Tag: Sonia

Charles Falconer: The current law has been abandoned. The director of public prosecutions (DPP) will not prosecute those motivated by compassion as long as they are not healthcare professionals, despite the fact they are committing a crime to which they have no defence, with a maximum of 14 years in prison.

This half-law brings unnecessary suffering. People fear death because they cannot control its timing or form, and the medical profession can’t help. People go to Switzerland to die earlier than they want, often alone. Those who cannot afford or do not have the energy to go to Switzerland take steps like hoarding pills to take their own lives, often alone to protect their loved ones.

People can suffer horribly in their final illness because the doctor cannot provide help for them to end the agony, when it is conspicuously the compassionate course.

Those who love them who do help often face an investigation and then an agonising wait as the DPP decides whether they are to be prosecuted.

The terminally ill should have a choice. If they want help they should be given it. Most won’t. There need to be safeguards to ensure that there is no pressure to have an unwanted assisted death.

Kim Leadbeater’s terminally ill adults (end of life) bill, published on Tuesday, contains robust safeguards – better than anywhere else in the world: two doctors and a high court judge have to be satisfied that the choice is freely made by ­someone with capacity to make that choice.

Countries where there are assisted dying laws for the terminally ill show that these laws do not lead to cases of coercion. The safeguards work. The inadequacy of palliative care in some parts of those countries does not lead to reluctant early deaths. Rather it leads to less fear and suffering. And to an improvement in palliative care.

Kim’s law does not extend to ­people who are suffering unbearably through some chronic condition but are not terminally ill. Her law is only for those who are dying within six months.

Throughout the world, up to 300 million people have assisted dying laws. Where those laws start with terminal-illness-only provisions, that is where they stick. There is no slippery slope. That slippery slope occurs where the law is an ­unbearable-suffering law, and what constitutes unbearable suffering becomes a difficult line to draw. That is not this case. Our courts have made crystal clear that it is for our parliament to decide the ambit of an assisted dying law.

Kim’s law with pre-assistance safeguards is a safer, more compassionate law than the current one. Parliament should make the change.

Sonia Sodha: You set out the case very powerfully and, like you, I’m hugely sympathetic to those with terminal conditions who want medically assisted suicide to be legalised. I can think of situations where I’d want it for myself. But parliament shouldn’t legislate unless it’s confident it can be done safely. I don’t believe this bill achieves that.

I’m not sure we can prevent people choosing assisted suicide because they feel they are a burden or would rather pass money on to their kids than spend it on care. Even more concerning, I don’t think the bill’s safeguards – approval by two doctors and a high court judge – would reliably detect if someone was being coerced, pressured or nudged into killing themselves. Coercive control can be extremely difficult to identify, including by victims.

High court judgments show family judges sometimes fail to investigate coercive control even where it’s alleged, which it may not always be in assisted-dying situations. It’s difficult to prove coercive behaviour in the criminal courts.

Busy doctors aren’t well placed to detect coercive control. If a doctor has no concerns, on what basis would a judge investigate? What if one adult child suspects their sick parent is in a coercive relationship with another adult child: how would they raise their concerns with the court, what resources would they need to do so, and what if they don’t find out their parent has opted for assisted suicide until it’s too late? The World Health Organization (WHO) estimates that one in six older people experience abuse.

I worry that limiting assisted ­suicide to those with terminal conditions with less than six months to live is more subjective than might appear. In Oregon, doctors who controversially regard anorexia as sometimes terminal have approved assisted dying for patients, to the horror of survivors who say doctors can give up too easily on them.

Predicting life expectancy is a guesstimate. Some doctors could apply these criteria expansively – on what basis should a judge intervene? Experienced KCs believe the bill could be subject to expansion by the courts via discrimination-based challenges under the European Convention on Human Rights.

These are just some of the substantial risks that worry me. As Wes Streeting highlighted this week, NHS resources are regrettably limited. Better palliative care can’t make death easier for everyone, but it could for many. While 300 people a day are estimated to die without the palliative care they need, I think this should be the priority.

CF You are hugely sympathetic to those with terminal conditions who want to be medically assisted to take their own life. Your reservation is that parliament should only legislate where it can be done safely. And your concerns are that people will be pressured into an assisted death either by feeling a burden or from being pressured, whether by coercive control or otherwise.

A significant number of countries have had assisted dying legislation for the terminally ill, some for more than a quarter of a century. Fears such as you express were expressed there before introduction. But they have not been realised. There is no evidence that in those countries people are being pressured.

Kim’s bill has more safeguards here than anywhere else. Oregon has had an assisted dying law for the terminally ill for 27 years. Many doctors were opposed before introduction. Now there is widespread acceptance that it has worked well and people are not being coerced.

Is that because the authorities are not picking up coercion? I very much doubt it. The people operating the law don’t think so.

Anyone with experience of terminally ill people will know that for some, becoming dependent on those they love is utterly unbearable.

Like everyone, I’m in favour of more and better palliative care. Like so many people opposing the bill, you make the false point that it’s either/or. It isn’t. Experience from many countries is that an assisted dying law for the terminally ill leads to improved palliative care because of greater focus on end of life.

