Photo by Leon Neal

Turning caretakers into killers

Baroness Meacher’s Assisted Dying Bill offers no real safeguards for the most vulnerable patients

Artillery Row

A decade ago, police in Stockport brought to justice the so-called “Stepping Hill Poisoner” after an investigation that far exceeded normal efforts. According to Nazir Afzal in his memoirs, The Prosecutor, more than a hundred officers, every forensic unit and medical experts in the area, along with several million pounds of taxpayers’ money, were invested into hunting down Filipino nurse Victorino Chua and sending him to jail for thirty-five years for three murders and thirty-one other offences, while many other serious cases were in the meantime put on hold.

The case drew comparisons in the media to Dr Harold Shipman, Britain’s most prolific serial killer who murdered up to two hundred and fifty people just east of Manchester in the previous decade. The police made a fatal error in that case by arresting him and then letting him go only for him to carry on killing. They finally caught him only after it came to their attention that he had forged the will of Kathleen Grundy, the last of his victims. 

How effectively will the safeguards work?

These cases demonstrate the difficulties involved in policing the NHS and its institutions effectively, and how hard it can be to bring just one determined criminal to court. Such questions of safeguards and public safety are central to whether the Assisted Dying Bill merits the support of Parliament. If the Bill is not safe, surely it must be rejected. If safeguards included in the Bill are abused or are open to abuse, perhaps at the cost of innocent lives, how can such failures be redressed? How effectively will the safeguards work?

At present, these are impossible questions to answer because the Bill offers no real safeguards: it contains nothing other than vague symbolic statements of intent without details of how they could or should be enforced.

Instead, Parliament is being asked to pass assisted suicide into law and let the Department of Health develop a code of practice at a later date. There is an arrogant assumption in its drafting that MPs and peers should and would allow themselves to be bypassed, that they would surrender their powers and duty of scrutiny and agree to sign a blank cheque.

The Bill is window-dressed seductively with many deceptive assurances of safety. Proposed safeguards include the demand for a prognosis of a terminal illness that will end the life of an adult patient within six months, a settled and informed wish for assisted suicide, mental capacity, freedom from pressure and, finally, the authorisation of two doctors and a High Court judge.

Physicians in Canada now describe it as a “logical progression”

Yet not one of these bears scrutiny. Take the first: the scandal of the misuse of the Liverpool Care Pathway demonstrated the folly of attempting to predict death even within 72 hours. Six months is nothing but guesswork, a fake line in the sand that could and would be challenged under laws prohibiting discrimination and inequality, thereby paving the way for the immediate expansion of the Bill and the removal of many of the initial protections. This pattern is often referred to as “the slippery slope” or “the open door”. More accurately, perhaps, physicians in Canada now describe it as a “logical progression”. It is witnessed, without exception and often swiftly, in every jurisdiction in which assisted suicide or euthanasia have been legalised, and extends assisted death to the mentally-ill, alcoholics, children, disabled people and those with dementia.

Nor does the Bill offer any clarity on what constitutes a “settled and informed wish to die”, leaving it wide open to subjective interpretation.  Freedom from pressure is an equally nebulous concept and extremely difficult for doctors and others to detect in a world where elder abuse and coercive control are already widespread and often go unnoticed. Furthermore, pressure can come from within: the 2020 report from Oregon revealed 53 per cent of patients requested lethal drugs because they feared becoming a burden on those that loved and cared for them.

In Oregon (the model for the Meacher Bill), the views of doctors count for so little that it is risible. If they decline lethal drugs, the patient goes elsewhere to get them. It is known as “doctor-shopping”, and it renders a key safeguard utterly meaningless in practice.  The Bill is silent, meanwhile, on the lethal drugs that will be used and how they will be stored, an important omission given the record of agonising complications involved in ingesting deadly cocktails in places like Oregon, Washington State and California.

Surely Parliament cannot responsibly decide to change the law unless and until such potential dangers have been addressed. Yet this Bill does not afford MPs and peers the opportunity to do so, because it seeks to take such matters out of their hands and delegate them to Ministers and civil servants instead.

Most doctors do not want that responsibility

Its authors not only manifest contempt for the democratic process but also for those it assumes will do the dreadful work of facilitating and assisting suicides. The Bill is unable to offer any explanation about the nature of the “consent” procedure expected of the High Court, for instance. Would the court scrutinise the doctors’ decisions or undertake inquiries of its own? The burden proposed for the judges is undefined by the Bill. It appears to have been founded upon an assumption that judges will rubber stamp the decisions of the doctors, who are made the gatekeepers and deliverers of death by this legislation.

Most doctors do not want that responsibility. A 2020 survey showed that the majority of those licensed to practice who are closest to terminally ill and dying patients those in palliative care, geriatric medicine, oncology and GPs do not support legalisation of assisted suicide, and will not participate in such practices.

There may be some, like Chua and Shipman, who kill for pleasure, for gain or from hatred and revenge. An “assisted dying” law would allow them literally to get away with murder. They would probably never be caught. Even if this Bill allows just one of those harrowing cases to happen again, it would be a betrayal of public safety.

Fundamentally, this Bill will change the role of medical professionals from care-givers into killers. It will make the taking of human life negotiable and expandable. All that remains will essentially be arguments about procedure. When this has happened in other countries, the doctors always seem to win and the vulnerable lose.

The current prohibitions against assisted suicide are effective safeguards that strike a delicate balance. Without them the health service will become dangerous for the most vulnerable people in our society. There is nothing in the Meacher Bill to protect them, just an awful lot that may bring them terrible harm.

Enjoying The Critic online? It's even better in print

Try five issues of Britain’s newest magazine for £10

Critic magazine cover