LONDON — In Britain, as in most jurisdictions in the United States, physician-assisted suicide is illegal. Parliament may be about to change that. A legalization bill died in the House of Lords this spring but has been revived. The House of Commons is scheduled to vote on the Terminally Ill Adults (End of Life) Bill on Friday. If it passes, policy in England and Wales will move toward that of Canada, where assisted suicide has become at least the fifth-leading cause of death and claimed, on average, the lives of 45 people a day in 2024.
The proposal’s proponents invoke two powerful values: compassion and liberty. They say the health system should give those who are in the “final six months” of their lives the option to end their suffering. Many opponents, on the other hand, consider it wrong in principle for the government to designate any subset of the population as having lives not worth living. They are joined by others who support assisted suicide in theory but believe that in practice a new policy would constrict options, pushing the most vulnerable members of society to their deaths. Among the opponents of the bill to whom I spoke this week, that’s the dominant worry: that in the name of freedom, patients in dire circumstances will be not just assisted but encouraged to die.
The legislation would change both the culture and the incentives of people and institutions in England and Wales. The availability of assisted suicide would enable governments to continue to skimp on palliative care — and to save money for the National Health Service — by dispensing with the most expensive patients. Those patients would confront a new reality in which their killing is a treatment option. And the medical profession, previously charged with healing, would be expected to deliberately hasten death. The Royal College of Physicians has expressed the concern that doctors wouldn’t be able to refuse to participate.
Other organizations have highlighted more deficiencies in the legislation. Beat, a charity focused on eating disorders, notes that the bill could make people with bulimia eligible for assisted suicide based on the physical harms the condition causes. (Eating disorders having already triggered such laws in other countries.) A group that aids victims of domestic abuse says the bill “lacks effective safeguarding” to keep such people from being coerced into suicide. Disability Rights UK has noted that its protections have weakened as it has made its way through Parliament.
The bill doesn’t require a mental health assessment for a candidate for assisted suicide, or that treatment for any mental health condition be offered, even though severe illness, such as cancer, obviously raises the risk of depression. The lack of safeguards reflects its supporters’ expansive views of when suicide makes sense. Charles Falconer, one of the bill’s leading sponsors in the House of Lords, has argued that “pregnancy should not be a bar” to the procedure. Pressed on the possibility that poor people might choose suicide unaware of the financial support they could receive, he was unfazed: “Your financial position might be an element in what makes you reach a decision.”
This grim logic threatens even the paltry restrictions the bill contains. If poverty can justify medicalized suicide for the terminally ill, why not for the chronically ill? Falconer has said, “People can suffer horribly in their final illness because the doctor cannot provide help for them to end the agony.”
But horrible suffering isn’t limited to these cases, which helps explain why Canada’s program quickly abandoned the requirement that an applicant’s death from “a grievous and irremediable medical condition” be “reasonably foreseeable.” It is now preparing to cover mental illness. Indeed, such groups as Dying With Dignity have sued in Canada, claiming that preventing the latter cases of assisted suicide is discriminatory.
The bill in Britain threatens to push many patients toward suicide because it is designed for one group of people but will often apply to another. In his 2020 book “What It Means to Be Human,” O. Carter Snead, a law professor at the University of Notre Dame, explains that much of contemporary bioethics law has in mind a vision of a person who is competent, independent, strong-willed and intent on exercising his autonomy. The bill appeals to many such people who are themselves in good health but imagine that they wouldn’t wish to keep living with severe illness.
In the nature of things, though, the people with the new choice before them will often be vulnerable, dependent, even confused. Snead tells me: “Because assisted suicide laws fail to grasp the diminished agency of human beings whose bodies are in severe distress, the framework they offer is rife with risks of fraud, abuse, duress, neglect and coercion.” Some will receive the message, directly and indirectly, that everyone would be better off with them dead.
Andy Burnham, the new prime minister, said in July that he “personally” believes that palliative care should be adequately funded before the government takes up assisted suicide. That was also the view of 60 percent of the British public in a May poll, with only 19 percent disagreeing. That’s the direction our feelings of compassion and our desire for more choices ought to lead us, in Britain and elsewhere.
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