Assisted Suicide, or Social Murder?

UK Labour MP Kim Leadbeater’s Private Member’s Bill (PMB) on assisted suicide has progressed through parliament at breakneck speed since being introduced on 16th October 2024. The Terminally Ill Adults (End of Life) Bill—now rebranded as ‘Voluntary Assisted Dying’ (VAD)—passed its second reading on 29th November, passed the committee stage on 26th March, produced its Impact Assessment (IA) on the 2nd May, and will be voted on in a third reading on the 16th May. If it passes second reading and progresses through the House of Lords, the IA states its intention for assisted dying to become available on the NHS by October 2029—although Leadbeater says “the four year limit is not a target, it’s a backstop”^[1]—and for up to 4,559 people per year to die using the service by its tenth year—although Leadbeater originally said in January this figure would be 17,000 per year.^[2]

Of course, this is not the first time a euthanasia or assisted suicide bill has been debated in UK parliament—it’s at least the fourteenth time in the last century and the eighth time in just the last decade. The Isle of Man introduced their Assisted Dying Bill only two months ago which will come into effect in 2027. And Scotland has its own assisted suicide PMB progressing on a more usual timeframe, having just passed its first vote this week after being introduced over 13 months ago. Although the Senedd only voted against legalising assisted suicide in October,^[3] VAD will be forced onto Wales too if Leadbeater’s Bill passes. Even if the current bid ultimately fails, Leadbeater can simply return with another PMB next year (and has already suggested as much),^[4] just like Lord Joffe did with four proposed euthanasia bills in the space of four years and Lord Falconer who has proposed three so far.

Rejected safeguards

The Bill has become considerably more dangerous since Leadbeater claimed it would have “the world’s strongest safeguards” in February,^[5] with the committee declining the majority of proposed protections. In total, 327 amendments were rejected—and only 30 of the amendments accepted were from opponents of the Bill. Expediency seems to have been a larger concern than safety: the committee passed a motion in January stating “it is expedient to authorise the payment out of money provided by Parliament of any expenditure incurred”.^[6] Furthermore, there was only a five week period for evidence to be submitted before the committee started (compared to a minimum of 12 weeks required for government-led public consultations on disability issues). The decision to use a PMB to introduce such a monumental piece of legislation allowed for faster and less thorough implementation, as IAs for Government Bills are usually introduced before the legislation goes to committee (instead of afterward). Leadbeater’s hand-picked committee was stacked with pro-euthanasia advocates: 14 of the 23 MPs supported the Bill at its second reading and all eight international witnesses are known supporters of assisted suicide and/or euthanasia; notably none came from Canada, the Netherlands, or even the US State of Oregon whose policy Leadbeater’s Bill is supposedly modelled on. Over 350 disability organisations in the UK oppose the Bill,^[7] yet none were invited to give oral evidence to the committee (although eventually after pushback, a single representative from Disability Rights UK was invited). Organisations representing the elderly and concerned with elder abuse, such as the British Geriatrics Society, Hourglass, and Standing Together Against Domestic Abuse, were also blocked from giving evidence.^[8]

Right To Life provide a video covering more of the amendments rejected but here are just some of them: that diabetes, eating disorders, Down’s syndrome, or “feeling like a burden” will not be sufficient conditions for VAD; that a High Court judge will be required to approve applications (which 60 MPs cited as the main reason they voted for the Bill at second reading); that a consultation with a psychiatrist, a palliative care consultant, or a fully qualified doctor (or any in-person consultation) will be required before VAD; that doctors cannot raise VAD with patients unprompted, cannot promote or advertise VAD, must inform terminal patients of alternative treatment options, or can be held liable in cases of negligence; that being in pain is necessary or sufficient for VAD approval; protections for people with Down’s syndrome, autism, learning difficulties, mental illness, or unhoused people; a 28 day ‘period of reflection’ before the procedure; protections against coercion, including for the elderly and regarding who can act as a proxy (Leadbeater actually claimed coercion could become when relatives try to talk a loved one out of suicide);^[9] that mental capacity must be established rather than presumed; confirmation of the specific lethal medication to be used and for the chosen medication to have a scientific consensus of not causing pain. Pulling these together, it is apparent doctors will be able to offer, coerce, and pressure vulnerable people–perhaps people who are not actively in pain but who may feel like a burden or are scared for their future–into killing themselves. And this can be done rapidly—far quicker than most NHS referrals take—and without a second opinion.

