The Assisted Dying Bill [HL] has been introduced by Baroness Meacher (Crossbench) and would apply to England and Wales only.
What is the current law on assisted dying?
Assisted dying is currently 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. However, 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”. As a result, there have been no prosecutions for the offence of assisting suicide since 2010.
What is the law in other countries?
Several countries or provinces around the world have introduced legislation allowing some form of assisted dying. The US state of Oregon was the first state in the country to introduce assisted dying laws, in 1997. The state’s Death with Dignity Act provided the legal framework for the same doctor-assisted, self-administered medication method of assisted dying that Baroness Meacher’s bill would introduce. The Oregon model has been followed in eight other states. Three Australian states have assisted dying as a legal choice, and legislation is undergoing pre-legislative scrutiny in the Republic of Ireland.
What would the 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 has provoked strong reactions on both sides of the argument.
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. However, following the Coroners and Justice Act 2009 and subsequent clarification from the CPS, offences of this nature are no longer prosecuted.
Others have raised concerns about the bill, and about assisted dying in general. The Christian Action Research and Education charity (CARE) has criticised the 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 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”. However, in September 2021, former Archbishop of Canterbury George Carey and rabbi Jonathan Romain 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 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 medication. The bill did not progress beyond committee stage. Similarly, an identical 2015 House of Commons private member’s bill, sponsored by Rob Marris (former Labour MP for Wolverhampton South West), was defeated on division at second reading by 330 votes to 118.
The current situation leaves the rich able to go to Switzerland, the majority reliant on amateur assistance, the compassionate treated like criminals and no safeguards in respect of undue pressure. Many people, caring so much for those they leave behind, are dying earlier and alone because they fear implicating their loved ones in a criminal enterprise. They hoard pills or put a plastic bag over their head when they are alone.
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.
Many peers spoke in favour of the bill. Others raised objections on philosophical and religious grounds. 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 Government took the same neutral position when Rob Marris’ bill was defeated at second reading in the Commons. While many MPs supported the bill, others raised objections about the difficulty of predicting the exact length of time a terminally ill person has to live, as well concerns about the exploitation of vulnerable people.
- 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
Cover image by Mahosadha Ong on Unsplash.