The dark ideology behind the assisted suicide campaign

The Terminally Ill (Adults) Bill introduced to the Westminster Parliament at the end of last year seeks to make physician assisted suicide legal in the UK. From the start the legislation, introduced as a Private Members Bill by Kim Leadbeater MP, was recognized as problematic – with numerous ambiguities and gaps where important practical detail was missing. At the first debate in the House (the so-called second reading) MPs were encouraged to vote in favour even if they had misgivings: flaws in the bill as presented would be carefully considered and dealt with at committee stage. What followed instead was a pantomime of manipulation and incompetence.

Of the fifty experts called to give oral evidence to the public bill committee only six were opposed to assisted suicide. Many of the questions were soft-ball invitations to air unsubstantiated claims about the safety of what was proposed and the unalloyed success of implementation in other countries. Witnesses from Belgium, The Netherlands or Canada on mute of course. Proceedings were rushed so that committee members could not have had time to study carefully the more than 420 written evidence submissions.

I was invited to give oral evidence to the committee – initially one of only two psychiatrists, both giving evidence as individuals with relevant expertise. The committee had declined to invite the Royal College of Psychiatrists despite the legislation requiring a change to the Suicide Act (1961) and therefore to national suicide prevention strategy.  No need, said the bill’s co-sponsor Kit Malthouse MP, since we have already invited the General Medical Council – apparently unaware that the GMC is an overarching body regulating medical practice while the RCPsych is a membership body overseeing the training of and representing the interests of psychiatrists. A public outcry led to a U-turn and as a result I was one of three, all seen on different days.

My session was interrupted by Leadbeater who wanted to assure the committee that there is no association between what she is promoting and suicide. The people she is interested in, she says, are not suicidal, they don’t want to die but they are dying – they just want to choose how and when. But the legal definition of suicide makes no reference to the person’s circumstances, only to the act itself. The opening sentence of Leadbeater’s bill says that its purpose is to “Allow adults who are terminally ill…to request and be provided with assistance to end their own life…”.  And Clause 24 of the bill seeks to change the Suicide Act 1961 – which makes encouraging or assisting suicide an offence – to exclude the deaths she proposes in her bill. There can really be no doubt that what is proposed is assisted suicide, and since “suicidal” means “relating to or likely to lead to suicide”, then people requesting assisted suicide are by definition suicidal. What Leadbeater says is wrong legally and logically, so why does she keep saying it?

One possibility is that she is using a campaigning tactic. Assisted suicide and euthanasia have traditionally not been popular ideas with the public and the assisted dying euphemism avoids direct acknowledgement of what is being proposed while having the advantage that a lot of people are unclear what it means in practice. It is also possible that Leadbeater simply doesn’t know the facts about unassisted suicide. In other words she is doing more than deploying strategic vagueness, she is voicing a belief that people who die by suicide in other circumstances are fundamentally different from people who will die by assisted suicide if her bill passes into law. The facts suggest otherwise – for example data from the National Confidential Inquiry into Suicide show that people who have what it called major physical illness and who die by suicide may well have the same characteristics as those who die by suicide and do not have such a physical illness. And why not – there is nothing about having a life-limiting physical illness that protects you from other risk factors for suicide.  Exploring the presence of such risks isn’t intrusive, dangerous, excessively bureaucratic, offensive or unreasonably time consuming – so why will Leadbeater not include it in the bill’s safeguards?

Assessment in Leadbeater’s bill is limited to mental capacity and coercion. That is, whether the individual is able to make a request for assisted suicide, not why they might want to. This framing has been tested repeatedly in committee, for example in relation to undue influence short of coercion, financial worries, psychological problems such as depression or sense of burdensomeness, and severe anorexia. It has proved impossible to get the bill’s supporters to agree to any significant change that would require exploration of and a response to remediable psychological or social influences on the decision to ask for assisted suicide. Proposed amendments are routinely defeated by a block vote and dismissive pushback comes in the form of protests about bureaucratic barriers or deliberate attempts to derail the proceedings. In the end what has emerged, both from observation of committee proceedings and (eventually) from direct questioning of Leadbeater, is that psychological and social assessment isn’t included in the bill because it doesn’t matter what the answer is.

At the core of this position is a libertarian or hyper-individualistic privileging of personal choice to the exclusion of all other considerations: it doesn’t matter why the choice is being made, only that it is being made by an “autonomous” individual.

Leadbeater’s campaign is heavily supported and influenced by Dignity in Dying, an organisation that is estimated to have spent more than £25 million on this project since 2005, when it changed its name from the Voluntary Euthanasia Society. To some extent the nature of their ideology is obscured behind the name change and the marketing techniques they use – slogans, slick advertising campaigns, specious opinion polls and celebrity endorsements – and the ill-informed incompetence of much of the debate taking place at committee stage.

The same obfuscatory function is served by another striking feature of the public debate, which is the extraordinary prominence given to the views of media personalities such as Pru Leith and Esther Rantzen. Leith, Rantzen and others have no particular expertise in the management of life-limiting illness or in understanding what influences suicidal thoughts and feelings, so why are their opinions so routinely reported?  The answer is that their role isn’t simply to promote assisted suicide, the product they are promoting is the way the decision should be made. The celebrity endorsement message is twofold – personal opinion and anecdote is more important than careful appraisal of evidence, and meeting the personal preferences of some individuals is more important than concern about the personal vulnerability of others.

Sarcopod days

A few months ago there was a story circulating about a young woman whose “life began when she was allowed to die”. That is, she changed her mind after being offered euthanasia in the Netherlands. The language is worth noting. Was she really not living before the offer of euthanasia? Dignity in Dying would say not – assisted suicide and euthanasia is “not about shortening life it’s about shortening death”. Even allowing some rhetorical leeway, it is difficult to read this as other than a judgement about lives not worth living. There is a cruel twist in the tail of the assisted suicide campaign. Extreme individualism typically prioritises the wishes of privileged individuals over community or societal needs, and especially over protection of the most vulnerable. Here however we are invited to accept without explanation the request for assisted suicide not because the person making the request is of especially high social worth but because they are leading a sort of un-life, something so self-evidently valueless that there is no need to explore why they don’t want it.

2024 brought the world the Sarcopod – an individual gas chamber in which you can suffocate yourself by pressing a switch to replace the air supply with nitrogen. Initial concerns seem to have focused on the lack of regulatory approvals for the machine rather than the grotesqueness of the idea. Meanwhile Dying with Dignity Victoria has announced an exciting new scheme – The Young Ambassadors, “young people from across Australia who are passionate about improving access and quality of end-of-life choices, including VAD.” They will “Inform young people about end-of-life care choices available to them, including VAD.” And “Connect young people navigating end-of-life care, their carers and families to relevant support and services.” VAD (Voluntary Assisted Dying) means assisted suicide and euthanasia – both now legal in Australia.

Nobody who follows what is going on internationally can possibly imagine that Leadbeater’s bill represents the last we will hear from the assisted suicide and euthanasia lobby.  It is the first step onto a road down which we are being shepherded by radical libertarian ideologues with a chilling agenda for societal change that is far from the liberal reform claimed by their supporters.