I supported the bill just out of general principle until I read here what was in it. That is a completely stupid process, it feels like a way to say we have allowed it without having to actually allow it.
The process really has been a shambles, it feels like whenever we say something like "we need to have a national conversation about this" we mean there should be a debate in parliament then we need to wait and see what the right wing columnists have to say.
A non-partisan issue like this seems like the perfect opportunity to have a citizens assembly on the issue.
The slippery slope Canada argument seems like a complete nonsense as well though, "what if everyone who wanted to die was allowed to?" surely everyone who wanted to die being allowed to is the system we should aim for as long as there are some safeguards to ensure it is actually what they want.
The issue of not wanting to be a burden just makes me sick, if I am suffering because I feel like a burden on my friends and family does that suffering somehow not count? We shouldn't be striving to keep people alive against their will, we should be striving to make sure the state steps in and they aren't a fucking burden on their family.
What about someone who may be bipolar, and wants to die during their depressive period, but loves life at other times? Would a permissive law protect them?
It doesn't have to be so permissive that you just give anyone who asks immediate euthanasia. A two week cooling off period and a single doctor sign off would deal with that issue.
Maybe a longer cooling off period if you didn't want to undergo additional assessment would work, I'm not really trying to have a full debate on the exact wording of the bill in a comments section, just pointing out it is possible to have safeguards short of a high court judgement.
Even a single doctor assessment might raise some questions if a physically healthy person requested euthanasia for no reason other than depression.
I don't really think a long term mental-health condition should bar your access to suicide anyway, I have been treated for depression, I suspect if I did the checklist now I would flag as depressed, does that mean I should be denied euthanasia if I get cancer?
The law as drafted caters for us bipolars. Either Doctor 1 or independent Doctor 2 will catch (the majority) of bipolar "applicants". The mandated time breaks will help in this. The second time break for the case to be put before the Judge also helps. A very small minority of bipolar folk will be handed the syringe to self destruct on "black dog days".
On Wednesday, I quietly sat holding my Nana's hand whilst she slipped away. I thought about my own mortality, would I want the prolonged death that she had for myself and the answer is definitely no. So I need to make provisions so that it doesn't happen. For me the legislation doesn't go far enough, which probably means it's a good compromise, neither side is happy.
There are a couple of points that aren’t getting much space in the debate.
A huge number of people who receive end-of-life care are already subject to what can be loosely described as medicated euthanasia through the administration of strong doses of powerful painkillers in order to ensure a less painful death. Dying hurts, in almost every case.
The other and perhaps more salient point in all of this is that this is a new parliament with a huge number of new and inexperienced legislators.
I admire the willingness to proceed but, whatever your view of the issue, surely it would be a more satisfactory outcome after MPs were able to feel their feet underneath them and get a handle of the business of making big decisions such as this.
There’s a very real chance that many will play safe or make a decision like the rest of us, based on our own principles, whereas the implementation of such policy as assisted dying will need to be determined by the professional, legal and ethical parameters required to make it work for those for whom it is deemed appropriate and necessary.
I fear this will fail and there will be lots of hand wringing by supposed supporters of assisted dying who can’t outline the specifics of what would make them happy in terms of legislation. Right now, there’s a lot of opposition in terms of what doesn’t exist now and might never exist in the future. The main arguments against I agree with relate to process, but the bill itself seems solid. And, as ever, perfect is the enemy of the good. If not now, then when (and how)?
I tend to side with DAG on this, who in Prospect wrote of defining legal certainty. And Ian’s point also about providing a small number of people agency and dignity.
I absolutely do not want to hold up the right to elect to die for those in great non-relievable pain, but I am very concerned about Alzheimer's sufferers almost by definition being locked out of this choice by the criteria.
Thanks Ian - that's very balanced and informative...
I'm for this, but for me it's the start of what's needed - what's important for me is living instead of existing - in the last couple of years of my Mum's live I saw a lot of people around her - in care etc. - who were existing, not living. Luckily for her she lived until just about the end.
For me - when I can't do the things I want to - experience nature, art, music - my quality of life is gone, and life turns into existence.
I want to be able to do something about that, when it happens, and that's what my LPA says.
Very helpful, Ian. It’s not an issue I am fixed on, although don’t think we are in a good place to debate this just now. I would say that with decent palliative care patients are in control of how (and to some extent when) they die. There are no where near enough palliative care staff to do this effectively for all.
