We write to express our concerns about the forthcoming debate around assisted suicide in connection with Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill. A Private Member’s Bill is an inadequate parliamentary process for an issue of such ethical and legal complexity.

Basing the argument for change simply on the need for “choice” is too simplistic. Laws must be concerned for the safety of the whole population, especially the most vulnerable. Research has shown that a person’s stated wish to die is frequently unstable and depends on the care and support they receive. The decrease in the rankings in terms of palliative care of countries with assisted suicide or euthanasia is worrying in this regard. Such care, not the offer of assisted suicide, is the ethical imperative.

The effectiveness of any supposed “safeguards” (even when described as“the strictest … anywhere”) needs detailed scrutiny. Coercion would be a reality with a change in the law. To deny this is to ignore the 400,000 cases annually of domestic abuse for older people in England and Wales. If the law were to change, we would see people with terminal disease feeling they should accept assisted suicide because (as has been the case for over 47 per cent of those seeking assisted suicide in Oregon and over 59 per cent in the State of Washington) they would feel they were a burden to friends and family. 

Experts in the subtle field of mental capacity and disability can err in their assessments and non-experts would have to spot where a question about decision-making capacity arose in the first place. Capacity assessments would not assess whether someone felt they were a burden. And being informed about palliative care by a non-expert is very different from receiving it. Even a High Court judge would find it difficult to investigate all such complexities.

Fundamentally, inventing a clear-cut moral distinction between the provision of something for the purposes of killing and the killing itself, undermines the western legal, ethical and common-sense affirmation that being formally “party to” an action involves shared responsibility for that action. The proposed Bill relies on worrying differences between, on the one hand, “providing”, “preparing” a medical device to “assist” a person to take lethal drugs (all of which are regarded as legal in the Bill) and, on the other hand, “inducing” another person to take the lethal drugs (which would warrant up to 14 years in prison).

Oregon, often held up as the paradigm where eligibility criteria have not expanded, has in fact shown slippage.  The definition of “terminal” turns out to include non-terminal conditions where the person has refused treatment, which would include anorexia and type-1 diabetes. 

It lacks prudence to allow such a radical change to healthcare practice at a time of crisis for the NHS, especially given the increased financial pressures on general practice, hospices and care homes. 

To allow assisted suicide would be to upend the ethics of healthcare. As Lord Walton (a neurologist) said, the prohibition of intentional killing “is the cornerstone of law and of social relationships.” Assisting suicide should have no place in medical practice or in a civilised society.

Dr Matthew Doré

MB.ChB, MRCP, BSc(Hons), PGCME

Palliative Medicine Consultant 

Honorary Secretary of the Association for Palliative Medicine for Great Britain and Ireland

Lead Editor for the Oxford Handbook of Palliative Care

Prof Irene Tuffrey-Wijne

Professor of Intellectual Disability & Palliative Care

Kingston University, London

Professor Mari Lloyd-Williams M.D., F.R.C.P., F.R.C.G.P.,

Professor of Supportive and Palliative Care

University of Liverpool / Liverpool John Moores University

Hon Consultant in Palliative Medicine , Liverpool Marie Curie Hospice

Dr Robert Barber FRPsych 

Consultant Old Age Psychiatrist and Honorary Clinical Senior Lecturer, Newcastle

John O’Brien

Professor of Old Age Psychiatry and NIHR Emeritus Senior Investigator

Department of Psychiatry

University of Cambridge School of Clinical Medicine

Alan Thomas

Professor of Old Age Psychiatry

Director of Brains for Dementia Research

Translational and Clinical Research Institute

Faculty of Medical Sciences

Newcastle University

Dr Paul Keeley MB ChB MSc FRCP

Clinical Associate Professor & Consultant Physician in Palliative Medicine

Glasgow Royal Infirmary

Professor Sheila the Baroness Hollins

FRCPsych, FRCP hon, FCMSA, FHEA, FIPD, Hon DD, Hon MD, Hon DLL, Hon DLitt, Hon DSc, DUniv

Emeritus Professor of Psychiatry of Disability at St George’s University of London, and Honorary Professor of Spirituality and Health in the Department of Theology and Religion at the University of Durham

Prof. Robert Howard

Professor of Old Age Psychiatry

University College London 

Professor Charles Foster

Faculty of Law, University of Oxford.