Assisted suicide, or euthanasia?

An amendment to unblur the line between ‘euthanasia’ and ‘assisted suicide’ was rejected—euthanasia being “the active, intentional termination of a patient’s life by a doctor who thinks that death is a benefit to that patient” (something which can be ‘voluntary’, ‘non-voluntary’, or ‘involuntary’) and assisted suicide being when the patient administers the lethal medication by themselves. Most assisted dying proponents no longer prefer the term euthanasia even when it is the correct legal definition, instead using more obfuscating and empowering phrases like “dying with dignity” and VAD. Leadbeater’s Bill states a doctor may “assist [a] person to ingest or otherwise self-administer the substance”, which legally is the definition of euthanasia. Tory MP Danny Kruger, who introduced the amendment, said:

[My] strong belief is that the reason why euthanasia has not been proposed in the Bill [...] which has been led by an organisation that used to call itself the Voluntary Euthanasia Society, is because the campaign has concluded that such a Bill would not pass Parliament and believes—I think correctly—that Members of Parliament and members of the public would object to euthanasia. But the logic of the Bill and of the campaign is actually for euthanasia.^[10]

And there is good reason to believe it: 99.9% of Medical Assistance in Dying (MAiD) deaths in Canada are actually euthanasia via medical practitioner injection.^[11]

Another rejected amendment concerned the provision of emergency medical care when suicide fails, which it should be noted is not rare: a study in the Netherlands found problems with ‘completion’ (e.g., failure to induce coma, induction of coma followed by awakening of the patient, or a longer-than-expected time to death) and ‘complications’ (e.g., vomiting or rapid muscle contractions) occur in 23% of assisted suicide and 9% of euthanasia cases.^[12] A physician also decided to administer lethal medication themselves in 18% of assisted suicides, legally making them euthanasia. Even more worryingly, Ontario’s chief coroner recorded 428 cases of doctors breaching guidelines around assisted suicide and a “pattern of not following legislation”.^[13] In Belgium, 32% of euthanasia cases occurred without consent: 70% of those were patients who were comatose, 21% of cases were in patients with dementia, and 25% of cases the physician proceeded without consent because they felt that euthanasia was “clearly in the patient’s best interest” or discussing it with the patient would have been “harmful”.^[14] The distinctions between ‘non-voluntary euthanasia’ and ‘involuntary euthanasia’ can evidently be ambiguous in many circumstances, leaving patients susceptible to coercion, abuse, or outright murder.

Palliative care issues

Two important proposed safeguards related to palliative care were rejected: one to prevent “living in an area where good palliative care is not available” being eligible grounds for VAD, and one that called for patients to have a legal right to good palliative care to accompany the Bill’s “right to assisted death”. Palliative care in the UK is in a shocking state of decline: Marie Curie, the UK's leading end of life charity, reports that over 100,000 people in the UK each year die needing palliative care but not receiving it, and that “people with lower socioeconomic position [...] and from ethnic minority groups are less likely to access high-quality palliative care”.^[15] In fact, only 5% of UK deaths occur in hospices^[16] and 215,000 people who die every year do not receive any end of life care.^[17] The Bill committee rejected amendments which would have allowed hospices and care homes to opt out of assisted suicide without being sued or having their funding cut, something described as “standard practice in US States that have adopted assisted dying”.^[18] This will have the effect of further gutting palliative care: in Canada, up to $350m per year may be being recouped by the State from the removal of funding to hospices that refuse to participate in MAiD.^[19] The government’s intention seems clear: care homes and hospices will have to choose between saving the lives of their patients or ending them—with the latter option clearly being made more financially viable.

Horror stories have been paraded by Leadbeater at various points as a justification for the speed of the bill’s passing through parliament—accounts of “very harrowing” and “horrific” deaths, patients in “unbearable” and “inhumane” states of suffering, pain, and agony.^[20] But many dying patients are in pain precisely because they are not receiving humane palliative care; the government is essentially withholding effective care from people at the same time as it is offering them assisted death. Even the Bill’s primary criterion, that “terminally ill” patients will be those eligible for VAD, is heavily disputed. The committee decided that “terminally ill” will mean “[a physician estimates you have] six months to live”;^[21] however, France's top scientific advisory body, Haute Autorite de la Sante, has just released a 100 page report stating that prognostication is far too uncertain at an individual level to rely on for establishing grounds for euthanasia.^[22]

We need to acknowledge that even if the most widely accessible version of this Bill passes, hundreds of thousands of people will still continue to die painful deaths each year—whether they try to access VAD or not—unless we increase funding for palliative care. We need to improve healthcare and social welfare. A key distinction between the UK and Canada is that 78% of people who requested assisted deaths there received palliative care,^[23] likely a much higher figure than would be the case in the UK. 80% of polled Scottish palliative care doctors were concerned that VAD would have a negative impact on the provision of palliative care.^[24] And with due reason: palliative care physicians were not involved in the care of over 65% of patients receiving euthanasia in Belgium, and were consulted in just 12% of euthanasia applications.^[25]

A slippery slope?

