A long-awaited liberal reform is in jeopardy
image: The Economist/Dreamstime
Nov 21st 2024
This newspaper believes in the liberal principle that people should have the right to choose the manner of their own death. So do two-thirds of Britons, who for decades have been in favour of assisted dying for those enduring unbearable suffering. And so do the citizens of many other democracies—18 jurisdictions have passed laws in the past decade.
Despite this, Westminster MPs look as if they could vote down a bill on November 29th that would introduce assisted dying into England and Wales. They would be squandering a rare chance to enrich people’s fundamental liberties.
The proposal—put forward as a private member’s bill by Kim Leadbeater, a Labour backbencher—seeks to set out the safeguards that would govern assisted dying for the terminally ill. This will be a free vote, in which MPs follow their conscience rather than a party line and Ms Leadbeater has received no help from the government, even though the prime minister, Sir Keir Starmer, has said he is in favour. A few weeks ago, it looked as if her bill would pass. Now opposition is growing and Sir Keir has taken up a position on the fence.
You might think the debate over assisted dying would be about principles. But appealing to God or the sanctity of life would no longer succeed in today’s Britain. Such arguments, however sincere, operate in a space that is governed by individual conscience, not the state.
What is more, the principle of assisted dying has already been established. The courts have ruled that doctors can withdraw life support from patients in a vegetative state. And Britons are free to travel to Switzerland for an assisted death. Between 2016 and 2022, about 400 people did so.
Ms Leadbeater’s bill extends this logic. Going to Switzerland to die costs about £15,000 ($19,000); companions risk prosecution. The bill would make assisted dying open to anyone who qualifies, rich or poor, including those who need their family to be with them.
Those who can no longer defeat the bill on principle have therefore joined those who worry about the details. But these arguments do not withstand scrutiny either.
Much of the running is being made by Wes Streeting, who as health secretary has argued that access to palliative care is too hit-and-miss to give terminally ill patients a genuine choice. That is a red herring. The closest analogue to Ms Leadbeater’s proposed system is in the Australian state of Victoria, which passed its law in 2017. It gathers data on palliative care and has found that assisted dying does not happen more often in places where access is patchier.
In any case Mr Streeting could afford to improve access to palliative care. Those in the hospice sector in England believe that an extra £350m-400m of annual statutory funding, around 0.2% of the nhs budget, would allow them to meet demand fully. Even then, the need for assisted dying would remain. One reason is that in around 1% of cases, the best palliative care does not ease physical pain; another is that most people choose assisted dying because they want autonomy.
In a bold piece of ministerial judo, Mr Streeting also argues that the health service, which he runs, is too broken to take on the burden of assisted dying. Yet doctors already routinely make decisions over life and death. Through the principle of “double effect”, doctors can administer painkillers to terminal patients knowing that they will cause death. One salutary consequence of Ms Leadbeater’s bill would be to bring these obscure judgments into the light, and to involve patients in them.
Critics also raise concerns about the risk of coercion. But that is not credible in this case. In Ms Leadbeater’s bill a person with around six months to live must make sustained requests approved by two doctors and a judge. The idea that an evil relative might go to great lengths to kill someone who will shortly be dead makes no sense.
Someone may choose an assisted death for fear of being a burden, which is cited as a reason in four out of ten cases in Oregon, which has had an assisted-dying law for longest. It would be better if people didn’t feel burdensome, obviously, but that does not stop them from making rational choices. Indeed, the option to die may be all the comfort people seek: a fifth of those handed the medication in Victoria never take it.
Even if opponents of the bill are reassured by these arguments, some cannot shake the fear that Ms Leadbeater’s law would be a slippery slope. If they mean that the criteria would sneakily be broadened to include the mentally ill or disabled without further legislation, then the facts are against them. In no case has an assisted-dying law restricted to the terminally ill expanded in this way. In Canada the scope widened, but that was because the courts enforced broad eligibility criteria derived from the country’s existing Charter of Rights and Freedoms.
If they mean that future legislation could extend the right to assisted dying after due debate and consideration, then that is not an argument against, but a recommendation. In the view of The Economist, Ms Leadbeater’s bill is drawn too tightly. Oregon and Victoria have shown that a doctor does not need to be present for the medication to be safe. A High Court judge is unnecessary when two doctors have already given their opinions. A prognosis of six months or less to live is arbitrary and imprecise. A 21-day cooling-off period is too long for people with only a very limited time to live; in 2021 California reduced this period from 15 days to two. None of that is an argument for voting down the current bill—indeed it can improve as it passes through Parliament.
Ms Leadbeater’s bill would have been better if the government had helped her prepare it, or if Sir Keir had set up a citizens’ assembly that weighed up the evidence and presented MPs with an agenda. The fact that he did not is one more example of his passive style of government. But that is not a reason to reject it, either. We would sooner that more Britons benefit from greater freedom, choice and dignity than none does. MPs should reassure themselves about the details of the bill, and then they should vote for it.
Source (Archive)
