Assisted dying debate must also consider who it might harm

As MPs prepare for the debate on assisted dying, many will be feeling the weight of their decision. Assisted dying is one of the most fundamental human rights issues. It’s about how we live, how we die, and how we care for our loved ones.

But Friday’s vote is not a vote about the principle of assisted dying. It’s possible to be supportive in principle of assisted dying, as Liberty is, and also hold serious reservations about the contents of the Assisted Dying Bill and the way it is moving through Parliament. There are shortcomings in the legislation that will leave chasms for people to fall through. MPs cannot look past those when it comes time to vote.

Everyone in this painful and complex debate is starting from a place of compassion, and Kim Leadbeater MP has undertaken a mammoth task with the best intentions. It’s been a particularly difficult exercise for parliamentarians when faced with so many distressing first person testimonies. But in order to make good law, we also have to hear many voices, sift through complex evidence, address competing rights, and reflect on unintended consequences.

The conversation so far has concentrated on who this Bill will benefit. It will undoubtably help many who choose assisted dying. But our attention cannot just be on who the Bill will benefit, we must also consider who this Bill might harm. While proponents of the Bill vigorously argue that this debate is not about disabled people, we cannot ignore the likelihood that this legislation, if passed, would go on to be amended as it faces intense political and legal pressure to expand. This is not scaremongering. Even in Oregon, often held up as an example that disproves the ‘slippery slope’ argument, we have seen understandings of terminal illness evolve and now include diabetes. Disabled People’s Organisations are speaking up against this Bill: we must listen to them.

Proponents of the Bill suggest that the safeguards in place are of the highest order. Concerns about the risk of coercion have been addressed with tough sentencing for direct coercion. But with assisted dying, what is far thornier is indirect coercion. This is where an individual might feel like a burden to their family or society and opt for assisted dying for this reason, but without disclosing it in assessments. The assessment process outlined in the bill is certainly layered, but it does not set out how concerns about indirect coercion would be investigated. Nor has there been an open debate about how it is not always possible to screen for indirect coercion and be confident that you have ruled it out, as we know from evidence from care homes.

There is an enormous risk that people feel internalised pressure, or indeed, inadvertent coercion from a creaking healthcare system. Good palliative and end of life care are not available to everyone in the country, and there is evidence that this disproportionately impacts marginalised and racialised communities. Social care is broken, the NHS is in crisis. Are MPs confident that against this backdrop of deeply unequal provision everyone will have true choice and autonomy when faced with the option of assisted dying?

Proponents have also pointed out that as a complex social issue, assisted dying has to be presented in a Private Member’s Bill and be subject to its limitations. But when David Steele put forward his Private Member’s Bill on legalising abortion in 1967, he had already built consensus with the relevant medical bodies. Here, no such consensus has been achieved, with practitioners in palliative and older adult care deeply opposed to the bill.

The Scottish Parliament will have spent four years debating and scrutinising their version of this bill before they get to a vote. Jersey will spend eighteen months drafting their bill. The House of Commons have given themselves three weeks between bill publication and Second Reading. If the vote passes, there will have been no pre-legislative scrutiny, no impact assessment, and the committee stage will have no public stakeholder consultation. A ‘principles first, details later’ approach is wholly inappropriate.

The assisted dying debate is deeply personal to each of us. But this is not a vote on the principle of assisted dying itself. MPs need to vote on the proposed law in front of them. If they find it wanting, they should oppose it.

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