This is very balanced and informative. Like you I'm in favour of the law passing, and I don't see how (without a massive change) it could be used to "euthanase" anyone frail and elderly or with dementia. My father had a horrible degenerative illness (which I'm not going to name to avoid upsetting anyone who has or knows someone with it), and he was terrified of what his end days were going to be like. Very fortunately he didn't get to experience that - he fell and had a quick and peaceful death shortly afterwards, and even now (many years later) I still feel guilty to be more relieved than sad that he died when he did, as what was in store for him would have been unbearable. Things were different in the past with more discretion for medical staff to increase doses of medication to speed the end of life - I'm absolutely sure that this happened to one of my grandparents in the 1980s. (Presumably the Shipman case put a complete stop to anything like this.)
Fundamentally a mature and evolving society within a democracy needs to respect an informed decision by an individual whilst the state maintains effective guardrails to avoid abuse. The current thoughtful proposal narrowly constrains such decisions to terminally ill individuals. It’s the minimum we should support.
It's important to remember that palliative is not the perfect science that objectors often imply: For some people, even in the best centres, with the best staff and the nest drugs, death can be painful and distressing for all. I have seen professionals in tears on several occasions.
But for me, the simple fact is encompassed by "Whose life is it anyway?"
If I can blow my brains out with a .357 Magnum, that's OK, but if I'm too ill to reach it, I can't have a civilized death instead? Seems wrong to me.
My mother's view is that there's a difference between being alive and not being dead. Just because you don't have a terminal illness with less than 6 months to live doesn't mean you have a quality of life that you want to exist through for an indeterminate period. My parents are in their 90s. Many of their friends have passed away in the last 20 years - some suddenly, some with long declines. Some of their friends have spent years in care homes with dementia.
My father has almost died several times in the last 3 years from assorted infections caused by him being unable to walk. He also has malignant prostate cancer. But he's probably in a better physical state than he has been for a long time due to good regular food and someone making sure he's drinking enough. Another infection may kill him, or not. But as long as he's happy, I'm happy.
My mother has a degenerative lung conditions and severe osteoporosis, meaning that standing up and walking is difficult. She lives alone and only goes out occasionally, but has a beautiful view from her window. She makes the best of what she can do. But she absolutely does not want to end up bed bound, with no ability to control her life.
I will be more than sad when they each go, but I will be gutted if they suffer unnecessarily because there is no legal method to allow them to say they've had enough.
This has been a rare issue where the public debate has changed my mind. I started off instinctively supportive but I’ve come round to being on balance against. The coercion argument and the Canadian experience are key for me. There are at half a million Northern Irish mammies that will want to shuffle off rather than be any trouble. And the whole thing does frame death a bleak and unnatural thing rather than an ending to be mourned and celebrated.
It's important to remember that the proposed UK law is similar to the Australian model not the Canadian one. Those against AD always go on about Canada but it's like comparing Apples with Pears...similar sure but not the same.
The Canadian judicial challenge slippery slope could be countered by reference to a supra-judiciary, but the Canucks don't have one. At the mo', we do - the ECHR. Another case against the Tugendtwat and Jenrong Tory loonies who advocated for walking away.
An excellent piece, and I sort of fall in a similar place to you - I'm instinctively for it...but have reservations that have crystallised recently.
There's one thing that I've not seen mentioned - my mother sadly passed away from a serious stroke at the end of last year, and she died slowly over a period of days after care was withdrawn. I feel this was the right thing to do - she didn't appear to suffer and had time for friends and family to gather at her bedside, despite being unable to communicate. If assisted dying was in place, I'm pretty sure there would be pressure to allow people in this situation to be 'relieved of their suffering', but how would that play out on the ones left behind? I would have HATED to have been offered the choice and would probably be suffering guilt over whatever decision was made for many years. I imagine this guilt may also be suffered by doctors and nurses who apply the treatment, and if not, are they people we would want to be making decisions?
It's also really worth watching Liz Carr's excellent documentary on iPlayer the covers the very real fear that people with disabilities have about this possible law.
Edit: My beloved dog passed away at the start of this year - I had to put her to sleep. It was fucking awful, but it was best for her and I know it was the right thing to do. But you do hear of dog owners getting their dogs euthanised because they're too much effort.
Why don’t they copy the Spanish system? I have a living will arranged by the Spanish NHS but held by a different authority, all the doctors can see is that I have made a living will, in it I have stipulated the terms in which it can be invoked and nominated my wife to be part of the decision making process.
I supported the bill just out of general principle until I read here what was in it. That is a completely stupid process, it feels like a way to say we have allowed it without having to actually allow it.
The process really has been a shambles, it feels like whenever we say something like "we need to have a national conversation about this" we mean there should be a debate in parliament then we need to wait and see what the right wing columnists have to say.
A non-partisan issue like this seems like the perfect opportunity to have a citizens assembly on the issue.
The slippery slope Canada argument seems like a complete nonsense as well though, "what if everyone who wanted to die was allowed to?" surely everyone who wanted to die being allowed to is the system we should aim for as long as there are some safeguards to ensure it is actually what they want.
