowed in Belgium, Luxembourg, and the Netherlands. The BMJ notes that in 2016, “Canada legalised both voluntary euthanasia and assisted dying for people whose death is ‘reasonably foreseeable’, in what it calls ‘medical assistance in dying’”.
What would the Assisted Dying Bill do?
Baroness Meacher has outlined her reasons for introducing the bill as follows:
My bill would allow terminally ill, mentally capable adults to have the option of accelerating their deaths with medical assistance.
It is based on assisted dying laws that have been in place in the US State of Oregon for almost 25 years. Too many dying people suffer against their wishes at the end of life in this country and our current law fails to protect dying people, who often feel they have no option but to seek help overseas or take matters into their own hands at home. Dozens of our citizens travel every year to Switzerland to make use of its assisted dying laws, at great emotional and financial cost. Many hundreds of terminally ill people take their own lives in this country in distressing circumstances. Even with the very best care, thousands of people in the UK every year will die without adequate pain relief or with unmanageable and distressing symptoms, despite the very best palliative care.
This law would help a small but significant number of dying people avoid unwanted suffering at the end of life but would also provide protection and reassurance to those living with a terminal illness that this option will be available to them if the worst should happen. Assisted dying would not be a substitute for palliative care, but an additional option alongside it; dying people need excellent palliative care and the option of assisted dying in the event that they find their suffering unbearable.
Overview of the bill’s provisions
Clause 1 of the bill would allow a person who is terminally ill to request and lawfully be provided with assistance to end their own life. This would be subject to consent from the High Court. The person requesting permission to end their life must be over the age of 18, have the capacity to make the decision to end their life and have been a resident in England or Wales for not less than one year.
Clause 2 would define the meaning of terminally ill. A person would be judged to be terminally ill if they have been diagnosed by a medical practitioner as having an “an inevitably progressive condition which cannot be reversed by treatment”. As a consequence of this condition, the person must be reasonably expected to die within six months.
Clause 3 sets out the conditions that would have to be met for a person to apply to the High Court to end their life. These conditions would include a signed declaration from the person made in the presence of an independent witness. This statement would have to be countersigned by a qualified registered medical practitioner from whom the person has requested assistance to end their life, and another medical practitioner who has no connection to the person, their treatment, or their family. The first doctor would be known as the attending doctor, the second as the independent doctor. Clause 3(3) states that each doctor must be independent of the other. They must also be satisfied that the person is terminally ill, has the capacity to make the decision to end their life and has a “clear and settled” intention to end their own life which has been reached “voluntarily, on an informed basis and without coercion or duress”.
Clause 4 would allow the attending doctor to prescribe medicines to the person who has satisfied the declaration in clause 3 to end their life. Clause 4(2)(d) would establish a mandatory 14-day waiting period between the day the declaration was signed, and the day when the person is legally allowed to end their life. Clause 4(3) would allow this period to be reduced to six days if the attending doctor and the independent doctor agree that death is likely to occur within one month of the declaration being signed. Clause 4(4) would allow a health professional to prepare the medicine for self-administration, and to “assist the person to ingest or otherwise self-administer” the medicine. However, the clause states that “the decision to self-administer the medicine and the final act of doing so must be taken by the person for whom the medicine has been prescribed”.
Clause 5 would allow persons involved in a case to refuse to participate on grounds of “conscientious objection”.
Clause 6 would ensure that any person involved in assisted dying would not be guilty of an offence.
Clauses 7 and 8 would give the secretary of state regulation-making powers around the registering of deaths associated with the act, and the issuing of codes of practice around assisted dying. Clause 9 would create monitoring and reporting powers related to the act, to be held by the chief medical officer.
Clause 10 would create offences related to the misuse of the declaration outlined in clause 3. Clauses 11 to 13 cover general regulation-making powers, commencement and technical provisions.
Perspectives on assisted dying
The debate over assisted dying provokes strong reactions on both sides of the argument.
Writing in 2005 about another bill on the topic introduced by Lord Joffe, the House of Lords Assisted Dying for the Terminally Ill Bill Committee summarised the debate in this way:
The [Joffe] bill is founded on the principle of personal autonomy. Its supporters believe that terminally ill people should have the right, subject to prescribed safeguards, to have medical assistance to die in the same way that patients, whether or not terminally ill, already have the right to refuse life-prolonging treatment. The bill’s opponents take the view that the two situations are not comparable, that it would be impossible to ensure that any safeguards were not abused and that the law should not be changed to permit intentional killing, whatever the motive.
The campaign group Dignity in Dying, of which Baroness Meacher is chair, has argued that current law contains no safeguards to protect dying people who want to control their death. It states that around 350 Britons have now travelled to Switzerland to end their life, at a cost of around £10,000 each. Dignity in Dying argues that many of these people travel before they are ready to die, because they are afraid of becoming too weak to make the journey. In theory, those that accompany them could face up to 14 years imprisonment. Dignity in Dying believe the bill would afford dying people with six months or less to live the “option to control their death”.
