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Artillery Row

Kim Leadbeater’s “safeguards” won’t keep people safe

The proposed legal hurdles are effectively useless

Kim Leadbeater has described her Bill on assisted dying as including the strongest safeguards possible. The Bill has multiple tests and stages that someone needs to pass to be “approved”. It is full of hurdles. But those hurdles are not safeguards.

The abuses of assisted suicide laws are now well known from other countries, and we have been promised they will not happen here. But the tests in the Bill do not target most of those abuses at all. For this Bill, the only real question is whether it is reasonable to think you might die within the next six months. If you are, there is then no bad reason to want to die, as long as it’s your genuine reason and not the result of pressure or coercion.

So, to take the sort of things that happen in other countries and are usually seen as tragedies, you might ask to die because you have no savings and do not think you can live off benefits if you are sick and can’t work. You might have been told you can only return home if a stairlift can be fitted, but the waiting list for this is 9 months. You might feel bad that the NHS is spending money keeping you in hospital. Or you might be afraid that the money you hoped to leave to your children is going to disappear into care home fees.

Under this Bill, these are good reasons to die. You can give the doctors and the Judge these reasons and they will have to approve it. The doctors can suggest it to you, as long as they aren’t putting pressure on you to say yes.

The doctors and courts are supposed to identify coercion or pressure. We don’t know what this means: coercion, in the law of undue influence, is hard to establish: “the will is overborne without the victim’s consent”, i.e. you are threatened into doing something you actively do not want to do. There isn’t an established meaning for “pressure”. Telling your mother that your life would be much easier if she left you the house rather than sold it to pay care fees would be manipulative, but it might fall short of “pressure”.

Pressure and coercion aren’t obvious. The person asking for assisted suicide won’t tell the doctors, as (due to the pressure) they will have chosen to die, and doctors aren’t investigators. Medical records don’t reveal the family life or finances of the patient.

To identify this, you would investigate the patient’s home life and finances (and those of anyone who might inherit). This would be intrusive and slow, and it would require powers to demand information and question friends and relatives. Without this, coercion and pressure will simply be invisible to the decision makers.

This is made worse by the fact that the Bill would allow someone to apply for assisted suicide effectively secretly. The doctor may advise the patient to “consider” discussing it with others but that is it. In other countries tragic cases have emerged where close family members say they had no idea their relative was seeking euthanasia until they were told to collect the body. This Bill almost guarantees such cases will arise in the UK — and expecting coercion or pressure to come to light without publicity is extraordinarily naïve.

The court will be as dependent as the doctors on the material provided by the applicant

The High Court’s involvement is trumpeted as a safeguard. However, courts are dependent on the material they see. The Bill requires the judge to question at least one doctor (they do not need to question the patient!), but while the judge can speak to others, there is nothing in the procedure that will warn a judge that they should have any doubts about coercion or how settled the intention to die is. The court will be as dependent as the doctors on the material provided by the applicant: and they may have very little time to deal with the question. Oregon is usually held up as an example of a well-controlled assisted suicide regime, but if the UK has Oregon’s rate, we would be looking at 8000 applications a year, two each week per High Court Judge if spread across them all — if restricted to the Family Division, maybe a dozen a week.

With 15 years experience as a barrister, representing clients in the Court of Appeal and the Supreme Court, I know that courts tends to rely on somebody arguing each side of a dispute. We rarely ask a judge, alone, to work out whether there are flaws in the background when someone is asking for something. Where they do this, e.g. when imposing a freezing order, the absent party may come to court later and object. Here, if the court gets it wrong, the person who might have objected will be dead.

Why are the safeguards so weak? The guiding principle in this Bill is that it should be easy and quick to obtain an assisted death. The drafters do not want people without capacity to be killed, nor do they want coercion or pressure to take place, but they are not worried enough about it to include safeguards that would be expensive, unattractive, or that might slow the process down for the target demographic of the well informed, financially secure, determined applicant: people who don’t want to be ordered to involve their family, or to get a psychiatric assessment they don’t think they need, or to wait during a long cooling off period.

This is designed by and for the determined and independent: people who do not easily imagine worrying that their children will stop visiting if they know they’ll inherit nothing, or being told they need an electric wheelchair but that they are low priority and might be considered next year. The vulnerability of the sick and elderly is ignored in this Bill. Therefore a system has been designed that looks like it has safeguards but where the safeguards are effectively useless.

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