Kim Leadbeater has produced a briefing claiming that the Committee Stage of her bill to legalise assisted suicide has been a success, strengthening the safeguards and ensuring that people are “protected at each stage” of the process.
Her briefing applauds the acceptance of multiple amendments, obscuring the reality that a significant number of key safeguarding amendments were resoundingly rejected by the committee, dominated as it was by strong supporters of assisted suicide.
In this briefing, we respond to each claim made by Leadbeater and demonstrate that, contrary to the misleading narrative presented in her briefing, the bill is more dangerous than ever.
Committee’s scrutiny of the bill
Claim: The committee’s scrutiny of the bill was a “thorough, collaborative process” and evidence from “all sides” was heard (pg. 3).
The reality:
The makeup of the committee, of which all members were selected by Leadbeater, overrepresented support for the bill in the House at second reading. While 55% of MPs voted in favour, 61% of the Committee supported the bill. Additionally, the witnesses invited to give oral evidence to the Committee were split 80% – 20% in favour of supporters.
Further, while all MPs selected to represent support for the bill were strongly in favour of assisted suicide, the majority of those representing the opposition did not object to assisted suicide in principle. Jack Abbott, chosen to represent the opposition to the bill, did not speak against assisted suicide, and voted with supporters in almost every division. He voted to reject most amendments tabled by the bill’s opponents.
Claim: The Committee “accepted around a quarter” of the proposed amendments (pg. 3).
The reality:
The majority of amendments passed were those tabled by Leadbeater. Only 30 of the 150 accepted amendments were tabled by MPs who voted against the bill at second reading. Throughout the process, multiple amendments tabled by opponents of the bill, aimed at making it safer, were generally rejected by its supporters.
Doctor conversations
Claim: Doctors may only discuss ‘assisted dying’ in the context of other end of life options (pg. 3) and the bill “prevents doctors from discussing assisted dying in isolation from other end-of-life choices” (Ibid).
The reality:
This requirement only applies to the official ‘initial discussion’ which takes place when a patient makes a declaration requesting assisted suicide (clause 5(3)). The bill as amended continues to permit doctors to raise assisted suicide with terminally ill patients at any time, whether or not they have expressed an interest in it, and there is no obligation for this to be presented to the patient alongside other options. This is despite several witnesses raising concerns about this during oral evidence. Professor Nicola Ranger, Chief Executive and General Secretary of the Royal College of Nursing, did not think it was “ever” right for a doctor to ask a patient “Is this something you have considered?”.
Most worryingly, Dr Miro Griffiths – a disability studies scholar and researcher at Leeds University – testified that allowing doctors to raise assisted suicide with patients would ‘‘accelerate’’ deaths. An amendment tabled to prevent doctors raising assisted suicide with patients who had not previously indicated interest, as well as one tabled to ensure doctors only discuss the subject with patients who raised it first themselves, were both rejected.
First and second assessment
Claim: The assessments conducted by the coordinating and second doctors are sufficiently rigorous to protect patients. The bill stipulates that in order for the coordinating doctor to approve a request for assisted suicide, they must be “satisfied” that the patient has a “clear, settled and informed” wish to end their own life (clause 7).
The reality:
The process by which this is established is far from rigorous, and the committee rejected multiple amendments which would have strengthened it.
The reflection periods of 7 days between the first and second assessments, and 14 days following the second assessment, are insufficient to ensure that the patient’s wish is “settled”. If the patient is expected to die within a month, the second period of reflection is just 48 hours (clause 17(2)(b)). The committee rejected amendments tabled to extend the second reflection period to 28 days, and 7 days if the patient is expected to die within one month, despite written evidence received from palliative care doctors that patients normally take a period of several weeks or months to adjust to their terminal diagnosis. The doctors say that during this time, patients who initially feel unable to live with their condition can find “peace and value in their altered life circumstances.” The doctors expressed concern that the reflection periods in the bill would mean that “patients and their families may miss out on a period of life they would have valued by seeking to end their lives prematurely, and these days, weeks and perhaps even months will never be regained.”
