I attended an interesting and important meeting about the assisted dying (AD) this week. The complex life and death decisions group (CLADD), hosted by King’s College London, arranged a panel discussion. The panel* included two MPs, a barrister and academic, a consultant in palliative care and a well-known journalist. They were asked to speak for 5 minutes on the subject before taking questions. In his introduction, the chair emphasised that this was not a ‘For or against’ discussion, more an exploration of the complexities and uncertainties. It was fascinating to hear how each of them, barring the palliative care consultant, had once been sympathetic to the principle of assisted dying (on the basis that individuals have a right to choose) but that they had come to realise that we are not ready to pass a law. Too many unanswered questions, too many uncertainties.
The barrister had worked on Noel Conway’s legal team, and as we know his was case ultimately unsuccessful as the courts decided that legalising AD (a matter of ‘transcendent public importance’) was for parliament. Professionally, he did all that he could (putting his ‘heart and soul’ into it) to win for his client, but in doing so he concluded that a new law’s implementation, while beneficial for some individuals, presented risks to society as a whole.
One of the MPs (who used to work as a psychiatrist and who completed a doctorate on capacity in mental illness) felt we should hold to the term physician assisted suicide (PAS), as ‘that’s what it is’ and stated his concerns around vulnerability. This was a common theme, and I think it is fair to report that the panel’s attention was not on those who would clearly benefit from AD, but on those who might choose an assisted death for the wrong reasons. An example – imagine an older patient who learns they will die from cancer within the next 6 months. Due to their illness, they will require a high level of social care for which they will have to pay a contribution. They may well choose to bring forward their death in order to ‘save their inheritance’. Or, their family may subtly coerce them. It is a horrible thought. But as the journalist said (and she has investigated coercion in many contexts), families are complex. We don’t know the half of what goes on.
Another MP (who has a background in health policy and has published a book on social attitudes to ageing) challenged consistent survey data showing that the public is in favour of AD. She pointed out that some members of the public are not completely sure what AD is, and confuse it with palliative care (which gives medical ‘assistance’, or care, to patients who are dying). She then explained that she was uneasy with such a complex issue being discussed in an arena, the House of Commons, that can be over-reliant on emotion, rhetoric, and anecdote. It was emphasised that a private members bill (PMB) is not supported by the level of research and civil service scrutiny that a government bill would benefit from. This certainly gave the audience pause for thought. I had no idea. Surely, I reflected, this profound matter needs all the resources available. But then again, AD has been debated repeatedly over the last twenty years, and there is a wealth of experience internationally to learn from. The data is out there.
Does the inherent complexity of a subject mean that it is unsuited to parliamentary debate? Does complexity dictate that if it is discussed, there should be a minimum level of preparation and scrutiny.
A third MP, an audience member, stood up to speak. She disclosed that she was inclined to support the bill, but of course that she would be listening carefully to the debate before the vote. She made the point that Parliament is well used to complex life and death decisions. Examples were not given, but it (usually) decides when to go war, it is involved in very consequential debates about healthcare, use of resources, criminal justice etc. The courts have made it very clear whether to legalise AD is a societal decision: they are not going to tell us what to do. Only parliament can decide.
So, is Parliament suited to debating this issue? We have seen and heard it in action. At its worst, the chamber brings out baying, simplistic and clearly political behaviours. At its best however, MPs such as those who attended this panel meeting, listen, gather information, discuss the pros and cons with their constituents and reflect before making their decision. Many bring relevant professional experience.
As a supporter of AD, (perhaps even a ‘hard autonomist’ as one of the panel members described his previous self) I worry that the subject’s very complexity might be held up as a reason not to trust the parliamentary process. There will be uncertainties. There will be risks. As an audience member said, anybody who tells you that a new law will exclude risk completely is either lying or deluded. What level of risk are we happy to tolerate? Is a small degree of risk (including the possibility that people will be externally coerced or internally motivated for the wrong reasons, or that they will suffer a prolonged or unpleasant death because of pharmacological unpredictability) counterbalanced by the current and historical risk that some patients suffer excessively on their journey to death?
None of us know all the answers. We can have our opinions, we can argue with each other, but at some point a decision has to be made. A decision will be made in late November. Perhaps, when MPs have considered everything and are still unsure, they will look to their high-level principles about autonomy vs societal safety (or, for some, their religious beliefs). Complexity is simplified into a binary decision. Jump or do not jump. Those whom we have elected to represent us are burdened with choice. However deep the complexities, they remain the best placed, if not the best ‘qualified’ to make that decision.
* Panel members:
Anna Dixon, MP for Shipley
Prof Alexander Ruck Keene KC (hon), Barrister
Sonia Sodha, Chief leader writer, The Observer
Ben Spencer, MP for Runnymede & Weybridge
Prof Katherine Sleeman, Palliative care consultant
