Beware the law of unintended consequences. A year ago, I wrote in support of assisted dying, touched by the arguments put forward by Dame Esther Rantzen and haunted by the memories of friends who had suffered miserable, prolonged deaths trapped by incurable disease.
Now, as the House of Commons approves the first step towards enshrining that process in law, I find myself worrying that those of us who found ourselves that side of the debate have made a terrible mistake.
That what started out as a legitimate and heartfelt desire to help minimise the suffering of the terminally ill has become an opportunity to promote their swift and convenient removal.
That, as Vincent Nichols, Roman Catholic Archbishop of Westminster, has succinctly put it: ‘The right to die will become a duty to die.’ It’s not that I object to the principle.
I still believe that there are times when it is more humane to assist a person’s passing than to prolong their suffering just to keep them alive.
But that is not what this Bill will achieve. If and when it finally passes into law, it will effectively enshrine state-sanctioned euthanasia. It will institutionalise the process of dying, making it a matter for the authorities in a way that could potentially lead to all kinds of abuse. It will change who we are as a country, from a nation that believes fundamentally in the sanctity of life to one that, well, doesn’t.
To be clear, under the current proposals, ‘mentally competent’ adults with fewer than six months to live and who express a ‘clear, settled and informed’ wish to die may ask for assistance in doing so.
Already I see problems there. For a start, give me a precise definition of ‘mentally competent’. Secondly, do doctors ever really know how long a person has left to live? Stories abound of people who have survived well beyond the odds.
How can anyone know a person’s allotted time with certainty?
Either way, assuming two doctors and a High Court judge agree, the patient would be given ‘an approved substance’ with which to end their life. This would have to be self-administered – a feat that would be impossible for patients suffering from some of the cruellest and most tortuous terminal illnesses, such as motor neurone disease, which is invariably fatal and traps the alert mind in a physical cage.
Arguably these are some of the patients who would benefit most from this legislation – and yet they would be excluded.
There are all sorts of other pitfalls. The doctors involved do not have to have known the patient for any length of time. Therefore, theoretically a medic who had only just familiarised themselves with a patient’s case could be trusted to make an informed decision both on their mental state and their remaining lifespan – a situation that presents ample opportunity for misunderstanding or, worse, abuse.
As for the judges, there is no requirement for them to interview the patient themselves, or any of their relatives: they will rule purely on the say-so of the doctors. And as the matter will be dealt with by the family courts – notoriously secretive – there is additional scope for problems to arise there.
What’s more, there is no right of appeal for relatives. This for me is a really big red flag. If we look at one of the greatest medical scandals of the past few years, that is to say the indoctrination of thousands of children and young adults by a section of the medical community motivated by a rigid gender ideology, it is all too clear how isolating patients from their loved ones might lead to catastrophic errors of judgment.
If the experience of the Tavistock clinic and the Cass Report has taught us anything, it’s that dogma and medicine can be very dangerous bedfellows.
My fear is that the same thing will happen here. That under the tried and tested ‘be kind’ banner, we are at risk of passing legislation whose consequences will prove the opposite of kind.
We have already seen in countries like Holland how seemingly well-meaning changes to the law have led to alarming mission creep. Assisted suicide was introduced in the Netherlands as far back as 2002, initially for patients whose suffering was deemed ‘unbearable with no prospect of improvement’. Over the first five years, such annual deaths among the Dutch averaged about 1,900.
But by 2023, as the definition of ‘unbearable’ grew ever wider, it had risen to 9,068 – more than 5 per cent of all deaths. They ranged from young people suffering from depression and autism to the elderly who felt they had become a burden on their families.
Last November, a Bill was introduced giving over-75s the option of medical euthanasia if they simply felt they had ‘completed life’. That, to me, is chilling.
If I thought this Labour administration had any sympathy for the elderly, I wouldn’t be so worried. But, thanks to the heartless removal of the winter fuel allowance and other measures in the recent Budget, it’s clear that the current government despises old people and regards them as second-class citizens.
It doesn’t take a big leap of imagination to envisage a similar situation such as the one in Holland happening here.
Already the elderly receive a poorer quality of care on the NHS as a result of QALYs (quality adjusted life years, i.e. the criteria by which a patient is judged a worthwhile use of funds in the context of treatment). How much more attractive will be the prospect of them removing themselves entirely from the economic equation through assisted dying?
In the context of ‘protecting our NHS’, it could be seen as doing one’s patriotic duty.
And we know how the elderly like to do their duty.
There are also, as far as I can tell, no safeguards in place to ensure that people aren’t led to their deaths by coercive control. When people become very ill, they can also become vulnerable mentally and it’s all too easy for the immoral and the unscrupulous to take advantage.
I don’t just mean self-interested family members but political administrations such as this one. I simply don’t trust them to get this right, given how much they’ve already got wrong – and given how ideologically stubborn, not to mention incompetent, they have shown themselves to be.
At the end of the day, if you are wealthy, well-connected and well-loved, you will be insulated from the pitfalls of this Bill.
But if you are poor, marginalised, lonely or vulnerable, it could, in its current form, prove very detrimental indeed.