Claim: “The doctor can advise [the patient] on informing their next of kin” (pg.1).
The reality:
This claim is trying to suggest that the doctor will inform the patient’s next of kin about their request for assisted suicide. In fact, the bill does not in any way require the patient’s family to be informed of their request for assisted suicide. Instead, it suggests that “in so far as the assessing doctor considers it appropriate, advise the person to consider discussing the request with their next of kin and other persons they are close to” (emphases added).
Not only is there no requirement to inform those who would be most deeply affected by the patient’s death, but the doctor is not even compelled to suggest that next of kin be informed. Therefore, there is no protection for the patient’s family, as they do not need to be informed unless the patient wants to inform them (a subject which they are not even required to discuss with their doctor), and there is no protection for the patient, as informing family members could help to protect them from abuse or coercion, both of which thrive in secrecy.
Further, this endangers opacity in what ought to be a transparent process. Just recently, there have been two cases of British citizens traveling to the Swiss clinic Pegasos and dying without their families’ knowledge.
Claim: “A different doctor who has not been involved in the person’s care must carry out a second assessment.” (pg. 1).
The reality:
The bill as amended still permits “doctor shopping”, which has been described as a common occurrence in other jurisdictions where assisted suicide is legal. Professor Preston of the International Observatory on End of Life Care told the committee in oral evidence that patients seek determinations from multiple doctors until they obtain approval. Leadbeater applauds the bill’s limitation of this to “only once’” in the case of the second doctor, but in reality, the patient can simply restart the process. There is no requirement for the coordinating doctor to be the patient’s usual doctor, and no restriction in the bill on the number of times that a patient can seek approval from a different coordinating doctor if the first refuses.
An amendment was tabled to prevent a patient seeking a second opinion unless there had been a “material change in circumstances”, and another sought to tighten the process by imposing a duty on the independent doctor to confirm that there had not been previous assessments before assessing the patient’s eligibility. The committee rejected both amendments, so doctor shopping remains possible under the bill.
Claim: The amended bill requires doctors to explain to patients “any possible complications” (pg.1) from the assisted suicide procedure.
The reality:
There is no such requirement in the bill. Clause 11(2)(d) provides that a doctor must discuss with the patient their “wishes in the event of complications”, yet there is no requirement for doctors to explain the nature of these complications to patients. Two amendments requiring this were rejected by the committee.
Multidisciplinary panels
Claim: The Committee’s decision to replace the High Court judge with a panel consisting of a psychiatrist, social worker and lawyer, was as a response to witnesses ‘strongly [advocating] for a multidisciplinary approach’ (pg.3).
The reality:
These witnesses advocated for a multidisciplinary approach at the earliest stages of the process. Dr Rachel Clarke has called Leadbeater’s claim a “gross misunderstanding” of her recommendations. Clarke, along with Dr Sarah Cox and others told the committee that end-of-life decisions should not be made by individual doctors, but by multi-professional teams.
Instead, the committee have introduced a multidisciplinary approach at the final stage of the process, replacing a crucial safeguard that was a key factor in the decisions of many MPs to vote for the bill at second reading. The psychiatrist and social worker will not be involved in the initial assessments of capacity and coercion, which is arguably where the expertise is most needed.
Kim Leadbeater portrays the replacement of the High Court judge as a strengthening of the safeguards, but this has really served to weaken the bill. While Leadbeater argues that the judicial element is retained because the commissioner will either be a High Court judge or a retired judge, there is no requirement for a High Court judge to be involved in assessing eligibility or to approve any individual requests for assisted suicide, and Leadbeater herself confirmed during the committee that the panel is “not a judicial entity”.
While the High Court judge would be required to be impartial, there is no such requirement for the panel. Given its voluntary nature, it will likely be composed of enthusiastic supporters of assisted suicide.