I welcome your sympathy. There is a real opportunity now to make terminal illness a less horrific experience for a significant number of people. I so hope you will join us in supporting this important reform.

SS You say there’s no either/or when it comes to legalising medically assisted suicide or addressing the palliative care crisis. That’s not true in a world of limited resources where the NHS is failing to provide tens of thousands of people a year with care that would reduce pain and suffering towards the end of life. Do you agree that unless this is fixed first, people will opt for assisted suicide because they can’t access care?

If you don’t think it’s an either/or, why haven’t you and Labour colleagues sought assurances from the chancellor that she will invest the billions a year needed to ensure everyone can access the palliative and social care they require? No doctor should have to tell patients that resource constraints mean they can’t alleviate their pain, but they can offer assistance to end their life. This is an important reason why the Association for Palliative Medicine is opposes the bill.

It’s thought that a third of female suicides could be related to domestic abuse. Domestic abuse campaigners believe there are 130 “hidden homicides” a year in which women are murdered by a partner or relative, yet their deaths are recorded as accidental or suicide. I know from colleagues the painstaking journalism required to investigate just one of these cases; the idea that the light-touch monitoring we see abroad would capture coercion where it occurs is extraordinarily naive. A review of Oregon’s monitoring revealed concerning gaps in information.

On Thursday the former president of the high court family division, Sir James Munby, published detailed analysis of the bill’s judicial safeguards and concluded they fall “lamentably short”. He said: “Only those who believe implicitly in judicial omniscience and infallibility … can possibly have any confidence in the efficacy of what is proposed” and pointed out that, even assuming an application takes only two hours, assisted dying applications would overwhelm the capacity of the family division. On what basis do you disagree with his assessment?

CF It is not right to delay correcting the suffering caused by the current law until palliative care has significantly improved across the UK.

The Commons select committee on health and social care, which was genuinely neutral on the issue, produced a report in February 2024 charting the course of the jurisdictions which had introduced terminal illness/assisted dying laws. In not one country was their any evidence either of abuse or despair at the lack of palliative care as a driving force.

You appear to think that assisted dying will be part of domestic abuse. You dismiss the absence of evidence of this from any relevant jurisdiction as “extraordinarily naive”. The evidence is overwhelming that terminal illness/assisted dying laws relieve the suffering of the dying without being abused.

Complaints about those laws focus on safeguarding excluding too many people from assistance. Kim’s law is the most safeguarded of all.

Finally, the views of Sir James Munby that the safeguards are inadequate and would overwhelm the judicial system. Not the conclusion from other, less safeguarded, jurisdictions. Your fears were expressed in all these other countries. They did not come to pass. We should be guided by the best evidence.

SS I agree there’ll always be some people who want medical assistance to end their own lives even if palliative care were as good as it could be; their wishes are important. But the question remains whether it can be legalised safely in a way that doesn’t lead to others being coerced or pressured into state-sanctioned suicide.

The select committee report was clear it can’t provide a definitive answer to a range of questions, including how effective safeguards against coercion are. The one jurisdiction MPs visited was Oregon; like me they expressed concern at incomplete data. More generally, they found hesitation among healthcare professionals about whether it’s possible to safeguard everyone. Absence of evidence of abuse doesn’t constitute evidence that it isn’t happening. In Ontario, it’s been reported that compliance concerns were raised regarding a quarter of assisted suicide providers last year.

More international evidence is needed on the effectiveness of safeguards and how we would monitor and investigate coercion in the UK. So many unanswered questions have been posed by doctors and lawyers about the bill: I wonder if we could agree that the fact there’s been so little pre-legislative consultation, analysis and scrutiny is far from ideal? And that a better first step would be a royal commission of experts charged with looking at whether and how medically assisted suicide can be legalised safely?

CF The question parliament faces is whether to legalise the provision of assistance to take their own life for those who are facing death from a terminal illness.

There is no disagreement, certainly between the two of us, that the current law causes huge suffering for many people and those they love because they cannot have that assistance. And there is no ­disagreement between us that there need to be robust safeguards to prevent abuse. The disagreement appears to be that you are not convinced that the safeguards will be adequate.

There is literally no evidence from any jurisdiction where there is a ­terminal illness/assisted dying law that their safeguards don’t work. And by working I mean preventing coercion, and ensuring only patients with capacity receive the assistance.

There have been 25 years of these laws in other countries. This is not a precipitate rush to change. It’s a long delayed and necessary reform where Kim’s bill takes the most cautious approach.

SS I agree the biggest disagreement between us is on whether safeguards could work in detecting coercion or pressure, and on whether the limits in the bill would be subject to expansion by doctors making subjective judgments, or by the courts responding to discrimination-based challenges.

I don’t think there’s the evidence to support the claim it can be done safely, and I think the burden of proof is on proponents of changing the law to show it doesn’t come with very significant risks. There’s no reversing the decision on medically assisted suicide, which is why it’s paramount parliament only legalises it if it’s confident the safeguards will work.

Despite our disagreement I’m grateful for the opportunity to discuss this with you so openly and respectfully, and I hope our readers will find our exchange illuminating regardless of their own views.