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By Angelika Reichstein
The Terminally Ill Adults (End of Life) Bill had its second reading on 29 November 2024. The Bill is similar to previous assisted dying Bills, in that it would only legalise assisted dying for those who have a terminal diagnosis and are predicted to be within the last six months of their lives. In the past, assisted dying Bills have faltered at the second reading stage, whereas this Bill has now moved on to the committee stage. However, this does not mean that the Bill has a smooth trajectory ahead of itself.
Assisted dying is a hotly contested topic with strong arguments on both sides of the debate. In every debate of assisted dying in Parliament, the same topics emerge. On the one hand, the need to protect the vulnerable, the risk of a slippery slope, and the need to expand palliative care services to counter the legalisation of assisted dying. And on the other hand, the protection of dignity, autonomy and the limits of palliative care to support the legalisation of assisted dying. Impeding progress in the debate is the fact that all these arguments are valid. Surely no one would wish to argue that we do not need palliative care services or that we do not need to protect the most vulnerable in our society. However, keeping the status quo condemns a small number of individuals to suffer and die in utter agony. In some cases, doctors blur the lines and give medication in such high quantities that it alleviates the suffering while potentially hastening death. As stated by Dr Simon Opher in the debate on November 29th: “I think that almost all doctors in terminal care have probably done this—doubled the dose of morphine knowing that it might curtail the patient’s life. That is a big fudge”. In other instances, their suffering makes individuals who can afford it travel to foreign countries to receive assistance in dying far from home and their loved ones, and earlier than they would have wanted. As a compassionate society we should not accept people dying under such circumstances, we can do better.
To move on from this stalemate in the debates and to enable the legalisation of assisted dying, the true focus must be made clear: we are not discussing alternatives to dying, but how to make dying a dignified process. While some arguments in the debate are presented as a choice between life and death, Peter Prinsley succinctly pointed out that: “We are shortening death, not life, for our patients. This is not life or death; this is death or death”. One option being to die in great suffering, and one to die some weeks earlier, but in a more dignified manner. It is high time we give dying individuals the right to die in dignity.
By legalising assisted dying, legislators are not devaluing life. In a similar vein, when legalising abortion under specific conditions, the legislator acknowledges that abortions happen, whether legal or not, and regulates them in a way that makes them safer, offering help to those who need it. Making sure women can access safe abortions does not devalue life, it protects women and brings a dangerous procedure within the ambits of safe regulation. Similarly, legalising assisted dying would regulate what is already happening – doctors speed up death out of compassion even at the risk of prosecution, dying individuals travel abroad to receive legal assistance – and would ensure that suffering individuals receive the help they want.
During the debate, the Bill was criticised for not being perfect. For example, Diane Abott stated: “I am not against legalising assisted dying in any circumstance, but I have many reservations about this Bill. In particular, I do not believe that the safeguards are sufficient” and Danny Kruger more generally that: “the point about process is that this Bill is too flawed; there is too much to do to it to address in Committee”. Alas, no law is perfect. Legislators are limited not just by practicalities and the existing legal framework into which the new law has to fit – we are also constrained by the limits of language and the limits of our knowledge (to quote Wittgenstein: “the limits of language mean the limits of my world”). However, this should not stop us from working out an assisted dying law that enables suffering individuals to die with dignity. The Terminally Ill Adults (End of Life) Bill does not present a perfect solution that alleviates all suffering. Arguably, individuals will continue suffering if they cannot be deemed in the last six months of their lives. However, this Bill is a vital step towards a more dignified approach to dying and to giving individuals autonomy over the last moments of their lives.