The outcome of last month’s referendum in New Zealand, which gave the green light to the introduction of assisted dying, has yet to re-ignite the debate on this sensitive issue in the UK. Doctors’ groups here continue to maintain a neutral or negative stance – seemingly at odds with the opinion of both the general public and their own members – and there is no legislation currently scheduled for parliamentary debate, either in the Commons or the Lords.
As we note below, other countries have managed to allocate parliamentary and judicial resources this year for similar legislation, despite the hurdles presented by covid-19, so why hasn’t the UK government been more proactive? The public support for such a move is all too apparent.
A poll conducted in 2015 by campaign group Dignity in Dying (DiD) found that 82 per cent of respondents wanted to see assisted dying made legal – and 53 per cent would think more positively about an MP who supported it. DiD’s follow-up survey saw similar levels of support, and noted there was even stronger support among people who stated they had a disability. It also found broad support for assisted dying across most faith groups.
More recently, in 2019, another campaign organisation – My Death, My Decision (MDMD) – commissioned a survey from the National Centre for Social Research (NCSR) that discovered that more than 90 per cent of people considered assisted dying acceptable in some situations.
A previous NCSR survey, two years earlier, revealed that public support for euthanasia remained consistent with previous surveys dating back 30 years, with 78 per cent saying the law should definitely or probably allow a doctor to end the life of someone with an incurable and painful terminal illness.
The medical profession, however, has long adopted a more conservative approach to assisted dying than the general public. The British Medical Association’s (BMA) current position – dating back to the 1950s – is that physician-assisted suicide, voluntary euthanasia and non-voluntary euthanasia should all remain illegal in the UK, and it assumes that “ongoing improvement in palliative care” already allows patients to die with dignity.
Compare this to the Netherlands, where one survey showed that in 2015 more than 90 per cent of GPs and 87 per cent of elderly care physicians supported the liberal Dutch approach to euthanasia and assisted suicide, possibly because the development of the associated legislation was carried out with input from the medical profession.
Nevertheless, the BMA is to debate its current stance at its AGM next June, specifically to consider the results of a survey – its first-ever on assisted dying – which last month found that 40 per cent of the 29,000 members who responded think the organisation should actively support a change in the law, and just 33 per cent wanted it to retain its opposition to such a move. Around 20 per cent of respondents thought it should revisit its 2005 stance of neutrality.
Similarly, the Royal College of General Practitioners (RCGP) is maintaining its 14-year opposition to assisted dying, despite a majority of GPs (51 per cent) voting earlier this year either to support a change in the law or to adopt a neutral stance – a major change since 2013 when 77 per cent of members polled were opposed to a change in the law.
Meanwhile, the Royal College of Physicians (RCP) reaffirmed its position of neutrality in March this year, although an online survey of its members 12 months previously showed more respondents were either neutral or supported a change in the law than were opposed to it, largely mirroring the RCGP survey results.
But with the RCP acknowledging that “the ultimate decision on assisted dying rests with society through parliament”, it seems that MPs bear most responsibility for the lack of progress towards the adoption of assisted dying in the UK.
Many attempts at legislative reform (all unsuccessful) have been made here, from 1931 – when the president of the Society of Medical Officers of Health proposed a voluntary euthanasia bill for incurable invalids – right up to the present day, when the latest iteration of Labour peer Lord Falconer’s Assisted Dying Bill stalled in the House of Lords earlier this year.
It remains to be seen whether a suggestion in August from Tory MP Andrew Mitchell, co-chair of an all-party parliamentary group on the issue, that assisted dying would become legal within the term of the current parliament proves any more successful.
Other countries – Belgium, Canada, Colombia, Luxembourg and the Netherlands – have already passed laws that permit euthanasia, and assisted suicide has been allowed in Switzerland since 1942. Assisted dying is legal in several states in the US (including California, Hawaii, Oregon and Washington State).
And this year has seen further moves internationally towards introducing or liberalising assisted dying legislation.
Seven months ago a parliamentary committee recommended that the Australian state of Queensland should legalise voluntary assisted dying for adults with an advanced terminal illness. MDMD notes that currently more than one-third of Australians have, (or shortly will have), access to a form of assisted dying since the state of Victoria passed its voluntary assisted dying law in 2017, followed by Western Australia in 2019. If Queensland follows, this would give the option of an assisted death to well over half (57 per cent) of Australians.
In Canada, legislation known as Bill C7 and provisionally approved last month is set to liberalise access to euthanasia and assisted suicide, although this particular move led UK campaigning group Care Not Killing to highlight one aspect of assisted dying that is rarely publicised – a government estimate predicted that the new law would save £87m in healthcare expenditure in the first year alone.
Germany repealed a ban on assisted suicide services in February. The country’s constitutional court ruled that to deny adults the right to professional assistance unlawfully denied them a ‘right to a self-determined death’.
In Ireland, at the beginning of October, TDs in the Dáil voted to progress a Dying with Dignity Bill to committee stage, bringing the option of assisted dying for terminally ill Irish citizens a step closer to becoming legal.
A few weeks ago the Dutch government approved plans to allow euthanasia for terminally ill children aged between one and 12 (it was already legal for children older than 12 in that country, with mandatory consent from the patient and their parents).
And in Scotland last month the SNP was said to be considering assisted dying proposals to be debated in Holyrood next May, an idea supported by 76 per cent of respondents in a subsequent survey conducted by DiD.
But it’s back to New Zealand that we should look, to see how ethical considerations determined the latest adoption of assisted dying. The legislation that formed the basis of the referendum there – the End of Life Choice Act, passed by the NZ parliament in 2019 – succeeded in addressing these considerations simply by introducing a set of criteria that a person has to meet before they’re allowed to proceed.
That person must be: suffering from a terminal illness that’s likely to end their life within six months, showing a significant decline in physical capability, and able to make an informed decision. The criteria do not include advanced age, mental illness and disability alone.
Lack of space in The Lowdown precludes further exploration of the various pro- and anti- arguments put forward whenever assisted dying legislation is proposed, but readers who’d like to know more may want to check these links: BMA, Care Not Killing, Dignity in Dying, Disability Rights UK and MDMD.
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