‘Slippery slope’ arguments abound in the discourse around the Bill; although this somewhat obscures the fact that the legislation would cause the deaths of vulnerable people from the very start if implemented, there are also many reasons to expect it would open the door to even greater evils in future. MAiD now accounts for 1 in 20 deaths in Canada, increasing from 1,000 suicides in its first year to 13,000 suicides by its sixth year,^[26] and this is set to increase further as ‘mental illness’ will become a qualifying condition for MAiD by 2027.^[27] The Netherlands too has seen a 60% increase in euthanasia for ‘psychiatric conditions’ in the last year.^[28] There seems to be an intention for assisted suicide to become mental health care. Tory MP Kit Malthouse stated: “To me, suicide is a healthy person taking their life”,^[29] while Labour MP Lewis Atkinson, when rejecting proposed safeguards for people with mental disorders, said “We should not be preventing anyone from accessing an option merely because of a mild element of depression”.^[30] Meanwhile data shows that wherever assisted suicide has been legalised, total suicide rates have increased while non-assisted suicides have not decreased.^[31]

A report from the UN Committee on the Rights of Persons with Disabilities has called for Canada to repeal MAiD Track 2 (whereby patients need not have a death that is "reasonably foreseeable”), stating they were “extremely concerned” by the fact that Ottawa broadened the law to include euthanising people who have ‘incurable physical illnesses’.^[32] Rather than safeguarding against this, Leadbeater appears to want to replicate MAiD’s Track 2, stating concerns that disabled people would face “barriers to access” VAD; this mirrors the same language used in both Canada and Australia to widen eligibility criteria of euthanasia to disabled people soon after initial legalisation.^[33] The Netherlands and Belgium have both expanded their legalised euthanasia to include infants and children of all ages (i.e. 0-16), and children aged 12-16 may even request assisted suicide or euthanasia by themselves. Although the Bill defines “(Adults)” in its title, the committee rejected an amendment which would explicitly forbid discussion by doctors of VAD with under 18s; Leadbeater said “We shouldn’t prohibit open conversation with terminally ill young people [...] this creates openness.”^[34] The door has been left wide open for expanding the eligibility of prognoses, medical conditions, and age.

The assisted dying bill together with the slashing of welfare form a coordinated attack on the disabled and the poor, an extension of quotidian social murder and eugenic austerity. The NHS just this week announced “unthinkable cuts”: plans to cut diabetes services for young people, rehab centres, and 5% of all jobs to address a supposed £7bn deficit.^[35] The DWP themselves admit the planned £7bn cuts to welfare proposed in their recent Green Paper will revoke payments from 1,283,000 people currently receiving the standard benefit (87% of all claimants) and 209,000 people receiving enhanced benefit (13% of all claimants). The social security system is linked to suicide already: 43% of Employment and Support Allowance (ESA) claimants have attempted suicide at some point in their lives and 66% have had suicidal thoughts;^[36] and the DWP’s Work Capability Assessment was linked to 590 suicides in the space of just three years.^[37] Furthermore, 54% of people in severe hardship live in a family that includes a disabled person,^[38] and more than half of people receiving Universal Credit (UC) are living in poverty and 43% of households receiving UC are food insecure.^[39] In Canada, where over 40% percent of disabled people are in poverty and disability welfare payments in all provinces are below the poverty threshold, 58% of MAiD applications come from people in poverty.^[40]

Budgeting death

Leadbeater^[41] and Minister of Health and Social Care Stephen Kinnock^[42] have both confirmed the private provision of VAD will be permitted, allowing the NHS to outsource VAD (like everything else) to private companies that will run the service for profit—inevitably incentivising death over life-affirming treatments. Somehow this is combined in the worst way possible with simultaneous confirmation that VAD is considered ‘medical treatment’ and thereby in the remit of the NHS. It is jarring to see the Bill propose amending the very first clause of the 1946 National Health Service Act, which is: “It shall be the duty of the Minister of Health [...] to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness”. Post-amendment, the NHS will, legislatively, become the “national health and assisted suicide service”.^[43]

