Assisted dying: A bill as foundationally unwise as it is practically imprudent

The approval of the Terminally Ill Adults (End of Life) Bill at its second stage in Parliament, the integral hurdle for the legislation to overcome, was a monumental development in the discourse surrounding the legalisation of euthanasia in the UK, with certain permissions for terminally ill citizens now awaiting specific Parliamentary scrutiny before they are written into law. For proponents of the bill, this is largely viewed as long overdue permission of fundamental liberty, or ‘dignity,’ for one to choose both the means and moment of their death. However, to perceive this bill in such an optimistic manner would be to overtly deny the several elements of both naivety and imprudence that have found their way into the most integral premises of the legislation, which render the bill far more ethically dangerous than initially meets the eye.

It is important, especially with such a morally charged debate, to lay out some sophisticated specificity about what exactly this bill seeks to legally change about the permissibility of euthanasia, or, as it is phrased in the legislation, “assisted dying.”

Recent surveys that have been published find a decisive opinion in favour of euthanasia being legalised in at least some form

The modern status quo in the UK has been legally established ever since the Suicide Act of 1961, which decriminalised suicide, identifying it as a mental health issue as opposed to an act of criminality, while simultaneously and unambiguously stating that assisted suicide is illegal and punishable by up to 14 years in prison. It is the latter of these regulations that have led to an increasingly popular argument for decriminalisation under at least some circumstances, with the level of the extremity of these reforms varying between proponents and pro-euthanasia groups. Consistent throughout all of these groups however was the moral notion of one having ‘dignity to die’ in an equivalent manner to how one should have autonomy about how one lives.

Before making my case for why this bill is overtly unwise both theoretically and practically, it is important to openly acknowledge that while polls have always been varyingly accurate in their presentation of public opinion, recent surveys that have been published find a decisive opinion in favour of euthanasia being legalised in at least some form. 65 % of those polled by YouGov this month favoured the law allowing for “someone to assist in the suicide of someone suffering from a terminal illness,” compared to just 15 % being opposed to such an amendment. This level of public endorsement could form the foundation of an MP’s opinion to approve the passage of the new bill from the perspective of wanting to accurately represent the moral perspective of their constituents as well as their own, in what was ultimately a conscience vote.

To that, I would make two fundamental arguments – one from a purely practical standpoint, and the other from a more theoretical ethical standpoint, both of which should be in the minds of every MP considering any introduction of legally permissible euthanasia, however limited. The practical argument is concerned with the very contents of the bill – specifically, the measures legislatively suggested, which the creator of the bill, Kim Leadbitter MP, describes as being “the strictest safeguards anywhere in the world” to ensure that the bill only accounts for the personal decision of a terminally ill adult expected to die within six months.

Until the lives of disabled people are treated with equal value to the rest of society, any discussion about a right to die is bound to fall into the same systemic discrimination against those who are disabled

Two compelling objections can be made here. Firstly, a provisional declaration of terminal illness, while evidentially founded, can never be made with the certainty that the provisions of the bill assume. This is a longstanding fact and is famously exemplified in the case of Stephen Hawking, who was informed back in 1963 that he was terminally ill, and was predicted to have just two years left to live, before proceeding to partake in a career of famous contributions to cosmology and physics before passing away in 2018, 55 years after his two-year prediction. While Hawking himself converted from an initial opposition to euthanasia to an eventual endorsement of the 2014 Assisted Dying Bill, the power of his story of defying predictions of terminal illness is emulated by Mary Kelly Foy MP within the Bill’s debate. Foy expressed a powerful testimony about how her non-verbal daughter Maria defied many predictions of her having just six months left to live by living a further twenty-seven years. Foy crucially adds that she is “filled with dread and fear” for others who are non-verbal and could have their autonomy overruled by uncertain predictions of terminal illness ‘expected’ within the six months that this bill would deem objective enough to permit the termination of one’s life. It is this nuance that I would argue could, if openly communicated to the public, shift the dial away from such widespread endorsement of euthanasia for terminal illness.

However, it is also important for MPs, and us more generally, to acknowledge that we cannot base issues of such individual ethical importance simply upon the majority public opinion, especially in such cases where minority groups are concerned. This is powerfully supported by disability rights activist Liz Carr, who testifies to how a disabled friend woke up after a life-threatening seizure to find a “Do not resuscitate” guideline written in her notes without her consent. She also recounts a separate instance of a conference with doctors who were shocked to hear that a 58-year-old man in a wheelchair had “any kind of quality of life at all.” For Carr, these are far more than individual anecdotes – she cogently evidences that they are part of a theme of how many disabled people “are still fighting for the right to exist.” Until the lives of disabled people are treated with equal value to the rest of society, any discussion about a right to die is bound to fall into the same systemic discrimination against those who are disabled, thus creating a tyranny of the majority that refutes the commonplace argument from public opinion.

However, above all of this, beyond the reach of any amendments or modifications that could be made to the bill to improve its safeguards at later stages of its passage, I would argue that there remains a consistent and significant imprudence to the approval of any legislation that makes the first step towards legalising any extent of euthanasia. My reasoning for this revolves around a general appeal to the idea of a ‘slippery slope,’ but not from the perspective of a fearmongering opposition to any legislation untested. Instead, it is founded upon evaluating the ramifications identifiable in other states where similar bills have been passed.

Once the first ethical hurdle is overcome, the ability to extremify the legal measures becomes easier and easier over time, and the safeguards become less and less protectionary for the groups affected

While states such as Switzerland have operated with legally permissible assisted dying for many decades, the Netherlands became one of the first fellow Western European countries to legalise assisted dying under very strict circumstances back in 2002. However, within the space of just over two decades, patients with dementia can now have their lives taken away if they have consented to the process beforehand – even if they couldn’t confirm this in their present state, the eligibility for euthanasia was expanded to encompass terminally ill children, and Dutch political party D66 have proposed legislation that would allow those aged 75 or older to go through euthanasia if they feel as though they have “completed life.” These policies all share the common guise of liberalism justifying their legislative worth. Yet, in reality, they accentuate the opposite: decisions about the termination of one’s life illiberally being made by the elderly who could be exploited for financial acquisition from wills and children who in any other decision of such magnitude would correctly be deemed too young to decide the highest gravitas.

It should go without saying that the matter of how we allow for the most comfortable end of life possible remains of utmost importance, however, there is an underfunded and profoundly important solution to this matter – palliative care, with which we can strike a solution that can bring comfort to the people in question while also leaving open the possibility of recovery, however unlikely, and preventing them from facing the psychological uncertainty from conflicting voices and advice around them about the preservation of their lives.

Therefore, beyond any modifications made to the bill, above any improvements made to the ethically insufficient safeguards in place, there is a sage notice of warning encompassing the debate as a whole: the warning of the internationally evidenced inevitability of succeeding euthanasia legislation. Once the first ethical hurdle is overcome, the ability to extremify the legal measures becomes easier and easier over time, and the safeguards become less and less protectionary for the groups affected. This bill therefore goes beyond being a practically imprudent piece of legislation – it is foundationally unwise in its eagerness to deny the clamours of minority groups in favour of a misplaced appeal to ‘dignity.’ In the words of Liz Carr, “Though some people are fighting for the right to die, we are still fighting for the right to exist.”