“The Commons Assisted Dying Debates test the nation’s readiness for change”

In March 2024, during a phone call with Dame Esther Rantzen, Sir Keir Starmer- then Leader of the Opposition- made a commitment to reignite the discussion on assisted dying. This issue had not seen debate in the House of Commons since 2015, when the previous bill was rejected. On 16th October 2024, the Prime Minister’s promise materialised, as a new Assisted Dying Bill was formally introduced in the House of Commons by Labour MP Kim Leadbeater.

The subject of assisted dying remains one of the most divisive and emotionally charged topics globally. The debate extends beyond mere legislative frameworks, touching deep ethical, moral, and personal convictions. The language used when discussing assisted dying often mirrors the beliefs of those involved. For example, terms like “physician-assisted suicide” and “euthanasia” can carry strong emotional connotations.

In the UK, the Parliamentary Office of Science and Technology defines assisted dying as “the involvement of healthcare professionals in providing lethal drugs intended to end a patient’s life at their voluntary request, subject to eligibility criteria and safeguards”. This definition encompasses two key scenarios: healthcare professionals prescribing drugs for patients to self-administer, also known as physician-assisted suicide, and healthcare professionals directly administering lethal drugs to end the patient’s life, often referred to as euthanasia. Assisted Suicide is a term legally accurate in the UK but is often contested. It implies assisting someone, regardless of their health status, to take their own life. Critics argue it unfairly equates terminally ill patients seeking autonomy with non-terminal cases of suicide. Euthanasia involves a third party, typically a medical professional, directly administering a life-ending drug. This practice is illegal in most countries, including the UK, as it is equated with murder or manslaughter.

Assisted dying remains illegal in England and Wales under the Suicide Act of 1961, which criminalises assisting or encouraging another person’s suicide. Violations carry a maximum penalty of 14 years in prison. While suicide itself is not illegal, aiding someone in ending their life is prosecutable.

Globally, countries and regions have diverse rules on assisted dying, offering models for potential legislation in England and Wales. The British Medical Association’s (BMA) map, showing international jurisdictions where physician-assisted dying is permitted, provides an infographic for this. The BMA adopt a neutral position on physician-assisted dying.

Switzerland, home to the well-known organization Dignitas, which features in media such as the film ‘Me Before You’, is a prominent example. The Swiss Criminal Code of 1942 allows assisted suicide provided the motive is not ‘selfish’. The lack of federal restrictions means non-residents, through organizations like Dignitas, frequently seek access to its services.

Oregon, USA, offers another model with its Death with Dignity Act (DWDA), enacted in 1997. This law permits terminally ill adults, with a prognosis of six months or less, to request life-ending medication. The patient must be mentally competent, make multiple requests, and self-administer the medication. In 2022, a lawsuit led to the removal of the residency requirement. Despite these safeguards, critics argue it does not sufficiently protect vulnerable individuals.

In Victoria, Australia, the Voluntary Assisted Dying (VAD) law enacted in 2019 mandates assessments by two doctors, a waiting period, and proof that the patient’s decision is voluntary. This rigorous process emphasizes patient protection but faces criticism for its complexity and impact on medical professionals.

These international examples highlight the different ways assisted dying can be regulated, with varying degrees of patient autonomy and protection. They also illustrate the challenges and risks inherent in legislating such a sensitive issue.

The introduction of bills by MP Kim Leadbeater and Lord Falconer has reignited the debate, supported by campaigns like the Daily Express’s “Give Us Our Last Rights”, which has attracted support from groups like Dignity in Dying and prominent public figures. The Bill proposes allowing physician-assisted dying for terminally ill, mentally competent adults with less than six months to live, enabling them to request a prescription for life-ending medication they would self-administer.

A survey commissioned by the Campaign for Dignity in Dying, the largest of its kind, sampled 10,897 adults across Great Britain in February 2024. The poll revealed that 75% of respondents support legalizing assisted dying, with 14% opposed. Support was particularly strong among disabled respondents (78%) and consistent across political lines, although slightly lower among people of faith (66%).

Campaigners argue that even with the best palliative care, some patients endure unbearable suffering. They contend that assisted dying allows individuals to maintain autonomy over their end-of-life decisions, particularly for those who are terminally ill and mentally competent. Moreover, the current law forces some to seek services abroad—often at significant personal and financial cost (averaging £10,000)—to access the option of assisted dying. A regulated system within the UK could ensure better oversight, fairness, and protection for vulnerable individuals while respecting patients’ choices.

Opponents of assisted dying raise valid concerns that, even with safeguards, vulnerable populations, such as the elderly or disabled, may feel pressured to choose it, particularly in the context of family dynamics and the stresses associated with terminal illness. Religious leaders, including the Archbishop of Canterbury, and various non-religious campaigners argue for enhancing palliative care, mental health services, and community support instead of pursuing assisted dying. There are also significant concerns regarding healthcare professionals’ rights to opt out and the potential conflict with ethical principles like non-maleficence, which underpin the medical profession’s role in preserving life. Critics worry that normalizing assisted dying could erode trust in doctor-patient relationships and compromise the integrity of the medical profession.

The upcoming debate on assisted dying in the House of Commons on November 29, 2024, followed by discussions in the House of Lords, represents a potentially transformative moment in the UK’s approach to end-of-life care. If passed, the proposed legislation would allow terminally ill patients the right to assisted dying, subject to strict safeguards, enhancing personal autonomy over health decisions. However, this debate also raises deep ethical concerns, particularly around protecting vulnerable groups, and touches on critical issues of medical ethics, patient rights, and the role of healthcare professionals. With growing public interest and support, alongside strong opposition from some religious and medical communities, the progression of this bill through Parliament will not only reflect societal views but also test the nation’s readiness for change in this sensitive and complex area of healthcare.

Cover Image from Alberto Biscalchin.