The IA predicts the “reduced cost from unutilised healthcare” will save the NHS £59.6m per year within a decade. This is likely a huge underestimate which excludes the money ‘saved’ from pensions, welfare, healthcare, social care, and palliative care from the tens of thousands of people who would remain alive if they were not euthanised. This point has been made before, when the UK 2021 Budget highlighted a saving of £1.5bn in pensions due to over-65s dying from SARS-CoV-2 in 2020 and 2021 (and imagine how much better those savings are after four more years of a completely unmitigated pandemic).^[44] Cost-cutting measures were a key motivator behind the legalisation of euthanasia in Canada, where a 2017 study by the Canadian Medical Association claimed MAiD could “save the country up to $139m per year”, and are being used as a motivator in France, where a leading think tank recently highlighted how euthanasia would “save €1.4bn per year”.^[45]

These banal fiscal arguments are being made at the same time as Labour looks to greatly deepen austerity with attacks on other fronts. Senior politicians are using increasingly threatening language: Liz Kendall warns “there isn’t an option of a life on benefits”;^[46] Rachel Reeves states “it is a stain on our country that we are allowing a million people […] sitting at home doing often nothing”;^[47] Scottish Secretary Ian Murray says “if you have a health condition or disability but don’t want to be written off, we will offer you a pathway back to work.”^[48] Official communications are even adopting this language, such as the DWP report in March titled “The cost of working age ill-health and disability that prevents work”.^[49] The discourse around the cost of disabled life reminds me of the Nazi propaganda for Aktion T4, the ‘involuntary euthanasia’ program which murdered up to 300,000 disabled people and developed the mass killing technologies later used in extermination camps: "This person suffering from hereditary defects costs the community 60,000 Reichsmark during his lifetime. Fellow German, that is your money, too."^[50]

What next?

The fact that the majority of criticism in mainstream media is coming from conservative and Christian outlets represents an abject failure of progressive organisations. Opposing this isn’t even controversial amongst the general public: a recent poll found 62% of people think legalising assisted dying is “too complex and polarised for MPs to decide at short notice”.^[51] Silence on this issue (or, worse yet, misplaced support for it) is an example of the general refusal to engage with disability and address internal ableism in our organisations—the most obvious recent example being the denial of the ongoing COVID-19 pandemic and abandonment of those who continue to be killed, maimed, and segregated by it. There needs to be much more engagement with, support for, and accessibility made available to disabled people and disability organisations.

MPs may have started to move against Leadbeater’s Bill: a poll of 103 MPs last week found a majority of 42% plan to vote against it (vs 36% planning to vote for),^[52] suggesting confidence has waned since the second reading when 51% of MPs supported (vs 42% opposed). Labour MP Naz Shah, who supported the Bill in November, now condemns it as “fundamentally flawed” and says she is “very disappointed” with its lack of safeguards.^[53] Until MPs care about reprisal or condemnation from their electorate these attacks will continue—it’s all too easy for them in the current climate. Case in point: only 42 out of 403 Labour MPs will vote against Starmer’s brutal welfare cuts;^[54] their expansion of social murder policies is already bold and shameless.

In a more progressive society assisted suicide could be a truly free decision, an expression of bodily autonomy chosen by people who otherwise have access to adequate healthcare, social care, housing, food, adequate pain medication, and so on. Indeed, assisted suicide is something which most disabled organisations remain neutral on in principle.^[55] However, we must set aside hypotheticals while we focus on the Bill immediately before us. Disability rights advocate Liz Carr, presenter of the critical documentary on assisted suicide Better Off Dead?, summarises the problem succinctly:

Assisted dying is a class issue… As long as we live in a world where certain groups of people are devalued […] it will never be safe to legalise assisted suicide, because no safeguard can protect against the abuse that will happen.^[56]

Assisted dying can never be guaranteed as a truly voluntary act of suicide in any State which first neglects assisting people to live. For many it will be coercive euthanasia, an expansion of quotidian violence targeting vulnerable bodies. Manufacturing the deaths of minorities labelled ‘economically inactive’^[57] or a ‘burden’^[58] is not about their freedom of choice, but the State’s freedom to practice social murder and eugenics.