The Select Committee hearing evidence about the Terminally Ill Adults Bill met again last week. Again, the expert witnesses drew out multiple problems with the Bill. Here are some highlights.
The Bill’s safeguards do not protect against coercion
A major concern of those opposed to the legalisation of assisted suicide is the problem of safeguards. This issue was highlighted by several witnesses on day four of the hearings. Dr Jane Monckton-Smith, Professor of Public Protection at the University of Gloucestershire, began the committee’s eighth evidence session on 30 October by saying that researchers estimate that every week in the UK there are 34 suicides linked to domestic abuse. She pointed to a clear link between domestic abuse, coercive control and suicide. She also argued that perpetrators often staged a murder to appear as a suicide.
Cherryl Henry-Leach, Chief Executive of Standing Together Against Domestic Abuse, cited research published by the Mayor of London’s Office in 2019 that indicated that in 10 per cent of domestic abuse cases, the perpetrator was the victim’s carer. A 2024 review of domestic abuse deaths showed that healthcare professionals had failed to identify an abusive situation in over 50 per cent of cases.
Professor Monckton-Smith concluded that the safeguards in the Bill are simply not adequate to establish whether someone requesting assisted suicide was trying to escape their abuse or the suffering caused by their illness. “If we cannot answer that question, then we should be very concerned,” she said. “Suicides are happening in incredibly high numbers, and this [Bill] might make that worse.”
The Hospice sector is on “the Brink”
Appearing before the committee on the third day of hearings, several specialists in palliative medicine and hospice care outlined their concerns regarding the legalisation of assisted suicide while the NHS is struggling to provide the level of care required.
Dr Suzanne Kite, President of the Association for Palliative Medicine, called for a national strategy to guarantee universal access to palliative care, which would be protected from any negative consequences from an “assisted dying service”. She also said that there was a need for better safeguards for patients and members of the caring profession.
Professor Katherine Sleeman from King’s College London, who has 25 years of experience in palliative care, described the current state of provision as “patchy, fragmented and woefully inadequate”. “There’s a huge gap,” she said, “between the number of people who need palliative care and the number who receive it.”
Toby Porter, the CEO of Hospice UK, which cares for more than 2800 terminally ill patients, said that the hospice sector was on “the brink”. This situation provided a precarious foundation for the introduction of assisted dying. And, according to Mr Porter, the situation is getting worse. He told the committee that since he gave evidence to the House of Commons committee in January, “almost a dozen hospices have announced significant and involuntary cuts to staff and services due to financial pressures.”
This “precarious” situation is likely to get even worse if the Bill becomes law. When the Bishop of Newcastle referred to figures indicating that 43 per cent of those working in palliative care settings would leave their jobs if assisted dying were introduced, Dr Kite acknowledged that a significant proportion of staff were likely to leave the sector. “Unfortunately,” she said, “we do need to ensure that there are senior doctors in hospices because they are vital to the provision of specialist level care, so there is that threat.”
A real risk to people with learning disabilities
During the Ninth Session, Ken Ross from the National Down Syndrome Policy Group, told the committee that among the people he had spoken to with Down syndrome, there was a real fear that the Bill would further target their lives. He said there are huge health inequities in the UK, and people with Down syndrome typically die 27 years earlier than their peers. Citing the 2023 report from the Learning from Lives and Deaths program that was established to improve healthcare for people with learning disabilities and autistic people, Mr Ross said 37 per cent of the deaths of people with intellectual disabilities were from preventable causes. This includes deficiencies within the health service, such as failures of coordination and treatment, and a lack of support in accessing care.
Mr Ross’ testimony cast serious doubt on the reassurances from Lord Falconer (the Bill’s sponsor in the Upper House), that “people with various learning difficulties or autism” can, “with proper assistance”, have the option of an assisted death. After outlining the vulnerability of people with Down syndrome to pressure and suggestion, Lord Goodman asked Mr Ross to comment on written evidence from the Portsmouth Down Syndrome Association that standard safeguards and protections within the health service are often ignored or abused where people with learning disabilities are concerned. Pointing to the experience of disabled people during the Covid pandemic as an example of the problem, he concluded: “There is a real risk that even with a process in place, it will be ignored.”
The Bill raises significant human rights concerns
In a statement to the committee, Alasdair Henderson, a lawyer with the Equality and Human Rights Commission, said that while the EHRC didn’t take a position on the questions of assisted suicide, the Bill did raise significant equality and human rights concerns. He told the committee that: “the rights of, and protections for, disabled people must be central to considerations related to this Bill.” He said,” It’s important to consider the risk of discrimination when determining how doctors and the Assisted Dying Review Panel would assess a person’s desire when and how to end their life. And that might mean that some further clarity is needed in relation to both the definition of terminal illness in clause 2 of the Bill and to the provisions related to the assessment of mental capacity and the role of disability among some other clauses.”
Responding to claims that both people with disabilities and those from minority communities faced health inequalities that made them more vulnerable to pressures to end their lives prematurely, Baroness Hayter asked Mr Henderson whether the present situation was not discriminatory. Those who are rich enough, she said, can go abroad for assisted suicide while the less well-off can’t.
While reluctant to give a definitive legal opinion on the spot, he politely argued there was no discrimination. “No. First of all, wealth is not a protected characteristic under the Equality Act, and second, there are so many other factors involved that I’m not sure it’s a straight question of discrimination of any kind,” he said.
Baroness Grey-Thompson DBE
One of the most significant contributions to the committee process so far, has been the evidence presented by Baroness Tanni Grey-Thompson. In her opening statement, she said: “If you had asked me when I first came to the House of Lords, would I support this Bill, I would have said yes. But in my time here and in my research, I’ve come to believe it is a danger to disabled people. …We can’t change the law or work through this legislation without understanding the experience of disabled people in wider society and how they’re treated.”
Echoing the remarks of Ken Ross, she highlighted the treatment of disabled patients during the Covid crisis, when many people were placed under a Do Not Resuscitate Order without ever being consulted. “That made a number of disabled people very nervous about accessing the care system. And we’ve seen that in Canada and Australia that people are really nervous about accessing healthcare because they think that, certainly in Australia, there’ll be a discussion around euthanasia.” She later pointed out that the training for Australian doctors on spotting coercion was a video presentation that lasted just two minutes and 50 seconds.
Like other witnesses, she raised the lack of clarity regarding the definition of terminal illness in the Bill. There are, she said, a number of conditions that could be interpreted as making someone eligible for assisted suicide. “…if someone like me got a pressure sore, and it didn’t heal, I would very easily fit into a six-month diagnosis. I’ve had three friends who have died from pressure sores. So it [the Bill] would absolutely cover disabled people … and that’s why I think it’s absolutely possible that suggestions will be made to disabled people, ‘Think of the family, think of the carer, think of the people around you’. It will be suggested that this will be a good route for disabled people to think about.”
Commenting on the accusation that an amendment to protect disabled people by specifically excluding them was discriminatory, Baroness Grey-Thompson argued that disabled people are faced with inequality in every area of life. She said I’d feel really sad if the first time we genuinely give disabled people equality, it’s over ending their lives.
The Committee will continue hearing oral evidence next week.
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