Others have raised concerns about the bill, and about assisted dying. In response to similar bills introduced in 2014–15 by Lord Falconer of Thoroton in the House of Lords and Rob Marris in the House of Commons, Living and Dying Well, an organisation founded in 2010 by Lord Carlile of Berriew and Baroness Finlay of Llandaff (both Crossbenchers), said it opposed the bills because they “fail the public safety test”. It said that doctors would “be licensed to supply lethal drugs to terminally ill people to enable them to end their own lives if they are thought to meet certain conditions”. That situation, it argued, “would represent a major change both to the criminal law and to the fundamental ‘do no harm’ principle that underpins medical practice”. The briefing continued:
Before legislation of such gravity can be responsibly enacted, serious evidence is needed, first, that the law as it stands is not fit for purpose; and, second, that what would be put in its place would be better. On neither count has any convincing evidence been presented. The law that we have is not perfect but it does what it is designed to do. It holds penalties in reserve to deter malicious assistance with suicide and it allows for discretion not to prosecute where that is appropriate.
The law also reflects social attitudes to suicide—that, while people who attempt to end their lives should be treated with understanding and compassion, suicide itself is not something to be encouraged, much less assisted.
The legislative proposals that have been put forward fail the public safety test. Safeguards to protect vulnerable people are either non-existent or, where they exist, inadequate. They also seek to involve doctors in practices in which most of them are unwilling to participate and to involve the courts in a way which blurs responsibilities for decision-making and undermines accountability.
The Christian Action Research and Education charity (CARE) has criticised the Meacher bill for not including a definition of suffering. It argues that this failure to mention suffering, and the failure to enforce it in the declaration terms outlined in clause 3, could lead to a situation where someone with six months to live but living pain-free would have the right to die, but a person living with unendurable pain but with several years to live, or without a terminal diagnosis, would not.
Concern has also been raised about the principle of consent, and the potential creation of a “slippery slope” where vulnerable older and disabled people are at risk of exploitation. The campaign group Not Dead Yet has argued that any change in the law could lead to disabled and terminally ill people feeling pressured to request an early death because they are anxious about being a burden. Writing in the British Medical Journal, professor of palliative medicine at Cardiff University Baroness Finlay of Llandaff (Crossbench) argues that doctors’ assessments on terminal illnesses are often “not black and white” and could be open to exploitation by family or friends. Baroness Finlay uses the example of family pressure out of sight of the doctor as one potential influence on a vulnerable patient’s decision to end their life. However, in the same article, consultant radiologist and chair of Healthcare Professionals for Assisted Dying Jacky Davis argues that concerns about a “slippery slope” are not backed up with evidence. Dr Davis cites research from Oregon showing that vulnerable groups are under-represented in figures of people who have chosen an assisted death.
Not Dead Yet also contends that the debate about assisted dying is tied to the value society places on disabled people’s lives, and that resources should be directed at improving care and support rather than changing the law. The group argues that if disabled people are “given the proper support and resources, they can live extraordinary lives”.
The issue has also divided religious leaders and organisations. In 2014, when the Assisted Dying Bill introduced by Lord Falconer of Thoroton (Labour) was being debated in the House of Lords, faith leaders from a number of different religions published a joint letter opposing the bill. The letter argued that every human life is of intrinsic value, and that the bill would allow individuals to “collude in the judgment that [a life] is of no further value”. In September 2021, former Archbishop of Canterbury George Carey and rabbi Jonathan Romain, a vice chair of Dignity in Dying, launched a new religious alliance in support of doctor-assisted dying. They argue that belief in the sanctity of life “does not mean believing in the sanctity of suffering or disregarding steps to avoid it”.
Does the public support assisted dying?
In August 2021, YouGov conducted a poll on public views of assisted dying in the UK for those with a terminal illness. 73% of those polled supported some form of doctor-assisted death for those with terminal illnesses. 50% supported similar measures for those suffering from a painful but not terminal illness. A separate 2019 poll of over 5,000 adults found that 84% supported some form of assisted dying proposals. This was an increase of two percentage points from the same poll conducted in 2015.
In February 2020, the British Medical Association (BMA) published results from a survey of its members on doctor-assisted dying. 50% of its members supported changing the law to allow prescribing for self-administered life-ending drugs. However, 46% of members opposed a change in law to allow doctors themselves to administer the drugs. The BMA noted the differences among doctors working in different specialities. For example, 47% of those in emergency medicine said they would be willing to prescribe life-ending drugs were it legalised, as did 45% of those in intensive care medicine. In contrast, 76% in palliative medicine said they would not be willing to do so, with those specialising in clinical oncology the next highest (60%). The BMA changed its stance on the issue in September 2021 from opposition to one of neutrality.
