Reflection on the Assisted Dying for Terminally Ill Adults Act 2024

In a few days from my writing this, MPs will vote on the Assisted Dying for Terminally Ill Adults Act 2024. This is a highly contentious and impactful piece of proposed legislation, designed to address one of society’s most ethically challenging questions: should terminally ill adults have the legal right to end their lives with assistance?

The Act aims to introduce a structured framework for assisted dying, encompassing strict eligibility criteria, procedural safeguards, and mechanisms for monitoring and accountability. While it reflects an effort to provide dignity and choice to terminally ill individuals, it also raises profound ethical, legal, and social concerns that could cause significant harm if not handled with care.

In this article, I aim to provide a balanced but fair view of the potential impact and risks the Act could have, particularly for disabled people.

Key Provisions

The Act outlines detailed criteria for those seeking assistance to end their lives. Individuals must make clear and voluntary declarations while being of sound mind and have a terminal illness expected to result in death within six months. The process necessitates the approval of two doctors and includes a mandatory High Court review.

Additionally, the Act seeks to balance the conscientious objections of healthcare professionals with the rights of patients and establishes safeguards against misuse, coercion, or malpractice.

Through amendments to existing laws, such as the Suicide Act 1961 and the Births and Deaths Registration Act 1953, the Act ensures that assisted deaths are distinguished from suicides and that proper records are maintained. It introduces criminal liabilities for those acting in bad faith and sets out annual reporting requirements to Parliament.

Potential Benefits

Proponents argue that the Act embodies compassion, autonomy, and respect for personal choice. By providing a legal pathway for assisted dying, it could alleviate suffering for terminally ill individuals facing unbearable pain and give them control over their final moments.

The regulatory framework aims to include safeguards to protect against coercion and abuse, ensuring that only those who meet the strict criteria can access assisted dying services. However, upon reviewing sections of the proposed law and listening to podcasts on the subject, I have developed significant concerns about its potential for harm.

Potential for Harm

Impact on Vulnerable Individuals:

The risk of coercion or subtle societal pressure cannot be overlooked, especially for individuals who feel like a burden to their families or society. While safeguards exist on paper, their practical implementation could be challenging, particularly for marginalised individuals or those lacking access to support systems.

Erosion of Trust in Healthcare:

Legalising assisted dying may erode trust between patients and healthcare providers. For some, knowing that doctors could legally assist in ending life might create fear or hesitation to seek care. This could disrupt the foundational role of healthcare professionals as preservers of life.

Emotional and Psychological Toll:

The decision to pursue assisted dying can impose a heavy emotional toll on patients, families, and healthcare providers. Families may grapple with guilt or unresolved grief, while healthcare workers could face moral dilemmas or long-term psychological strain from their involvement.

Unintended Normalisation of Assisted Dying:

One of the most significant concerns is the potential for the practice to become normalised. Legalising it for terminally ill adults might pave the way for its extension to non-terminal cases, a phenomenon often referred to as the "slippery slope." This raises critical questions about where and how boundaries would be enforced.

Cultural and Religious Divisions:

Assisted dying directly conflicts with the moral and spiritual beliefs of many communities, potentially deepening societal divisions. Although the Act allows conscientious objection, its broader implications for societal cohesion and respect for diversity remain concerning.

Broader Ethical Implications:

The Act challenges society to reconcile competing values: autonomy versus the sanctity of life, and compassion for the suffering versus the potential devaluation of human life. It demands extraordinary sensitivity from policymakers and healthcare professionals in addressing these tensions.

Global Context:

Assisted dying is addressed differently worldwide, with laws reflecting each region’s cultural, ethical, and legal frameworks. In Europe, countries like the Netherlands and Belgium have liberal policies permitting euthanasia and assisted suicide under strict criteria, including unbearable suffering and voluntary consent. Belgium extends access to minors and non-terminal cases, while Switzerland allows assisted suicide for altruistic reasons, making it a hub for "suicide tourism." Spain and Germany have also legalized assisted dying, whereas France permits only passive euthanasia, with ongoing debates about reform.

In North America, Canada’s MAID program permits assisted dying for terminal and chronic conditions, with discussions about including mental health conditions. In the U.S., assisted dying is legal in 11 states, following strict guidelines such as terminal illness and self-administration of life-ending medication. In South America, Colombia allows both euthanasia and assisted suicide, highlighting a progressive stance on end-of-life care. Meanwhile, Australia and New Zealand have implemented assisted dying laws focused on terminally ill patients, with Australia’s regulations varying by state.

In Asia and Africa, the practice is less accepted, though passive euthanasia is permitted in India, and there is debate in South Africa. Across the globe, key concerns include safeguarding vulnerable individuals, balancing autonomy with the sanctity of life, and the potential for societal pressure or ethical dilemmas for healthcare providers. While proponents emphasize compassion and relief from suffering, critics warn of unintended consequences, making assisted dying a topic of ongoing ethical, legal, and societal debate.

Conclusion

The Assisted Dying for Terminally Ill Adults Act 2024 represents a bold yet divisive step in addressing end-of-life choices. While it offers hope for those seeking relief from unbearable suffering, its potential for harm—particularly to vulnerable individuals and societal values—cannot be underestimated.

As MPs prepare to vote, the importance of rigorous scrutiny and careful consideration cannot be overstated. If enacted, the Act will require vigilant monitoring, ongoing dialogue, and a steadfast commitment to ethical principles to minimise its potential damage and safeguard its original intent.

As a disabled person, I worry about the introduction of such legislation because of the chances that the system could be moved to force vulnerable people to end their lives when they have other options open to them, but as assisted dying is easier and more cost-effective it is seen as their only option.

Under the Mental Capacity Act 2005, capacity is decision-specific and must be assessed for each individual decision at the time it is made. This means that when considering a request for assisted dying, healthcare professionals would need to evaluate whether the individual fully understands the nature and consequences of their decision, free from coercion or impaired judgment. The assessment involves ensuring the person can comprehend, retain, and weigh relevant information to make an informed choice and communicate their decision clearly. However, conditions such as depression, anxiety, or cognitive decline could complicate these assessments, raising concerns about the reliability of determining capacity in such emotionally charged and complex situations. Robust safeguards and clear guidelines would be essential to uphold the integrity of these assessments and protect vulnerable individuals.