Medical experts have warned that amendments to the assisted dying bill could be a “slippery slope”, as hundreds of changes are added to the bill.
The Terminally Ill Adults (End of Life) Bill has had as many as 300 amendments tabled so far, with more expected over the coming weeks.
The bill is set to be among the most controversial to pass through parliament in the past decade, with experts across the spectrum disagreeing on whether the changes will improve or worsen the legislation.
Among the most hotly debated amendments is the removal of approval of a High Court judge, which was seen by many politicians as an extra safeguard that allowed them to vote for the bill.
The amendment by Labour MP Kim Leadbeater, who proposed the bill, would see this being replaced with an expert panel consisting of a senior legal figure, psychiatrist and social worker to give their final approval.
Dr Matthew Doré, representing the Association for Palliative Medicine, said: “It’s an example of the slippery slope. The slippery slope is because they’re not really safeguards. They’re in criteria of eligibility. It’s within those criteria of eligibility, and then you can access this service and take these medications and end your life. The problem is … how do you deal with people outwith that circle?
“They say, ‘Well, on the basis of equality, why can’t I have it? If it’s about choice, why can’t I have it? Well, what about chronic illness? I’m suffering for longer, so why can’t I have it?’
“This is an example of [the slippery slope], even pre-legislation. ‘Well, why can’t I have it with MND compared to someone else?‘ But hence, the length extends [to 12 months].”
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Sir Nicholas Mostyn, a former High Court judge, gave evidence to the committee of MPs, and told The Times that the bill, as initially written, “would not fly at all” because there “weren’t enough judges to go around”.
Mostyn said: “My oral evidence … it was very emphatic that the bill as constituted would not fly at all. That to say blithely it will be checked by a High Court judge was completely unrealistic.”
He added that there were “not enough High Court judges to go around” in the family court division, with just 19 currently in place.
“Why is everybody so fixated on it being checked by a real, living, serving High Court judge, when the alternative … is a retired judge, somebody like me,” he said. “A KC who sits as a deputy High Court judge, why are they not good to sit on this panel?”
He added: “Surely a panel with a diversity of interests, with a psychiatrist and a social worker being the wing people, that would be better, because High Court judges aren’t medically qualified.
“I would have thought that having these two extra people bringing a diversity of experience is an improvement on it.”
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Another amendment to the bill, tabled by Liberal Democrat Tom Gordon MP, would allow terminally ill patients with neurodegenerative conditions who have 12 months to live to access an assisted death.
Mostyn, who also has Parkinson’s disease, said he was in favour of the amendment allowing those with neurodegenerative diseases to access the service with 12 months to live. He said: “It is impossible if you’ve got Parkinson’s for any doctor honestly to say that you’re going to be within six months of death, even when you’re in the advanced stages. It’s really, really impossible.
“The condition is so complex. It manifests itself in so many different ways … There’s no predictability about it”.
Sir Robert Buckland, the former lord chancellor, condemned the current assisted dying bill as “unworkable” on the podcast, The University of Law.
He said that the proposed law would put “huge pressure” on medical practitioners to come up with a conclusive view “that very often won’t be right”.
Buckland said he questioned whether judges were really “equipped to be the arbiters of such a morally fundamental question”, and added: “This bill seems to be being rushed … that I think it is wrong and is something I worry about.”
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From MPs, there was dismay that safeguards had appeared to have been dropped.
Florence Eshalomi MP said: “The key safeguard that was used to persuade MPs who raised valid questions about the bill has now been dropped. To say that is worrying is an understatement. Can they explain why lawyers, psychiatrists, and social workers won’t be overwhelmed? Just a farce.”
Diane Abbott said that the safeguards on the assisted dying bill were collapsing. “Rushed, badly thought-out legislation needs to be voted down,” she said.
Baroness Hale of Richmond, the former president of the UK’s Supreme Court and a prominent supporter of assisted dying, has warned MPs against removing judges from the process of signing off assisted dying cases.
She said the process did not necessarily need to be undertaken by a High Court judge but could also be done by district or circuit judges as well.
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“I have always taken the view that it is a good idea to have a judicial element in the safeguards to introduce an element of independence and distance from the doctors, she told the Financial Times.
“The best and most practical solution would be to have a single judge doing it, but not necessarily, or even ideally, a High Court judge.
“This is a grassroots, down-to-earth decision, involving a real person in real circumstances and my belief is that any qualified and suitable judge should be able to do it.”
Q&A
The Terminally Ill Adults (End of Life) bill is set to be one of the most controversial pieces of legislation debated in parliament this decade. Put forward by Labour MP Kim Leadbeater, it would allow terminally ill adults to end their lives with the assistance of a physician, if they have less than six months left of life.
After a vote from MPs in its second reading, the bill was scrutinised by a committee of politicians and experts. Now, Leadbeater has tabled amendments to the bill, and it will then progress to a report stage, where all MPs can propose amendments.
Here are the main amendments so far, explained.
Will there be any checks in place of a High Court Judge?
The addition of a High Court judge’s approval was one that gave many politicians voting for the bill peace of mind.
Instead, Leadbeater now proposes that a “voluntary assisted dying commission” should be made to “introduce a multidisciplinary layer of protection”. The panel would be chaired by a High Court judge or other legal professional. The panels would be chosen by a Voluntary Assisted Dying Commission.
The panel would comprise a legal chair, a psychiatrist and a social worker, who would use their professional expertise in “assessing mental capacity and identifying any risk of coercion”.
Who will be able to access assisted dying now?
One amendment, suggested by Liberal Democrat MP Tom Gordon, would allow terminally ill neurodegenerative patients with illnesses such as motor neurone disease, Parkinson’s or Huntingdon’s to choose an assisted death if they have 12 months to live.
For other terminally ill people, the law would still be capped at six months. Those in support of this amendment say that for people with conditions such as Parkinson’s, it can be hard to estimate when death would be six months away, but it is easier to estimate at a year. Others also say that many people with neurodegenerative conditions would lose their capacity to choose six months from their death, and this would allow them to select this option.
What happens now?
Each week, MPs on the committee will meet to discuss the amendments tabled for the bill. Amendments that are agreed will remain in the legislation when the bill progresses to the report stage, where all MPs can amend the legislation before it’s third reading. If MPs still vote in favour at this stage, it will progress to the House of Lords for scrutiny.