The issue of not wanting to be a burden just makes me sick, if I am suffering because I feel like a burden on my friends and family does that suffering somehow not count? We shouldn't be striving to keep people alive against their will, we should be striving to make sure the state steps in and they aren't a fucking burden on their family.
What about someone who may be bipolar, and wants to die during their depressive period, but loves life at other times? Would a permissive law protect them?
It doesn't have to be so permissive that you just give anyone who asks immediate euthanasia. A two week cooling off period and a single doctor sign off would deal with that issue.
"The median duration of bipolar I mood episodes was 13 weeks"
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210663
And that's assuming the disorder is diagnosed in the individual.
There would be a real risk that someone with a treatable condition would be allowed to die in a too permissive system of assisted dying.
Maybe a longer cooling off period if you didn't want to undergo additional assessment would work, I'm not really trying to have a full debate on the exact wording of the bill in a comments section, just pointing out it is possible to have safeguards short of a high court judgement.
Even a single doctor assessment might raise some questions if a physically healthy person requested euthanasia for no reason other than depression.
I don't really think a long term mental-health condition should bar your access to suicide anyway, I have been treated for depression, I suspect if I did the checklist now I would flag as depressed, does that mean I should be denied euthanasia if I get cancer?
The law as drafted caters for us bipolars. Either Doctor 1 or independent Doctor 2 will catch (the majority) of bipolar "applicants". The mandated time breaks will help in this. The second time break for the case to be put before the Judge also helps. A very small minority of bipolar folk will be handed the syringe to self destruct on "black dog days".
On Wednesday, I quietly sat holding my Nana's hand whilst she slipped away. I thought about my own mortality, would I want the prolonged death that she had for myself and the answer is definitely no. So I need to make provisions so that it doesn't happen. For me the legislation doesn't go far enough, which probably means it's a good compromise, neither side is happy.
A thoughtful piece, as always.
There are a couple of points that aren’t getting much space in the debate.
A huge number of people who receive end-of-life care are already subject to what can be loosely described as medicated euthanasia through the administration of strong doses of powerful painkillers in order to ensure a less painful death. Dying hurts, in almost every case.
The other and perhaps more salient point in all of this is that this is a new parliament with a huge number of new and inexperienced legislators.
I admire the willingness to proceed but, whatever your view of the issue, surely it would be a more satisfactory outcome after MPs were able to feel their feet underneath them and get a handle of the business of making big decisions such as this.
There’s a very real chance that many will play safe or make a decision like the rest of us, based on our own principles, whereas the implementation of such policy as assisted dying will need to be determined by the professional, legal and ethical parameters required to make it work for those for whom it is deemed appropriate and necessary.
I fear this will fail and there will be lots of hand wringing by supposed supporters of assisted dying who can’t outline the specifics of what would make them happy in terms of legislation. Right now, there’s a lot of opposition in terms of what doesn’t exist now and might never exist in the future. The main arguments against I agree with relate to process, but the bill itself seems solid. And, as ever, perfect is the enemy of the good. If not now, then when (and how)?
I tend to side with DAG on this, who in Prospect wrote of defining legal certainty. And Ian’s point also about providing a small number of people agency and dignity.
I absolutely do not want to hold up the right to elect to die for those in great non-relievable pain, but I am very concerned about Alzheimer's sufferers almost by definition being locked out of this choice by the criteria.
Thanks Ian - that's very balanced and informative...
I'm for this, but for me it's the start of what's needed - what's important for me is living instead of existing - in the last couple of years of my Mum's live I saw a lot of people around her - in care etc. - who were existing, not living. Luckily for her she lived until just about the end.
For me - when I can't do the things I want to - experience nature, art, music - my quality of life is gone, and life turns into existence.
I want to be able to do something about that, when it happens, and that's what my LPA says.
“It should be done calmly and generously and with the steady conviction that you might be wrong.”
What a beautiful sentence. Universally applicable. Let me know if you ever start a cult.
Very helpful, Ian. It’s not an issue I am fixed on, although don’t think we are in a good place to debate this just now. I would say that with decent palliative care patients are in control of how (and to some extent when) they die. There are no where near enough palliative care staff to do this effectively for all.
This is very balanced and informative. Like you I'm in favour of the law passing, and I don't see how (without a massive change) it could be used to "euthanase" anyone frail and elderly or with dementia. My father had a horrible degenerative illness (which I'm not going to name to avoid upsetting anyone who has or knows someone with it), and he was terrified of what his end days were going to be like. Very fortunately he didn't get to experience that - he fell and had a quick and peaceful death shortly afterwards, and even now (many years later) I still feel guilty to be more relieved than sad that he died when he did, as what was in store for him would have been unbearable. Things were different in the past with more discretion for medical staff to increase doses of medication to speed the end of life - I'm absolutely sure that this happened to one of my grandparents in the 1980s. (Presumably the Shipman case put a complete stop to anything like this.)
