UK Assisted Dying Bill: Right to Dignified Death Truly Free of Coercion?

In the United Kingdom, surprisingly, the Terminally Ill Adults (End of Life) Bill, also known as the “Assisted Dying Bill”, was introduced by Labour MP Kim Leadbeater and went through its second reading in the Commons on 29 November 2024. As of the time of writing, the bill is being debated at the committee stage. The bill “allow[s] adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own life, without criminal liability for the assisting doctors.” 

The bill, as introduced, permits residents of English or Wales registered with the NHS in either place to request assistance to end their life if they meet the following main criteria:

• They are aged 18 and over.
• They have the mental capacity to make an informed decision.
• They are terminally ill and are in the final six months of their expected life.

Technically, the bill provided criminal immunity to the doctors who assisted the patient in ending his own life, following the provided process. Otherwise, the doctor may face criminal charges in homicide, in particular, aiding and abetting suicide.

The present bill is a surprising development, given previous failed attempts to introduce similar bills in the UK.

While its passage through the second reading reflects the changing public view of assisted dying in principle, the operation and safeguards remained controversial. One might recall the Sherlock Holmes story “A Study in Scarlet” (or the BBC rendition of “A Study in Pink”), where the killer talked the victims into killing themselves.

As part of the proposed safeguards, two independent doctors and a High Court judge must be satisfied the patient is mentally capable of making the decision and has done so voluntarily. The bill explicitly imposes criminal offences for any inducement to prevent coercion and pressure. However, there are concerns that these are insufficient to root out all forms of coercion or pressure. 

Labour Party’s Diane Abbott raised concerns that the judge’s role might serve as little more than “a rubber stamp”. She highlighted the potential vulnerability of terminally ill people who may feel compelled to seek assisted dying because they don’t want to “be a burden” or due to the cost of their care.

The Bill does not provide clear definitions of coercion, pressure, or inducement. It leaves room for ambiguity about what qualifies as undue influence. For instance:

• Would simply mentioning the option of assisted dying constitute coercion? 
• Could family members express emotional distress about caregiving unintentionally pressure the patient?

The degree, intention and directness of such actions or words could raise complex questions about what qualifies as coercion or pressure. These issues remain a significant point of contention, but these may be the everlasting question in life.

Medically assisted dying or suicide is more than a medicolegal issue but also a dilemma in medical ethics. The debate in the bill’s committee reflected dividing views from different sectors of society. On one hand, proper safeguards are essential to respect a patient’s autonomy. However, complexity would mean less certainty for the doctors and difficulty in navigating the process for the patient who is terminally ill. There cannot be a perfect solution, but it is hoped that a balance could be found.

While terminally ill individuals deserve a dignified death, it is hoped that a balance can be achieved through discussion to implement proper safeguards against the misuse of the proposed mechanism.