Authored By: Anisah Uddin
University Of Roehampton
Introduction:
This legal article will establish the legal context, implications and statutory provisions of assisted dying in the UK, particularly on the Terminally Ill Adults (End of Life) Bill currently undergoing Parliamentary hearings and weigh the strengths and weaknesses of this proposed bill.
In the UK, assisted dying has sparked many ethical, legal, and societal debates, especially with Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill introduced in October 2024. 1Proponents argue assisted dying reduces the prolonged suffering of individuals suffering from terminal illnesses and allows these individuals to die with dignity, whilst the deontological approach claims that physicians have an ethical duty to honor a patient’s wishes, including helping them end their suffering when requested. 2 However, concerns about the broader implications of legalizing assisted dying, particularly for vulnerable populations, persist. 3 One primary concern is that legalizing assisted death for terminal illnesses could extend to those who are not terminally ill, leading to state-sanctioned death in various situations. 4 Justice Secretary, Shabana Mahmood cautioned that assisted dying might turn the state into a provider of death. 5 However, Labour MP Kim Leadbeater perceives it as an empathetic option for terminally ill individuals. 6
Legal context:
The primary UK legislation on assisted suicide and the provisions around it is the Suicide Act 1961. 7 This legislation specifies assisting suicide is illegal in England and Wales and is punishable by 14 years imprisonment. 8
This legal restriction has led to 80% of British people supporting Dignitas, which is a Swiss assisted dying organization, for over ten years. 9 This highlights the clear gap in the UK legislation system on end-of-life care, which is a sector that has been unacknowledged. 10 Therefore, the Terminally Ill Adults (End of Life) Bill aims to modernize UK legislation to permit terminally ill adults, with safety provisions, to request assistance in ending their own lives. 11
Safeguards and Protections for this Proposed Bill
The Terminally Ill Adults (End of Life) Bill proposal to Parliament does include safeguards and protections for the people to meet who want this end-of-life care.
One of these provisions is that this Bill will only be available for people who are suffering from terminal illness and have less than six months to live will be eligible for assisted dying. 12 Secondly, the applicants must be assessed by two independent doctors, and an expert panel to confirm their illness and mental capacity and endure a waiting period to ensure this decision is not rushed. 13 Thirdly, while this is not a mandatory step, this process will strongly encourage family thoughts and emotional support. 14 Lastly, the medical staff working with those who want assistance with dying should be trained to detect coercion, emotional stress and be able to assess mental health problems. 15
These provisions are created to allow people who want to die the ability to change their minds and ensure coercion does not influence their decisions. 16
Societal Implications:
The societal implications of assisted death include reshaping the societal definitions of dignity, autonomy, and suffering. 17 Traditionally, dignity has been linked to preserving life as long as possible, regardless of the extent of the suffering. 18 However, if the Terminally Ill Adults (End of Life) Bill passes, the concept of dignity may shift toward allowing people to choose peace over suffering and decide when their suffering should end. 19 Suffering, particularly in old age and terminal illness, is traditionally managed through palliative care. 20 Assisted dying would challenge this, especially when palliative care no longer ameliorates permanent pain, because it offers an alternative path for those whose suffering can’t be reduced, and their physical health is declining. 21 Hence, this bill will give autonomy to those suffering from terminal illnesses and grant them the same rights over their medical care as healthy people have over their medical and reproductive care. 22
The biggest societal criticism towards this bill is that this bill can inadvertently pressure those who are vulnerable because of their mental illnesses and terminal illnesses to choose death due to social stigma and fear of being a burden to their friends, family, and government. 23 This potential coercion concern is supported by former Prime Minister Gordon Brown, who criticized this bill by saying, ‘An assisted dying law, however well intended, would alter society’s attitude towards elderly, seriously ill and disabled people, even if only subliminally.’ 24
Furthermore, this bill is unlikely to reach the people it aims to help, particularly those who are severely terminally ill, disabled, or mentally ill. 25 This is because these vulnerable people normally need caregivers to live and so will never have the mental capacity to make these decisions by themselves. 26 Hence, the caregivers, social workers, family, and hospital staff will have to make these decisions. 27 Not only is the decision to end someone’s life incredibly traumatizing, but these people, who will have to make these decisions, are not equipped to handle these types of situations. 28 This could create mistakes because some will have to decide what is best for the vulnerable person, but it will also take away the voices of those who are vulnerable by restricting their right to make decisions about their lives. 29
A counter to this criticism is that this proposed bill will include measures to prevent coercion, as stated above under Safeguards and Protections such as detailed assessments by healthcare professionals, mandatory waiting periods and psychological checks. 30 This strict test ensures that only those who are approved by healthcare professionals and complete the mandatory assessments are allowed to have this procedure. 31 This bill is aimed to provide an alternative pathway to terminally ill patients and reassure them they can end their suffering if wanted by them. 32
Legal Implications:
Traditionally, England’s legislation and principles have been built on the foundation of Christian values. 33 Therefore, legalizing assisted dying would challenge this principle, as it goes against the biblical principle of the sanctity of life and promotes the quality of life instead. 34 This would create a significant shift in the UK’s legal system and would raise questions about the state’s role in personal end-of-life decisions. 35
The debate surrounding assisted dying in the UK has increased through many landmark legal cases that have tested the boundaries of existing laws and argue the prohibition of this right to end their life violates their human rights considerations. 36