Identifying and protecting against dishonesty, coercion and pressure
Claim: The bill has strengthened protections against abuse and coercion (pg.4).
The reality:
In fact, it appears that the Committee chose to ignore oral and written evidence regarding this, and disregarded recommendations for how to truly protect the vulnerable.
The Committee heard multiple times during oral evidence that coercion is not always overt, and that more subtle forms of coercion could go undetected by doctors. Amendments were tabled to strengthen these safeguards, by adding requirements that the patient had not been encouraged, manipulated, or unduly influenced to request assistance to end their lives. The Committee voted 15-8 to reject all three amendments, leaving only explicit coercion on the face of the bill. This endangers vulnerable people who are not subject to behaviour that is overtly problematic, but are nonetheless requesting assistance because of the words, actions or influence of another person.
Further, the bill does not attempt to protect against internal coercion, which can occur not because of the actions of others, but simply because the person believes that they are doing what is best for their loved ones and caregivers. Despite statistics from other jurisdictions showing that feeling a burden to others is a key motivating factor in choosing assisted suicide – 43% cited feeling like a burden in Oregon – the Committee rejected an amendment intended to prevent a person from requesting assisted suicide in order to benefit others.
The Committee also rejected an amendment requiring doctors to ask the patient why they wanted to end their own life, which would have helped doctors to determine internal coercion. Under the bill as amended, the coordinating doctor does not need to understand the patient’s true motives or any factors that may be influencing their decision beyond obvious coercion or pressure.
Leadbeater emphasises in her briefing that women in particular will be “significantly better protected under this bill” yet the committee ignored powerful arguments made by Naz Shah, a victim of domestic abuse, in favour of these amendments. She contended that safeguarding against encouragement would help to protect victims of abusive relationships, who could be encouraged by an abusive partner to request assistance in a way that would not be apparently malicious.
Reporting and reviewing the process
Claim: “strict new reporting requirements have been introduced” (pg. 4).
The reality:
The committee voted to transfer reporting responsibilities from the Chief Medical Officer to the Voluntary Assisted Dying Commissioner (VADC). This removed independent oversight in a decision that was criticised by some committee members as enabling the VADC to “mark their own homework”.
Provision of assistance
Claim: “Only the person themselves can administer [the lethal drug]” (pg. 2).
The reality:
However, the doctor can still assist the person to “ingest or otherwise self-administer” the lethal substance (clause 23(7)(c)) as an amendment tabled to remove this provision (A463) was rejected by the committee.
Leadbeater also claims that the doctor has to remain with the patient until they have died, but the committee rejected an amendment requiring the doctor to remain in the same room as the patient. (A429) The bill explicitly states that “the coordinating doctor need not be in the same room as the person to whom the assistance is provided.” (clause 23(11)). This could enable a relative or other person to administer the lethal drugs.
The committee rejected amendments intending to clarify what doctors should do in the event of complications, and did not rule out the possibility of a doctor acting to escalate the patient’s death.
Disability
Claim: “Nobody will be eligible on the basis of a mental illness or a disability alone.” (pg. 5).
The reality:
This directly contradicts evidence given by Dr Miro Griffiths, who noted that there was often a lack of distinction between the definition of terminal illness in the bill and the definition of disability in the Equality Act 2010. Disability and terminal illness are overlapping terms and many disabilities would meet the criteria for assisted suicide.
As Dr Griffiths identified, the Equality Act defines disability as having a “physical or mental impairment, and the impairment has a substantial and long-term adverse effect on [the individual’s] ability to carry out normal day-to-day activities.” Therefore, it is clear that there is a considerable overlap between the experience of being disabled as defined in the Equality Act, and the experience of being a patient with a terminal illness.
Dr Griffiths also noted that people with disabilities (citing his own condition as an example) have been classified by doctors as having a terminal illness. He recommended reducing the terminal prognosis threshold to address this, and raised concerns that patients who could otherwise live longer with access to treatment are dying prematurely. Another witness – Fazilet Hadi, head of Disability Rights UK – also noted that “there is a huge overlap between disabled people and people who will at some point become terminally ill”.
