THIS Wednesday, a private member’s Bill will be introduced in the Commons on legalising assisted dying.
This turns an ethical dilemma into an urgent question with profound implications for end-of life care in Britain, and for the wider treatment of disabled, chronically ill or elderly people.
Many campaigners for a change in the law are motivated by the desire to alleviate suffering, as well as in a belief that each person should have autonomy over their life and when it ends.
Most argue a carefully framed law would include safeguards to prevent coercion or abuse such as vulnerable people being guilt-tripped or put under medical or family pressure to choose suicide, and many stress the restriction of provision for legally assisted death to patients with no realistic chance of recovery.
The latter is not universal. Reports are already circulating that several dozen MPs wish to widen the scope of Kim Leadbeater’s Bill to include people who are “incurably suffering,” though Leadbeater herself is on record opposing this.
Whether or not she does, however, disability groups opposed to legalisation are right to point out that countries which have gone down this path have widened eligibility criteria well beyond the original category of terminally ill adults.
Organisations run by and for disabled people — Disabled People Against Cuts (DPAC), the Glasgow Disability Alliance, Not Dead Yet UK and more — believe legalised assisted suicide poses a threat to people with disability or chronic illness, and they point to evidence in the experiences of countries which have legalised it already.
Their argument is that a legal framework for doctors to kill patients, or provide patients with the means to kill themselves, soon normalises this practice. This is borne out by the steady rise in the number of cases in countries which have legalised it: Belgium saw assisted suicides multiply more than tenfold between 2003 and 2021. In the Netherlands they now amount to over 5 per cent of all deaths.
Both countries have extended it to people who are not terminally ill. It has been legal to assist the suicides of children of any age in Belgium since 2014 and in the Netherlands since last year.
Many proponents of assisted dying oppose use of the term “euthanasia,” which is sometimes associated with the Nazi programme of extermination of disabled and mentally ill people, but it is hard to argue the killing of small children can take place with their informed consent. In the Netherlands assisted suicide for people with psychiatric conditions has become more common, with depression now an eligible illness.
But the country whose experience rings the loudest alarm bells is Canada, where as DPAC’s Ellen Clifford has argued, “assisted suicide is coming to replace the social safety net.”
Canada’s parliamentary budget officer estimated the cost saving achieved by doctor-assisted suicide for people who would otherwise continue to receive medical treatment at $86.9 million in 2020, and predicted this would increase to almost $150m the following year as a result of loosened eligibility criteria.
Cases where people requesting treatment, or facilities to help them live with dignity, have been offered assisted suicide have made headlines, including that of Paralympian Christine Gauthier, who was denied funding for a stairlift in her home and offered assisted suicide instead.
Applicants for assisted dying have cited poverty preventing them from access to treatments or housing adjustments that would make their conditions bearable.
A survey of the 13,102 Canadians who ended their lives in this way in 2022 found more than a third cited feeling a burden on family, friends or caregivers.
The Canadian example shows what happens when medically assisted death becomes a “treatment” path among others in a society with high levels of poverty and severely underfunded health and social care systems.
That has to give any socialist in Britain pause for thought. One fifth of British adults live in poverty, rising to one third of disabled adults.
The crisis of under-resourcing in our NHS is common knowledge, with patients routinely forced to wait months or years for treatment. Health Secretary Wes Streeting acknowledges that the poor state of palliative care means legal assisted suicide might not give “people the freedom to choose, without being coerced by the lack of support available.”
The cost of social care is a national scandal, and Labour has ducked even the Tories’ inadequate plans to cap care home costs, which can easily devour a lifetime’s savings or force the sale of a house.
It is not scaremongering to imagine that elderly people might feel pressure to die to ease the financial burden on their loved ones, or that forms of pressure might be put on them by unscrupulous relatives keen to secure an inheritance.
The prominence of disability rights groups in opposing assisted suicide is also linked to the undervaluing of disabled people’s lives in our society.
The non-consensual application of do-not-resuscitate orders to patients with disabilities during Covid dramatically illustrated this. We have had 14 years of Conservative government in which disabled people were depicted as frauds and scroungers, a burden on the public purse, with an associated rise in hate crimes against them.
It would be naive to believe this is unlikely to play out in their treatment, with recommendations and even bullying of patients towards assisted suicide already evident in some Canadian cases.
Analogously, the social exclusion of people with disabilities leads to exaggerated fear of chronic medical conditions, with prominent disability rights activists including Tanni Grey-Thompson and Liz Carr reporting being told by strangers they would rather die than have to live like them. With appropriate treatment and adjustments in living and working conditions, many people with disabilities live purposeful and rewarding lives, but this is often not understood by others until they experience conditions for themselves.
Any change in the law must be considered in terms of its real-world impact on vulnerable people in Britain now. Consideration of individual rights, abstracted from social and material realities, is a liberal approach, not a socialist one.
We cannot dismiss the concerns of disabled people’s organisations or ignore the evidence of the impact of medically assisted death on the vulnerable in other countries.
There is a powerful case that assisted suicide is impossible to safely legalise in a capitalist society which judges a human being’s worth by how much profit can be extracted from them.
Socialists need to stand in solidarity with the most vulnerable. That means opposing Leadbeater’s Bill.
