Health

A rushed UK law is no way to make such a vital, painful decision as how to die | Sonia Sodha


Labour goes into its conference this weekend with a friendly warning it would do well to heed. The Starmerite thinktank Labour Together has just published its analysis of why Labour won. Its conclusion: Labour has been “cautiously hired, on a trial basis, liable to prompt dismissal if it deviates even slightly from its focus on voters’ priorities” and that it must “not get distracted by pet projects”.

No 10 should take note. Last week, it was reported that Starmer’s team are working behind the scenes to urge MPs who topped the private member’s bill ballot to take forward legislation to legalise assisted dying , a reform that appeared nowhere in Labour’s manifesto but which Starmer has made clear he personally supports. This is despite it being a major reform that could be open to significant abuse, and with nowhere near enough work done on what sufficient safeguards would look like, and how we would monitor whether or not they were working.

Private members’ bills enable backbench MPs to introduce legislation to the Commons. The best chance of getting a bill into law is to get one of the prized top spots in the ballot at the start of every parliamentary session. MPs can either advance their own legislation – campaign groups will try to target them ready-made bills – or adopt a “handout” bill, where the government asks MPs to take on usually technical and relatively uncontroversial changes it has not found time for. There are many procedural hurdles a bill has to pass and it has far greater chance of becoming law if tacitly backed by the government.

Keir Starmer has made no secret that he backs a change in the law on assisted dying. He voted for a bill to legalise assisted dying in 2015, and has said on many occasions that he is personally in favour of changing the law. But there are huge concerns about a lack of safeguards in existing proposals that have been advocated for by campaigners outside and inside parliament. MPs who back a change in the law to legalise doctors assisting patients diagnosed with terminal conditions and less than six months left to live to die – subject to two doctors, and perhaps a judge, signing off their request – paint it as “very modest” and “narrow”. It is nothing of the sort.

There is no fixed definition of what constitutes a “terminal” illness and medical experts say it is impossible to accurately predict life expectancy beyond a few days; so legislation could end up covering people living with a wide range of conditions with huge latitude for doctors on what they sign off.

Although I am personally sympathetic to the principle that people in pain should have the autonomy to choose when to end their life, signoff by doctors or a judge is not an adequate safeguard: how will they establish whether someone is being coerced or pressured into the decision, and what would be the evidentiary bar? We know some judges in the family courts fail to understand coercive control between partners, let alone whether relatives are exerting pressure because it would suit them for their unwell parent to choose assisted dying in terms of caring responsibilities or financial considerations, in a world where social care is so underfunded.

And what of the pressure people will feel themselves – that ending their lives is the right thing to do so as not to be a burden – once society sanctions the possibility? How would we even know if this process is being abused given potential victims of wrongful state-sanctioned deaths would no longer be with us, and what of the likely disproportionate impact on women?

None of these important issues has been remotely worked through or adequately addressed in parliamentary debates to date. In fact, some supporters have been extraordinarily dismissive; one naive MP ridiculed safeguarding concerns as “the view the nation is teeming with granny killers”.

Parliament must not simply adopt the legislative proposals of campaigners. These are important questions that need to be examined by a neutral body of experts, such as a royal commission or the Law Commission. But there is a risk that behind-the-scenes government pressure means this is adopted by a new parliament with insufficient scrutiny. While Starmer says it will be a free vote, it bodes badly that No 10 is reportedly pressurising Labour MPs who’ve topped the ballot to adopt a bill. One can imagine the conversations behind the scenes: that this is something the prime minister wants to happen; what a great way to make their mark to usher such important social legislation through the Commons. The bill may not be formally whipped, but there are many impressionable, ambitious new MPs aware of Starmer’s personal views.

There are those who argue that this would be no different to when homosexuality and abortion were decriminalised, and the death penalty abolished, through private members’ bills in the 1960s. But the moral calculus in all of these was simpler, and a huge amount of prelegislative work had been done by various royal commissions and cross-departmental committees around what form legislation should take. No such work has been done on assisted dying.

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So why the rush? It likely comes back to Starmer’s personal beliefs that stem from when he modified CPS policy as director of public prosecutions to ensure prosecutions for assisting suicide only take place if they are in the public interest; a good reform that resulted in only 24 prosecutions between 2009 and 2024, including for other crimes such as homicide.

But Starmer’s enthusiasm for a speedy change in the law without independent consideration of safeguarding issues suggests he has not properly understood the risks as well as benefits of reform in this area. It is very significant that two of the most thoughtful members of his cabinet, Shabana Mahmood and Wes Streeting, have expressed serious reservations. The risk is that Starmer’s personal backing could mean a bill that looks simple on paper – but is ridden with the potential for abuse – gets passed by the Commons, which then may or may not meet with resistance in the Lords. Starmer has no mandate for prioritising this, however implicitly. He was elected by voters to deliver on his manifesto, not his personal conscience. If he really wants to pave the way for assisted dying, his government should set up a balanced royal commission of experts, rather than tacitly backing legislation that has not been properly thought through.

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