Dr Philip Murray

Fellow, Director of Studies in Law and Tutor, Robinson College, Cambridge

Affiliated Lecturer, Faculty of Law, University of Cambridge

Dr Mary Neal

Reader in Law (Healthcare Law and Ethics)

University of Strathclyde

Dr Nigel Biggar, CBE

Professor Emeritus of Moral Theology

University of Oxford

Revd Professor Joshua Hordern

Professor of Christian Ethics, University of Oxford

Richard Rex, D.D.

Professor of Reformation History

Chair of the Faculty Board of Divinity

Faculty of Divinity

University of Cambridge

David Owens MD MRCPsych

Visiting Associate Professor, University of Leeds

Leeds Institute of Health Sciences

Conor Casey

Senior Lecturer,

University of Surrey School of Law

Dr. Angela Costley

PhD (Maynooth), MSt (Oxon), PG Cert (Dunelm), BA Hons (Dunelm), SSB, SSL

St. Mary’s College, Oscott

George Corbett

Professor of Theology, University of St Andrews

Dr Mehmet Çiftçi MPhil DPhil (Oxon)

Public Bioethics Fellow

Anscombe Bioethics Centre

Jane Cooper

Examination Fellow of All Souls College, Oxford

Maria Rupprecht

University of Bristol and Cardiff University

Rev Philip Fellows 

Doctoral Student, University of Aberdeen

Dr Gavin E Jarvis MA(Cantab) MA PhD VetMB FHEA MRCVS

Associate Professor of Analytical Pharmacology

School of Medicine | University of Sunderland

Dr Fernando Cervantes 

Reader in History, University of Bristol

David Albert Jones MA (Cantab), MA, MSt, DPhil (Oxon), FHEA

Professor of Bioethics

St Mary’s University, Twickenham

Dr Sarah Jane Boss 

Lecturer in Dogmatic Theology, St Mary’s College Oscott

Philip Booth

Professor of Finance, Public Policy and Ethics

St Mary’s University, Twickenham 

John Ritzema 

Pharos Foundation, University of Oxford

Revd Dr Michael Lang

Senior Lecturer in Liturgy and Church History

School of Theology

St Mary’s University

Dr. Catherine Knowles 

Lecturer Religion and Education, 

School of Theology, St Mary’s University, Twickenham

Deacon Dr Harry Schnitker, Obl.O.Ss.S., Diocese of Aberdeen.

Senior Lecturer in Church History, School of Theology, St Mary’s University, Twickenham

Stephen Bullivant, DPhil PhD

Professor of Theology and the Sociology of Religion

Director, Benedict XVI Centre for Religion and Society

Professor David Paton

Chair of Industrial Economics

Nottingham University Business School

Dr Mary McCaughey

Director of Studies/ Lecturer in Theology

Oscott College 

Prof Stephen Parker

Prof of Education and Religious History/Director of CERRL

St Mary’s University, Twickenham

Maggie Doherty 

Director, The Art of Living & Dying Well, St Mary’s University

Dr Rebekah Lamb 

Lecturer in Theology and the Arts, University of St Andrews, Scotland

Alberto Garzoni 

DPhil Candidate in Theology and Religion – Keble College, University of Oxford

Thomas Pink

Emeritus Professor of Philosophy

King’s College, London

Dr James Orr

Associate Professor of Philosophy of Religion

Faculty of Divinity, University of Cambridge

Dr Katherine Backler

Career Development Fellow in Ancient History,

Trinity College, Oxford.

Professor Michael D. Hurley

Professor of Literature and Theology

University of Cambridge

Professor Thomas O’Loughlin MRIA, FRHistS, FSA, FSA Scot., FLSW. 

