Euthanasia, literally “good death”, was a term adopted in the 1870s to refer to intentional medical homicide of suffering patients using chloroform or other anaesthetic agents. Since then creative euphemisms for life termination have been much in evidence. ‘Death with Dignity’, ‘Easeful Death’, ‘Medical Aid in Dying’. The apparently benign term ‘Assisted Dying’ used in recent parliamentary debates is only the latest of a long list of deliberately misleading appellations. 

But MP Kim Leadbetter’s Private Member’s Bill to be introduced to the Commons on 16 October has had yet another make-over. It is now entitled ‘Choice at the End of Life’. There’s little doubt that this new phraseology comes from Dignity in Dying, the leading campaign organisation, who have long preferred the anodyne description “dying people deserve the choice to control the timing and manner of their death”, avoiding any mention of unsettling concepts like the administration of lethal drug combinations, and the possibilities of coercion by professionals or relatives. The uncertainties, emotional salience, messiness and grisly details of the life-exterminating process are carefully air-brushed so as not to frighten the horses.

Instead reassuring words like ‘safety’, ‘choice’ and ‘protection’ abound. Sarah Wootton, Chief Executive of Dignity in Dying, assures us that “Safety is woven into the fabric of proposals for law change, introducing practical measures to assess eligibility, ensure rigorous medical oversight, and robustly monitor every part of the process.” Kim Leadbeater claimed that the proposed legislation will give us the right to “see out our days surrounded by those we love and care for, knowing that when we are gone they can remember us as we would like to be remembered,” phraseology which seems better suited to an undertaker’s sales pitch. What are they trying so hard to hide?

Philosopher Kathleen Stock provides an incisive comment: “At times, it can sound as if one is being offered a particularly relaxing spa treatment. With a pleasing ring of supportiveness, you are now being “assisted” in achieving something, rather than being killed by a doctor or killing yourself.” 

The proposed Bill requires that doctors will certify that the patient has less than 6 months to live. I worked as an NHS consultant for more than 20 years, and there were many times when I and my colleagues were hopelessly inaccurate in predicting how many months or years a person had to live. In reality it is not uncommon for a person who is diagnosed with a ‘terminal illness’ to live on for years or to die within days. Diagnostic errors, spontaneous remission, new treatments, random events, all conspire to make the prediction of death a foolhardy business. And yet the proposed Bill assumes that busy doctors across the NHS, with widely differing levels of technical expertise, will provide accurate prognostication every time.

Prescribing lethal medication means that the prediction of death is, of course, a self-fulfilling prophecy. No-one will know that my patient killed themselves unnecessarily, in the mistaken belief that they only had weeks to live. Medical mistakes are an unfortunate fact of life and serious errors in diagnosis are not uncommon, even in specialist centres. Sadly the Assisted Dying legislation would open up yet more possibilities for tragic mishaps. 

The Bill requires doctors to prescribe and supply highly lethal and toxic drugs for the patient’s use alone. But there are obvious possibilities for errors, accidents and abuse. Do we want a new supply of lethal drugs to be circulating in our community and accumulating in bathroom cabinets? Sir Keir Starmer and his colleagues have informed us that the NHS is broken, overstretched and failing. Is this the best time for NHS doctors, pharmacists and administrators to take on the new and awesome responsibility of ensuring clean death on request? And will patient’s continue to trust their physician, knowing they are increasingly trained and practised in the grisly mechanics of life-termination? 

Doctors are instructed to ensure that those with suicidal intent have “a clear and settled intention to end their own life which has been reached voluntarily, on an informed basis and without undue influence, coercion and duress.” So what exactly is undue Influence? It’s an extraordinarily vague phrase in a fraught emotional context in which there may be subtle pressure, manipulation, or ‘gaslighting’ from loved-ones and relatives. 

Campaigners seem to live in an alternative reality in which suffering individuals make autonomous decisions about ending their lives calmly and rationally, and relatives are respectful, compassionate and unfailingly benign. They airily dismiss the possibility that relatives might subtly pressurise elderly and infirm people for their own purposes. But in the real world inhabited by clinicians, social workers and law enforcement agencies, elder abuse and coercive control by relatives and others is hardly unusual. And sometimes its the emotional distress of relatives and loved-ones which can be a source of immense pressure on those with a terminal illness. “I can’t bear to watch him suffer. Can’t we suggest to him that he doesn’t need to carry on like this?” In the state of Oregon, more than 40% of those who end their lives through physician assisted suicide provide as a reason “burden on family, friends or caregivers”.

And what about the social context for this momentous change in medical practice? Across the developed world we are witnessing a steady increase in the numbers of old and frail people coinciding with progressive weakening and breakdown of traditional family structures. Social cohesion is under threat and those who describe themselves as lonely and isolated continue to rise year on year. Do we really want to introduce state-sponsored life termination into this challenging mix?

Kim Leadbeater writing in the Guardian claimed that someone with a terminal condition only had the bad options of suffering in misery and often in great pain, or travelling to Switzerland. She pointedly failed to mention the highly effective option of expert palliative care, despite the fact that this legally mandated and demonstrably effective treatment is a central part of end of life care across the UK.  Despite woeful underfunding and neglect, broken Britain still has the best palliative care services in the world. Let’s prioritise and support excellent care rather than legalising state-sponsored elimination of the most vulnerable in our midst, masked under the duplicitous slogan “choice at the end of life”.