The Assisted Dying for Terminally Ill Adults Bill is due to be debated in the House of Commons on 29^th November. The Bill is only for England and Wales but given that Scotland is already considering a Bill and the Republic of Ireland have voted to note a final report by a committee on assisted dying, which calls on the government to legalise assisted dying in certain restricted circumstances, the focus is likely to shift to Northern Ireland should the Bill pass.

Throughout our history the concept of assisting someone to end their life struck at the heart of the values we held as a society. Physicians undertook to care and do no harm and the development of the Hospice movement was a response to the importance of easing the suffering of terminal illness and helping people to die with dignity. Within just a few decades the focus has shifted. In bioethics the principle of respect for personal autonomy has become the defining argument and suddenly even the word dignity has been changed in meaning.

The main means of attacking the current legal framework has been the concentrated emphasis on heart rending instances of an individual’s desperate plight with an incurable illness. This understandably attracts our sympathy and compassion. We can all relate to instances of a loved one’s suffering at the end of life, but for every account of a trip to the Dignatas clinic in Switzerland or there are so many others, where even in the final days and months of life relationships have been healed, important words are spoken and peace is found.

Once Assisted suicide is permitted a whole range of new questions arise which may be an unintended consequence of the initial decision but in essence change the entire health culture, which will affect not only how we as individuals think but also how government makes fiscal decisions. Canada prided itself on the strictness of the criteria it had introduced but when the Quebec Supreme Court decided in 2020 that the exclusion of disability from the legislation was discriminatory, the Canadian government extended the relevant legislation to include mental disorders which did not affect cognitive abilities.

It is difficult to resist the conclusion that stringent safeguards are illusory. This is not surprising. Once the principle is conceded and the Rubicon is crossed, why should the State stop at those with a terminal illness who have less than 6 months to live and wish to end their own lives? The next step to extend the prerogative to those with incurable illnesses who may well have years to live but who feel that life is not worth living. Pressure is already being brough to bear by influential commentators like the retired High Court Judge Sir Nicholas Mostyn who suffers from Parkinson’s and who wish such conditions to be included in the Bill. If the Bill passes how long will it be before the next step is demanded as has almost invariably been the case in other jurisdictions that have changed the law?

It is surely telling that much of the most effective opposition has emerged from those living with disabilities who fear that the change in law means that their lives are less valued. If the Canadian laws are adopted, then any acute suffering per seis potentially a valid ground. Many disabled people identify with the Canadian army veteran, offered medical assisted suicide as a solution to her problem of obtaining a home wheelchair ramp.[1] Are we really saying that it could in any circumstances be legitimate for society to offer assisted suicide to children or euthanasia for the mentally disordered. Yet that is what has happened the Netherlands and Belgium, and it is naive to believe that similar sorts of debate will not happen in the UK in the future should the resent legislation pass.

What we seem to have lost in the clamour for personal autonomy is any idea of the common good or the unintended consequences of legislation aimed at shortening death, but, in reality, opening up a Pandora’s Box where the prevailing culture is changed and it suddenly become acceptable and financially expedient in a healthcare context to discuss euthanasia and assisted suicide as solutions to complex problems.

It is particularly poignant that the greatest opponents of the legislation are those suffering from a lifelong disability who fear that the law on assisted suicide will move quickly to remove the 6-month criterion and include those who suffer from a life long illness[2] . This tells them clearly that their lives are less valued or not worth living.

The current draft Bill permits any medically qualified practitioner of their own volition to discuss with a patient suffering from a terminal illness the possibility of assisting them with their own suicide. Is this not to fundamentally alter the patient doctor relationship? Do we really want our elderly relatives to see themselves as a burden (as 42% of those availing of the procedure in Oregon did in 2022) or think that because of their socio-economic circumstances death would be away out of their misery?

Because I have a moral objection to the legislation in principle it is easy to characterise opposition from a religious perspective as ultra vires and not relevant to the debate. This is wrong because religion is not merely a matter of private opinion but “a vital contributor to the national conversation”. Christianity underpins much of the legal system in the West and in moving decisively in a different direction legislators surely require a better understanding of the alternative world view they are embracing rather than appeals to hard cases and inchoate fervorinos about the absolute sanctity of personal autonomy and choice.

Footnotes:

[1] https://www.cbc.ca/news/politics/christine-gauthier-assisted-death-macaulay-1.6671721 

[2] Pressure is already being brought to bear by influential commentators like the retired High Court Judge Sir Nicholas Mostyn who suffers from Parkinson’s and who wish such conditions to be included in the Bill.

For more on this topic, click here for the transcript of a recent lecture given by Brett Lockhart KC at QUB, and you can find EA resources on this issue here.

Brett Lockhart KC is a Deacon in St. Bridget’s Church, Belfast.