Professor Emeritus of Historical Theology

The University of Nottingham

Dr Christopher Wojtulewicz

Lecturer at St Mary’s College Oscott

Research Fellow, Blackfriars Hall, University of Oxford

The Revd Dr Lyndon Drake

Research Fellow, Faculty of Theology and Religion

University of Oxford

Maria Power

Senior Research Fellow in Human Dignity, Blackfriars Hall

University of Oxford

Jack Bull

Lecturer in Biblical Studies 

St Mary’s University Twickenham

Professor Julian C. Hughes

Honorary Professor and former NHS consultant in old age psychiatry

Bristol Medical School, University of Bristol.

Rev Dr Richard Finn OP

Director, Las Casas Institute for Social Justice

Blackfriars Hall, University of Oxford

John Stayne

Honorary Fellow in the Department of Theology and Religion, Durham University 

Daniel Rodger

Senior Lecturer, Operating Department Practice

Institute of Health and Social Care

School of Allied and Community Health London South Bank University

Ambrose Gillick PhD

March Course Lead

Kent School of Architecture

University of Kent

Dr Anna Wilmore

Stipendiary Lecturer in German

St Hugh’s and St Anne’s Colleges, University of Oxford

Prof. Jacob Phillips

Professor of Systematic Theology

St Mary’s University

Prof. Hannah J. Joyce

Professor of Electronic and Photonic Engineering

University of Cambridge

Edward Chan-Stroud 

Research Fellow in Theology and Religion 

University of Oxford

Professor Tom Greggs, MA (Oxon), PhD (Cantab), DLitt, FRSE

Marischal (1616) Chair of Divinity

University of Aberdeen

Katerina Levinson 

Stipendiary Lecturer of Spanish at St Anne’s College, Oxford. 

Dr Andrew Fairbairn

Retired Consultant in Old Age Psychiatry

Former Honorary Senior Lecturer, Newcastle University,

Newcastle upon Tyne

Dr Karen Harrison Dening

Professor of Dementia Nursing (honorary), De Montfort University, Leicester

Associate Professor (honorary), University of Nottingham

Rev Dr Dermot Tredget, MSc, MA, PhD

Visiting Lecturer in Theology at St Mary’s University, Twickenham 

Tom Dening

Professor of Dementia Research

Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham

Dr Dominic White

Fellow, Blackfriars Hall, University of Oxford

Acting Director of Research, Margaret Beaufort Institute of Theology, Cambridge

Prof Nathan Davies 

Professor of Ageing, Applied Health and Care Research, Centre for Psychiatry and Mental Health, Wolfson Institute for Population Health, QMUL

Dr Maria Czepiel

Leverhulme Early Career Fellow

University of Warwick

Dr Caroline Healy

Course Lead, MA in Catholic School Leadership

Faculty of Education, Theology and The Arts

St Mary’s University, London

Dr Imogen Choi

Associate Professor of Spanish

University of Oxford

Dr Edward A. David

Lecturer in Ethics & Values and AKC Director

King’s College London

Dr Tim Hearn

College Lecturer, Newnham College, University of Cambridge.

Principal Investigator

Department of Medical Genetics

School of Clinical Medicine

University of Cambridge 

Rev Professor Alasdair Coles

Professor of Neuroimmunology, Head of Department of Clinical Neurosciences

University of Cambridge

Dr Jonathan Price

Matraszek Fellow of Pusey House & St Cross College, University of Oxford

Faculty of Law, University of Oxford 

The Revd Dr Charlie Bell PhD MRCPsych

Official Fellow in Medicine and Public Theology, Girton College, Cambridge

Specialist Registrar in Forensic Psychiatry

Dr Francis Young

University of Portsmouth

Senior Research Associate

Professor Ilora Baroness Finlay of Llandaff FRCGP, FRCP, FMedSci, FRCPE, FHEA, FLSW

Cardiff University

Hon Prof Palliative Medicine

Professor Judith M Lieu

Lady Margaret’s Professor of Divinity Emerita

University of Cambridge

Revd Prof James Walters

Director, LSE Religion and Global Society

London School of Economics

Dr Jan C. Bentz

Lecturer, Blackfriars Studium, Oxford 

Angela Vincent

Emeritus Professor

University of Oxford

Retired Professor of Neuroimmunology

Dr Maria Madalena Brito

Canterbury Institute (Oxford) 

