There is perhaps nothing more 2020s than taking a sensitive, morally fraught issue loaded with complexity and nuance, and casting it as progress and kindness versus indifference and obdurate conservatism. When even senior members of the clergy fall into this trap, it is a sign of just how much social media has collapsed public discourse into a simple question of right or wrong.
The debate about assisted dying has become depressingly reductionist, but I was still taken aback when the former archbishop of Canterbury George Carey last week chose to mirror its flaws rather than adopt a more careful tone. He urged bishops in the House of Lords to back Labour MP Kim Leadbeater’s private member’s bill to legalise assisted dying because it is “necessary, compassionate and principled”, saying: “The sad history of scientific exploration… is that church leaders have often shamefully resisted change. Let’s not follow that trend.” He implied that bishops had a duty to reflect the “vast majority” of Anglicans who support legalisation.
These comments epitomise so much of what’s wrong with the debate. First, like many of the strongest proponents of legalising assisted dying, Carey fails to acknowledge there are ethical concerns on both sides of the debate. Of course we should feel moved by appeals from individuals with painful health conditions likely to be terminal and who want to be prescribed lethal drugs to end their own lives.
But, as I’ve written before, there are good reasons to believe that the safeguards that have been proposed to date – the need for a terminal diagnosis where someone might reasonably be expected to have less than six to 12 months left to live; the signing off of each request by two doctors and possibly a judge – will not prevent some individuals from being pressurised into a state-sanctioned wrongful death.
The motivation could come from relatives or carers, or from not wanting to be a burden, or the fact that they simply can’t access the palliative care needed to live a dignified life. And Carey linking his colleagues’ concerns about assisted dying to “shameful” resistance of change is a troubling sleight of hand to imply that his own support for assisted dying occupies a higher moral plane.
Last week, I took part in an event on assisted dying at King’s College London that adopted a starkly different frame: a focus on the detailed questions and concerns that a panel of five speakers thought would need to be discussed and answered by parliamentarians before any vote to legalise it. The panel included a palliative care consultant, two MPs (one a psychiatrist, the other a health policy specialist) and a leading KC who specialises in the law on mental capacity and health ethics, and who represented the late Noel Conway in his legal challenge to overturn the criminalisation of assisted dying. None of us expressed opposition to the moral principle, but everyone spoke to the questions of how assisted dying could be safely legalised that had arisen for them as a result of their professional work.
I gleaned new insights from their expertise – for example on the issue of whether establishing someone’s mental capacity to choose death could function as a safeguard around consent. Alex Ruck Keene KC said that, in his experience of training doctors on the mental health capacity act, there remain gaps in understanding even in relation to existing law.
Ben Spencer MP, a psychiatrist whose specialism is treatment in the absence of consent, highlighted the difficulties in carrying out a capacity test for consent to an intervention, and his view that such tests would not pick up coercion or act as a meaningful safeguard.
On the issue of a terminal diagnosis with a specific time left to live, we talked about how difficult it is to predict that accurately. Keene has since said that he believes it would be “quite possible” that the courts would entertain discrimination-based challenges to the limits of any assisted dying legislation; other lawyers have also raised this. Canada expanded the availability of assisted dying in 2021 to those without terminal conditions; a new report last week highlighted some troubling cases, including an isolated man in his 40s with inflammatory bowel disease and substance abuse and mental health issues, who opted for an assisted death after being proactively offered it in a psychiatry assessment.
The second troubling thing about Carey’s intervention is the oversimplifying of public opinion to try to strong-arm parliamentarians into supporting legalisation regardless of any qualms. Assisted dying campaigners have sent personalised emails to MPs telling them polling shows the vast majority of their constituents back it. But the reality of public attitudes is more nuanced; new data from King’s shows that, while a minority of the public feels strongly either way, around six in 10 say they only tend to support or oppose, neither support or oppose, or don’t know; and a majority of supporters say they would probably change their mind if someone were pressurised into it.
A 2021 Survation poll highlighted that just 43% of the public correctly identify “assisted dying” as giving someone with terminal illness lethal drugs to end their life; 42% think it is giving people the right to stop life-prolonging treatment, and 10% hospice-type care. MPs obviously do not exist to translate basic polling into legislative votes: they need to assure themselves that any safeguards could reduce the risk of abuse, and how they will monitor how well they are working.
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There is something disheartening about the way this is playing out. There’s been no pre-legislative deep dive into these safeguarding issues; instead, we have a prime minister gung-ho about a parliamentary vote as a way of honouring a promise he made to a celebrity campaigner, and a legislative process that, because it is a private member’s bill, is ill-equipped for the scrutiny needed. Informed and well-founded concerns have been dismissed as “scaremongering”.
Where I take some comfort is my conversations with a handful of thoughtful MPs who understand how complicated this is. Between them, I hope they can shift the debate from emotionally fraught appeals to compassion and a forensic examination of the balance of risks and how safeguards may or may not operate. We desperately need that to happen before parliament even thinks about taking a decision on the principle.