Fundamentally a mature and evolving society within a democracy needs to respect an informed decision by an individual whilst the state maintains effective guardrails to avoid abuse. The current thoughtful proposal narrowly constrains such decisions to terminally ill individuals. It’s the minimum we should support.
It's important to remember that palliative is not the perfect science that objectors often imply: For some people, even in the best centres, with the best staff and the nest drugs, death can be painful and distressing for all. I have seen professionals in tears on several occasions.
But for me, the simple fact is encompassed by "Whose life is it anyway?"
If I can blow my brains out with a .357 Magnum, that's OK, but if I'm too ill to reach it, I can't have a civilized death instead? Seems wrong to me.
My mother's view is that there's a difference between being alive and not being dead. Just because you don't have a terminal illness with less than 6 months to live doesn't mean you have a quality of life that you want to exist through for an indeterminate period. My parents are in their 90s. Many of their friends have passed away in the last 20 years - some suddenly, some with long declines. Some of their friends have spent years in care homes with dementia.
My father has almost died several times in the last 3 years from assorted infections caused by him being unable to walk. He also has malignant prostate cancer. But he's probably in a better physical state than he has been for a long time due to good regular food and someone making sure he's drinking enough. Another infection may kill him, or not. But as long as he's happy, I'm happy.
My mother has a degenerative lung conditions and severe osteoporosis, meaning that standing up and walking is difficult. She lives alone and only goes out occasionally, but has a beautiful view from her window. She makes the best of what she can do. But she absolutely does not want to end up bed bound, with no ability to control her life.
I will be more than sad when they each go, but I will be gutted if they suffer unnecessarily because there is no legal method to allow them to say they've had enough.
100%
There's a big, important difference - for me - between living and existing...
This has been a rare issue where the public debate has changed my mind. I started off instinctively supportive but I’ve come round to being on balance against. The coercion argument and the Canadian experience are key for me. There are at half a million Northern Irish mammies that will want to shuffle off rather than be any trouble. And the whole thing does frame death a bleak and unnatural thing rather than an ending to be mourned and celebrated.
It's important to remember that the proposed UK law is similar to the Australian model not the Canadian one. Those against AD always go on about Canada but it's like comparing Apples with Pears...similar sure but not the same.
The Canadian judicial challenge slippery slope could be countered by reference to a supra-judiciary, but the Canucks don't have one. At the mo', we do - the ECHR. Another case against the Tugendtwat and Jenrong Tory loonies who advocated for walking away.
A really thoughtful and balanced piece.
I’m glad to hear both points of view.
An excellent piece, and I sort of fall in a similar place to you - I'm instinctively for it...but have reservations that have crystallised recently.
There's one thing that I've not seen mentioned - my mother sadly passed away from a serious stroke at the end of last year, and she died slowly over a period of days after care was withdrawn. I feel this was the right thing to do - she didn't appear to suffer and had time for friends and family to gather at her bedside, despite being unable to communicate. If assisted dying was in place, I'm pretty sure there would be pressure to allow people in this situation to be 'relieved of their suffering', but how would that play out on the ones left behind? I would have HATED to have been offered the choice and would probably be suffering guilt over whatever decision was made for many years. I imagine this guilt may also be suffered by doctors and nurses who apply the treatment, and if not, are they people we would want to be making decisions?
It's also really worth watching Liz Carr's excellent documentary on iPlayer the covers the very real fear that people with disabilities have about this possible law.
Edit: My beloved dog passed away at the start of this year - I had to put her to sleep. It was fucking awful, but it was best for her and I know it was the right thing to do. But you do hear of dog owners getting their dogs euthanised because they're too much effort.
It's worth saying that not all disabled people feel the same as Liz Carr, many fully support and long for the option of AD.
There is also no evidence that assisted dying, in countries where it is legal, harms disabled or vulnerable people. There's been considerable intense research on this subject, this article summarises a lot of that research: https://www.mydeath-mydecision.org.uk/2024/05/13/the-views-of-disabled-people-within-the-assisted-dying-debate/
88% of people who identify as disabled favour changing the law on assisted dying in at least some circumstances.
Why don’t they copy the Spanish system? I have a living will arranged by the Spanish NHS but held by a different authority, all the doctors can see is that I have made a living will, in it I have stipulated the terms in which it can be invoked and nominated my wife to be part of the decision making process.
Thank you for this honest and informative piece. It’s the best thing I’ve read on the issue.