Kim Leadbeater’s Bill faces a landmark second reading on Friday (Image: Tim Merry)
How can we legalise assisted dying for those who are suffering and near death without endangering the lives of other vulnerable people? Kim Leadbeater MP has attempted to strike that balance, releasing the text of her bill legalising assisted dying for those with less than six months to live.
Although eligibility is tightly restricted, detractors worry Leadbeater’s bill is the thin end of the wedge, and that before long we could see the disabled, the ill, or the elderly pressured to end their lives.
Listen to these arguments for long enough and Canada usually comes up. My home country legalised assisted dying in 2016. Since then, it’s earned a reputation for lax regulations, minimal safeguards, and widening eligibility.
These criticisms are overstated – a vast majority of Canadian assisted deaths occur for justifiable cases through a reasonable process. Yet there are problems, and they are significant enough to generate significant opposition to the bill from those who see it as the starting point of a slippery slope leading to widening eligibility and escalating deaths.
Bearing those criticisms in mind, how does Leadbeater’s bill compare to Canadian legislation? There are two key differences.
First, in Canada, eligibility was always loose and opaque. “Those with a reasonably foreseeable natural death” in an “irreversible decline” with “enduring and intolerable” suffering can theoretically apply for assisted dying. If you think that’s confusing and vague, you’re not alone: so did Canadian doctors.
WhatsApp chats and email chains proliferated, with frustrated medical professionals asking colleagues for help deciding whether their patient’s death was “reasonably foreseeable” or what qualified as “intolerable.”
In the bill before Parliament, eligibility is tightly limited to those with terminal illnesses. In addition, the bill defines terminality as those expected to die naturally within six months as a result of their illness.
Leadbeater’s bill would place UK legislation far from Canada’s wide eligibility standards and closer to the tight restrictions found in America, Australia, and New Zealand. State and national governments in these countries have allowed assisted dying for the terminally ill going back as far as 1997, without significant expansion or ‘slippery slope’.
Their medics have not had to interpret legal terminology in the same way as their Canadian peers. The six month rule is designed to prevent those with several years left to live from accessing assisted dying, and while it can be tricky to precisely estimate a patient’s prognosis, it provides a clear framework for doctors to follow and significantly limits the pool of eligible people.
Secondly, a key difference stems from the fact that Canadian laws and are subject to the country’s constitution. The original legalisation for assisted dying was brought into being by a Supreme Court ruling in 2015, and in 2019, a judicial decision led the government to scrap any requirement that applicants’ death be “reasonably foreseeable,” suddenly offering the option to anyone suffering from physical illnesses.
This widening of eligibility was caused by the courts shaping the law, as every time a judge had a different view the effect would be to widen the scope. This has made the policy appear unpredictable, frightening the public and leading to concerns about eligibility widening further.
The UK, which does not have a written constitution, need not fear the blunt hammer of a legal ruling. The Supreme Court of the UK has already decided the matter is best left to Parliament, and while some have voiced concern about the European Court of Human Rights getting involved, this appears unlikely.
In the UK, it is parliament, not the courts, who is in control. The journey assisted dying policy could take in Britain will therefore be very different.
The next step for the bill is its second reading, due on the 29th of November, when MPs will vote on whether to allow it to continue to committee stage. If it does, it will be reviewed by MPs and experts before being sent to the Commons and the Lords who will further amend it.
Each step provides an opportunity for experts and the public to get involved and introduce safeguards for the most vulnerable. A “sunset clause” could also be built into the bill, allowing Parliament a vote on whether to keep or repeal the low in five years’ time if MPs have reason to regret their decision.
Protections will also be added by the Health Secretary, who the bill appoints to decide logistical regulations. The Social Market Foundation has published a briefing recommending ten safeguards to ensure Britain cannot follow Canada’s path.
Some, like limiting eligibility to those with terminal illnesses and clearly defining legal criteria, have already been included. But others can be added by the Secretary such as training requirements for doctors involved in the process, setting procedure for them to follow, oversight to ensure rules are followed and reporting obligations to keep policymakers and the public informed – all safeguards which Canada lacked.
Kim Leadbeater’s bill is a first draft, open to criticism but equally open to amendments. It sharply diverges from Canada and operates in a very different judicial system, while still offering relief to those terminally ill patients who wish to use it.
We urgently need to discuss the specifics of the bill, but the need to alleviate the suffering of those at the end of their life should not be outweighed by the bad experiences of a single country.
– Gideon Salutin is a senior researcher at the Social Market Foundation
Send your MP a quick message on Assisted Dying Bill with this online form
We are asking our loyal readers to support Dame Esther Rantzen and other terminally ill people who want greater choice at the end of life by writing to your MP and asking them to support the
Introduced in the House of Commons by Kim Leadbeater MP, MPs will debate it on November 29 – but this Bill will only pass if enough MPs vote in support.