Instead of taking on board these concerns, the committee rejected Rachael Maskell’s amendment to exclude patients with a disability and/or mental illness from qualifying as terminally ill solely on that basis. This amendment would have prevented disabled and/or mentally ill patients from being considered terminally ill on the basis of those conditions alone. This means that as the bill stands, patients could qualify as terminally ill solely because of a disability or mental illness. Therefore, the claim that nobody will be eligible on the basis of a mental illness or disability ‘alone’ not only does not rule out those conditions as a basis for seeking assisted suicide, but also suggests that these conditions will qualify the patient for assisted suicide if they additionally meet the thresholds established in Sections 2(1) and 2(2) of the bill.
Claim: Kim Leadbeater cites the approval of an amendment establishing a Disability Advisory Board as further protecting disabled people in the Bill (pg. 4). The board would assess the impact of the Bill on disabled people and report annually on this.
The reality:
As Dr Miro Griffiths stated in evidence to the committee, disabled people are already struggling to access support with day-to-day living. This will only be exacerbated by the bill, which he rightly stated would make it feel like assisted suicide was their only option.
Considering the committee’s initial refusal to hear from disability organisations when selecting witnesses for oral evidence, it is clear that Leadbeater’s reference to the advisory board is a last-ditch attempt to restore the reputation of a bill which so clearly fails to protect disabled people.
Mental illness
Claim: Kim Leadbeater argues that the bill protects those with mental illness, citing the committee’s acceptance of Daisy Cooper’s amendment requiring that the patient be referred to a psychiatrist (“if an assessing doctor has doubts as to a person’s mental capacity”, pg. 5) as one such safeguard.
The reality:
This on its own does not sufficiently protect those with mental illness: the amendment in question only requires the doctor to refer the patient for the psychiatrist assessment “if they have doubts as to capacity of the person being assessed.” (clause 11(6)(b). What constitutes ‘doubt’ is not defined in the bill, is a vague term in and of itself, and leaves too much to the discretion of the doctor.
Indeed, Dr Rachel Clarke stated in oral evidence that assessments of patient capacity were “poorly conducted”. Requiring that doctors only refer the patient to a psychiatrist when they have doubts further exacerbates this problem. A more concrete amendment tabled by Sojan Joseph – which mandated that the independent doctor be a registered psychiatrist – was rejected by the committee.
Moreover, as noted by Dan Hitchens, a patient who does not seem to understand the information presented to them, but does not have an easily identifiable mental impairment, will be deemed to have capacity. An amendment tabled to prevent this (A50) was rejected by the committee.
The committee also rejected several amendments addressing the fundamental flaw in the test for mental capacity as outlined by the Mental Capacity Act. The Act presumes the patient’s capacity: the patient is deemed to have capacity unless the facts suggest otherwise. The proof of capacity is also on the balance of probabilities, meaning that a doctor could be 49% unsure of the patient’s capacity, but the patient would still be eligible for assisted suicide.
Despite this, the committee voted against removing the presumption of capacity and against changing the standard of proof to ‘beyond all reasonable doubt’. Shockingly, it also rejected an amendment requiring the co-ordinating doctor to establish that the patient is not requesting assisted suicide because their judgment is ‘impaired’ by a mental illness or other condition.
The committee also rejected Dr Andrew Murrison’s amendment requiring patients to be assessed for any ‘remediable suicide risk factors’ – depression is one example.
This Bill will not protect those with mental illnesses. Rather, the failure to tighten the test for mental capacity will lead to the rubber-stamping of requests for people who do not have mental capacity to assent to assisted suicide.
Anorexia
Claim: the bill “would exclude anorexia as a qualifying condition.” (pg. 5).