Dr Christian Sahner

Associate Professor of Islamic History

Fellow of New College

University of Oxford

Dr Joanna Black

Head of Regulatory Affairs and Quality Assurance

University of Oxford

Revd Canon Professor Alison Milbank

Emeritus Professor of Theology and Literature

University of Nottingham

Professor John Wyatt

Emeritus Professor of Neonatal Paediatrics

University College London

Dr Monika Tlalka

Research Coordinator

Department of Surgical Sciences, Oxford University

Dr Sarah Cox MBBS BSc FRCP MSc RCPathME

Consultant in Palliative Medicine

President, Association for Palliative Medicine of Great Britain and Ireland

Edward Hadas

Lecturer in Political Economy

Department of Continuing Education

University of Oxford 

Dr Daniel De Haan

Frederick Copleston Senior Research Fellow

Campion Hall and Blackfriars

University of Oxford

Dr Bijan Omrani 

Honorary Associate Research Fellow, School of Education

University of Exeter

Dr Dominic Burbidge

Lecturer in Politics, University of Oxford

Prof. John Harding

Professor of  Materials Simulation

University of Sheffield

Dr Leonardo Franchi

School of Education, University of Glasgow

Prof. Christopher Megone

Professor of Inter-Disciplinary Applied Ethics

University of Leeds

The Reverend Canon Jarel Robinson-Brown 

Regents Park College, Oxford 

Brendan Smith

Professor of Medieval History

University of Bristol

Dr Kay de Vries

Professor Nursing Older People

Faculty of Health & Life Sciences

De Montfort University

Dr Andy Northcott

Geller Institute of Ageing and Memory

Senior Lecturer in Sociology of Medicine

University of West London 

Dr Samantha Brooks, PhD

Associate Professor of Cognitive Neuroscience 

School of Psychology

Liverpool John Moore’s University

Sr Margaret Atkins CRSA,

Research Fellow,

Blackfriars, Oxford

Dr Shafiq Ahmed

Principal Lecturer

School of Medicine, University of Sunderland

Agnes Ayton, MD, FRCsych, MMedSc, MSc

Vice Chair of Faculty of Eating Disorders, RCPsych

Clinical, Director HOPE PC

Oxford Health NHS FT

Terry-Lee Marttinen

PhD (C) History of Medicine

Centre for Medical Humanities, Oxford Brookes University

Dr Michael Wee

Junior Research Fellow

Wolfson College, University of Oxford

Dr Andrew Ayton, FRHistS

Retired Senior Lecturer in History

University of Hull

Dr Miles Leeson

Reader in English Literature

University of Chichester

Prof. Paul D. Murray

Professor of Systematic Theology,

Department of Theology and Religion, Durham University,

Prof. Rebecca Rist

Professor of Medieval History

University of Reading

Dr Maria G. Turri FHEA, DPhil, PhD, MRCPsych

Senior Lecturer in Creative Arts and Mental Health

Queen Mary University of London

Dr Nicola White

Senior Research Fellow & Deputy Head of the Marie Curie Palliative Care Research Department. 

Co-chair of the Palliative Care Research Society (PCRS)

Division of Psychiatry. University College London 

Prof. Mark Elliott

Professor of Public Law

University of Cambridge

Dr Jamie Wilmore

Departmental Lecturer in Practical Chemistry

University of Oxford 

Dr Calum Miller

Research Fellow in Bioethics

University of Oxford

Dr Nuriye Kupeli

Principal Research Fellow

Marie Curie Palliative Care Research Department 

Division of Psychiatry, University College London

Dr Cosima Gillhammer

Career Development Fellow in Medieval English

Lady Margaret Hall, Oxford

Dr Jeremy Corley

Former lecturer in Scripture,

Ushaw College Durham

Kevin Yuill 

Emeritus Professor of History

University of Sunderland

Dr John P. Mason MRCPsych DHMSA

ISPS member EC writing group 

TAPER consortium international research group

PhD (C) History of Psychiatry

Centre for Medical Humanities 

Oxford Brookes University