What has been said in Parliament?
Baroness Meacher’s bill follows Lord Falconer’s 2014 bill of the same name that would have introduced similar provisions to allow a person who is terminally ill to request and be given assistance to end their own life via the use of self-administered prescribed drugs. The bill did not progress beyond committee stage. Similarly, an identical 2015 House of Commons private member’s bill, sponsored by Rob Marris (then Labour MP for Wolverhampton South West), was defeated on division at second reading by 330 votes to 118.
The principle of this bill is that those who are terminally ill should have choice over how they die, but subject to effective safeguards that prevent pressure or abuse. It would lead not to more deaths, but to less suffering. Disabled or older people without a terminal illness would not be eligible for an assisted death. The bill does not legalise voluntary euthanasia where a doctor directly administers life-ending medication; rather, it provides that the final act in an assisted death must be taken by a patient who has mental capacity both at the time of the request and at the time of their death.
The House heard views expressed from both sides over nine hours of debate. For example, the philosopher Baroness Warnock (Crossbench) expressed support for bill. She said “it seems to me obvious that the law has to be changed. We are often told that it works well, but the trouble is that Directors of Public Prosecutions change and the law is not stable. The guidelines are therefore not stable and uncertain. It is clear that we do need to change the law; that is what we are being offered in the Bill”. Living and Dying Well board member Lord Alton of Liverpool (Crossbench) argued “public safety and incrementalism are my main reasons for opposing this bill. Great play has been made today by many speakers about choice and autonomy […] How much autonomy is there in this bill? I think that the word “assisted” in the title is the key. Who will be required to do the assisting? It will be doctors, of course, and very few want to do it”. The Archbishop of York argued that the bill could deprive some terminally ill individuals of valuable time with family at the end of their life.
The Government believe that any change in the law in this emotive area is an issue of individual conscience. In our view, it is rightly a matter for Parliament to decide rather than Government policy.
The bill was given second reading The Government took the same neutral position on Rob Marris’ bill, which was defeated at second reading in the Commons by a margin of 212 votes.
House of Lords Assisted Dying for the Terminally Ill Bill Committee (2005)
The House of Lords Assisted Dying for the Terminally Ill Bill Committee was appointed to consider and report on the Assisted Dying for the Terminally Ill Bill, introduced by Lord Joffe (Crossbench) on 24 November 2004. In its report, the committee said any assisted dying bill “should take account of the following considerations which have emerged in the course of our inquiry”. These were:
- a clear distinction should be drawn in any future bill between assisted suicide and voluntary euthanasia in order to provide the House with an opportunity to consider carefully these two courses of action, and the different considerations which apply to them, and to reach a view on whether, if such a bill is to proceed, it should be limited to the one or the other or both (paragraphs 243–246);
- any future bill should set out clearly the actions which a doctor may and may not take either in providing assistance with suicide or in administering voluntary euthanasia (paragraphs 247–248);
- if a future bill should include terminal illness as a qualifying condition, this should be defined in such a way as to reflect the realities of clinical practice as regards accurate prognosis (paragraphs 250–251);
- a definition of mental competence in any future bill should take into account the need to identify applicants suffering from psychological or psychiatric disorder as well as a need for mental capacity (paragraphs 252–254);
- consideration should be given in any future bill to including “unrelievable” or “intractable” suffering or distress rather than “unbearable” suffering as a criterion (paragraphs 255–256);
- if a future bill is to claim with credibility that it is offering assistance with suicide or voluntary euthanasia as complementary rather than alternative to palliative care, it should consider how patients seeking to end their lives might experience such care before taking a final decision (paragraphs 257–258);
- in setting a waiting period between an application for assisted suicide or voluntary euthanasia and the carrying out of such actions, any future bill should seek to balance the need to avoid increased suffering for determined applicants against the desirability of providing time for reflection for the less resolute. Such a waiting period is of less importance in the case of assisted suicide but needs to be considered carefully in the case of voluntary euthanasia (paragraphs 259–260);
- any new bill should not place on a physician with conscientious objection the duty to refer an applicant for assisted suicide or voluntary euthanasia to another physician without such objection; it should provide adequate protection for all health care professionals who may be involved in any way in such an application; and it should ensure that the position of persons working in multi-disciplinary teams is adequately protected (paragraphs 261–263);
- any new bill should not include provisions to govern the administration of pain relief by doctors (paragraphs 264–266).
- House of Commons Library, The Law on Assisted Dying, 22 January 2020
- House of Lords Library, Assisted Dying Legislation: North America and England and Wales, 1 March 2017
- House of Commons Library, The Assisted Dying (No 2) Bill 2015, 4 September 2015
This briefing was amended on 18 October 2021 to include further information relevant to the bill.
Cover image by Mahosadha Ong on Unsplash.