The reality:
However, during oral evidence, Chelsea Roff gave evidence arguing that in other jurisdictions, anorexia is often considered a terminal illness because of its “physical manifestation”. She stated that there were 25 cases in California and Colorado where malnutrition resulting from anorexia is considered a terminal condition.
Indeed, there are cases in the UK in which anorexia is already being referred to as ‘terminal’. Chelsea Roff cited a 2012 Court of Protection case in which a 29 year old woman with anorexia was labelled as being “in the terminal stage” of her illness, and was told that her death was “inevitable”.
Chelsea Roff also cited statistics showing that 60 people with eating disorders globally had died by assisted suicide. So, while Kim Leadbeater has used Australia to support the assertion that anorexia will not qualify as a terminal illness in the Bill (she states that there have been no cases of anorexia patients having assisted suicides there), there have been many assisted suicides of anorexia patients internationally.
If this bill becomes law, it is more than likely that patients with anorexia would qualify as terminally ill. This could have been avoided, but the committee ignored warnings and rejected five amendments intending to prevent this.
Voluntarily stopped eating and drinking
Claim: “It is not unusual for terminally ill people to stop eating and drinking at the end of their lives…”.
The reality:
As Dan Hitchens highlights, the issue raised was the likelihood of a patient who is not terminally ill qualifying because they have voluntarily decided to stop eating and drinking. This has been identified as a serious loophole internationally. Chelsea Roff cited evidence from the American Academy of Aid-in-Dying Medicine, which stated that “Legally, there is nothing in the letter of the law…that explicitly prohibits accepting voluntary stopping of eating and drinking as a terminal diagnosis to qualify for aid in dying.” The Academy was also quoted to have argued that this would “essentially eliminate” eligibility criteria (e.g. requirement of terminal illness).
Instead of closing this loophole, an amendment tabled to prevent this was forcibly withdrawn after significant opposition by members of the committee.
Palliative care
Claim: ‘Assisted dying is not an alternative to palliative care but as a [sic] holistic approach to end of life care’ (pg. 6).
The reality:
The committee rejected Rachael Maskell’s amendment, which would have insisted that the patient meet with a palliative care specialist. Furthermore, Dr Sarah Cox cited evidence showing that palliative care improves three times more in countries that have not legalised assisted suicide. She therefore concluded that legalised assisted suicide was “impeding the development of palliative care services.”
Surveys
Claim: Kim Leadbeater cites the Royal College of General Practitioners dropping their official opposition to assisted suicide as an indicator that ‘no medical royal college in the UK opposes assisted dying law change’ (pg. 7).
The reality:
Over 250 GPs signed a letter protesting this change, saying the change “grossly misrepresented” its members’ views. It was reported that out of 54,000 members of the Royal College of GPs, there were only 8,779 respondents. Of those respondents, only 33.7% were in support of assisted suicide. 47.5% were opposed, and 13.6% were in favour of the College adopting neutrality.
Claim: Leadbeater refers to surveys carried out by the Nuffield Citizens’ Jury, in which there was apparently 70% support for assisted suicide, and 71% across the Citizens’ Jury.
The reality:
Nevertheless, as we have outlined in greater detail here, the selection of jury members was incredibly biased: prior to the process, 17 out of the 27 members were already in favour of assisted suicide. It would only have taken one member of the jury to change their mind and there would have been a net swing away from supporting assisted suicide.
Claim: Leadbeater also cites the British Social Attitudes survey, in which it is claimed that 78% of the public support assisted suicide.
The reality:
A 2021 poll found that 42% of those surveyed thought “assisted dying” was stopping life-prolonging treatment; 10% thought it was palliative care, and a further 5% admitted they didn’t know. It is therefore misleading to rely on this survey when there is general public misunderstanding of what constitutes ‘assisted dying’ to begin with.
Conclusion
Kim Leadbeater’s briefing to MPs is full of misrepresentations about the bill as amended by the committee. We hope MPs will take our analysis of these points into consideration, and vote against the bill at Third Reading.
