India Gordon
The UK is at a pivotal moment in its history with the proposed Terminally Ill Adults (Assisted Dying) Bill having passed its second reading in the last month. If approved, the Bill could transform end-of-life care in the UK, marking a significant step forward in patient autonomy. However, to truly ensure the safety and dignity of patients, adequate safeguards are needed to address the procedure’s intrinsic practical and ethical challenges. need to be robustly defined to protect vulnerable individuals while balancing its practical and ethical challenges.
The Law
The right to life underscores various human rights charters, including the United Nations’ Declaration of Human Rights. Advocates of assisted dying argue that the procedure is an intrinsic extension of this right as individuals should be able to determine when and how they want to end their life. They believe that terminally ill patients are entitled to dignity in their medical autonomy, especially when all treatment options have been exhausted.
In the UK, assisted dying remains illegal under the Suicide Act 1961, which prohibits anyone from assisting another in ending their life. While there have been numerous previous attempts for legislation change, no bill has succeeded in becoming law. However, with a recent poll finding that 75% of respondents supported the legalisation of assisted dying in the UK, policymakers face the challenge of balancing its potential practical and ethical considerations while preserving the dignity of terminally ill patients.
The Terminally Ill Adults (Assisted Dying) Bill
Lobbied by MPs such as Kim Leadbeater and various patient advocacy groups, the Terminally Ill Adults (Assisted Dying Bill) proposes legislation reform that would allow patients aged 18 and above, who have been given a prognosis of six months or less in their terminal illness, the option to end their life with a doctor’s assistance should they wish to do so. The bill specifically stipulates that two doctors need to establish that the patient has adequate mental capacity to make a fully-informed decision, meaning they need to demonstrate that they are acting out of their voluntary wishes and understand the nature of the process and the potential effect it may have on their relatives.
Therefore, the primary purpose of the bill is to prioritise patients' dignity in their decisions during the end stages of their life. The bill also looks to avoid the criminal prosecution of terminally-ill patients' relatives who travel with them abroad to countries like Switzerland, where over 500 British citizens have sought access to assisted dying services from Dignitas since its establishment in 2011.
The Opposing View: A ‘Slippery Slope’
Opponents of the bill, including senior MPs and religious organisations, believe that legal assisted dying procedures inherently risk a ‘slippery’ slope. They warn that there is space for potential misuse and coercion that could lead to a significant number of patients seeking assisted dying and expanding eligibility of conditions existing beyond originally proposed legislation.
Those against assisted dying frequently cite the potential vulnerability of terminally ill patients to pursue assisted dying procedures if they feel pressured to. The risk of relatives who seek financial gain, such as inheritance, may exploit terminally ill patients’ vulnerability and coerce them into pursuing euthanasia. And even if there are no parties posing ill intent present, some patients may pursue assisted dying if they believe themselves to be an emotional or financial burden on their loved ones and healthcare services, in which case assisted dying becomes a seeming obligation rather than genuine choice. These practical concerns are further exacerbated by the psychological toll that terminal illness can have on people, which critics argue renders a patient’s capacity to make fully-informed decisions precarious in its objectivity.
Critics of assisted dying draw attention to the psychological toll that terminal illnesses can have on people, rendering their capacity to make fully-informed decisions precarious in its objectivity.
Another significant concern of legislation is the potential for expanding the types of conditions that would deem a patient eligible for assisted dying services, which has already occurred in Switzerland and Belgium. While the Bill’s current proposal limits eligibility only to those with terminal physical illnesses, opposing parties fear that it could eventually seek to include mental health conditions. For instance, in May 2024, Zoraya ter Beek, a Dutch citizen, travelled to Switzerland to end her life after enduring years from chronic depression and anxiety. Her case sparked conversation about the ethical implications of extending assisted dying to individuals with non-physical conditions, raising questions about the boundaries of eligibility and the adequacy of safeguards to protect vulnerable individuals.
While there are concerns about logistics and ethical challenges regarding euthanasia, proponents of the bill argue that by preventing the legalisation of assisted dying in the UK, citizens are faced with declining health which can worsen their quality of life in terms of their physical and mental wellbeing. And because options for assisted dying are only currently available abroad, patients may actually feel inclined to pursue it earlier than they may want to, as advocates argue that these patients may worry that their declining health will render them unable to in the future. Therefore, it is clear that individuals need access to end-of-life care without unnecessary delays or uncertainties.
Conclusion: Future legislation
Ultimately, the challenges facing these legislation exemplify the need for policymakers to ensure that any future legislation contains robust safeguards that protect the safety and dignity of terminally-ill patients.
Avoiding coercion - The proposed Bill suggests that if doctors suspect patients are making decisions out of coercion or emotional manipulation, they can refer them to external psychologists. However, without formal training, doctors may only recognise overt signs of pressure, overlooking more subtle signs, which inherently undermine the necessity for patient autonomy.
Assessing mental capacity - When assessing a patient’s mental capacity, a panel of multidisciplinary professionals should be consulted. Instead of solely relying on only two medical doctors’ judgements, combining the expertise of doctors, trained psychologists and clinical ethicists, would more reliably assess a patient’s mental state. This would mitigate the risk of wrongful decisions.
Address gaps in current palliative care - Finally, legislation could also benefit from improving the standards and availability of current palliative care. By ensuring that patients have access to adequate medical and emotional support, this minimises the risk of them choosing assisted dying due to feelings of isolation or unrelieved suffering.
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