In Pretty v United Kingdom, 2002 37 Diane Pretty suffered from motor neuron disease and was paralyzed from the neck down. 38 Because of her suffering, Diane wanted to end her life but needed legal assurance that her husband would not be prosecuted if he assisted her in ending her life.39 After the court’s refusal Diane challenged this decision, arguing this violated her rights under the European Convention on Human Rights (ECHR), specifically Articles 2 (right to life), 3 (prohibition of inhuman or degrading treatment), 8 (right to respect for his/her private and family life), 9 (freedom of thought, conscience, and religion), and 14 (prohibition of discrimination). 40 In this case, the Court concluded that Article 2 could not be interpreted as conferring a right to die, and the interference with Pretty’s Article 8 rights was justified in a democratic society for the protection of others. 41
Even though, the court reaffirmed the UK’s prohibition of assisted suicide, it also acknowledged the potential room for future reform in this area. 42 The court suggested this reform can be done by aligning Article 8 of the European Convention on Human Rights, which protects the right to private life to the right to privately decide when to end your life, thereby excluding involvement from outside institutions and government bodies. 43 Also, the court suggested Article 14 of the European Convention on Human Rights could be linked to assisted suicide because this Article prohibits discrimination in the enjoyment of rights and freedoms. 44
Furthermore, the case of Tony Nicklinson further highlighted the complexities surrounding assisted dying laws in the UK. 45 In 2005, Tony Nicklinson became paralyzed after a stroke and could only communicate through eye movement. 46 Through communicating in eye movements and a computer, he described his life as being a ‘living nightmare.’ 47 Because of his never- ending pain and suffering, Nicklinson begged for legal permission to end his life without going to prison. 48 His legal argument was identical to Diane Pretty’s argument that the current law violated his right to private life under Article 8 of the ECHR. 49 Even though Nicklinson was in obvious suffering, which would not improve, the High Court rejected his claim in 2012, because the court held Parliament should make these decisions and grant legislative change. 50 After this, Nicklinson refused food, water, and medical treatment, leading him to die of pneumonia. 51
His case led to legal discussions about whether the ban on assisted dying violated the right to private life (Article 8 ECHR). 52 The Supreme Court suggested that Parliament should decide on this issue but acknowledged that the right to private life could potentially extend to decisions about ending one’s life. 53 Therefore, if this Bill passes, denying people the right to assisted death could be an infringement on their rights under Articles 8 (right to private life) and 3 (prohibiting torture or inhuman treatment). 54
Article 14 of the ECHR prohibits discrimination in the enjoyment of rights and freedoms. 55 If assisted dying is legalized, concerns may arise over whether certain groups, such as the elderly, disabled, and mentally ill, could be societally pressured to choose death. 56 Critics argue that vulnerable populations will face indirect discrimination if assisted dying becomes widely available, creating pressure to end their lives to avoid being a financial or emotional burden. 57
To ensure assisted suicide is compatible with the Human Rights Act 1998, the Terminally Ill Adults (End of Life) Bill would require detailed safeguards, which they have already established in their Bill. These include:
- A process to confirm the person seeking assisted death has an incurable, painful condition 58
- Assessments by multiple healthcare professionals 59
- Family involvement to provide emotional support 60
- Strict conditions to prevent coercion of vulnerable people 61
These two cases showcase the tension between individual autonomy and state interests in preserving life and protecting vulnerable populations. 62 This proposed Bill seeks to address the legal and ethical challenges by providing a framework that balances the right to die with dignity against the need to safeguard against potential abuses. 63
International Perspectives
Despite the UK not permitting assisted suicide, there are many regions that do, and thus global perspectives on this can offer insights into the implications and challenges of legalizing assisted dying in the UK. 64 These international approaches to assisted suicide highlight the diverse approaches to this issue across the globe, with considerations towards culture, ethics, and legal considerations. 65
Some countries allow their country’s physicians to perform euthanasia or assisted suicide if it is voluntary, it is well considered, and they are suffering unbearable never-ending pain. 66 These requirements are very similar to the requirements introduced in the Terminally Ill Adults (End of Life) Bill. 67 For example, In the Netherlands, the Termination of Life on Request and Assisted Suicide Act 2001 68 allows physicians to perform euthanasia or assist in suicide if the patient’s request is voluntary, the decision is though out well, and the patient is experiencing unbearable suffering with no hope of improvement. 69 However, In the Netherlands patients as young as 12 can request euthanasia, with parental consent required for those under 16. 70 This shows the number of people who qualify for assisted suicide can broaden as the bill ages. 71 This could reaffirm the critics’ worry that this bill can gradually open the floodgates to all types of people, not just the terminally ill. 72
However, Canada shows that 78% of people who requested assisted death were given palliative care instead, showing that doctors assess each case thoroughly before offering assisted death. 73 This high percentage of people who decide against assisted suicide, even if they ask for it, shows that healthcare professionals are correctly supporting their patients by listening to their needs, 64 Baruch A. Brody, ’The Sanctity of Human Life’ in Michael J. Cholbi (ed) Medically assisted death (Cambridge University Press 2015) 61 and delivering high standard care. 74 Similarly, in Oregon, one-third of individuals approved for assisted dying later chose alternative treatments or palliative care, suggesting people can and have changed their minds once they know assisted dying is an option. 75 This clarifies that assisted dying in other regions has not led to widespread abuse, and many people change their minds or opt for palliative care because the security of knowing they can end their suffering is enough. 76
Conclusion:
This legal article showcases the large number of British people who support assisted dying legislation and believe the Parliament should address these issues. However, this article also highlights the high potential of mistakes and coercion, which could occur if this Bill is implemented into the UK’s legislative system. Ultimately, the Terminally Ill Adults (End of Life) Bill is a balance between granting autonomy and dignity to those suffering and protecting vulnerable people from exploitation. For this Bill to be ethical and successful, it must include safeguards to ensure that those choosing assisted dying are doing so freely and thoughtfully, without undue influence.
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Reference(S):
Legislation:
Suicide Act 1961, s 1.
Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2001 (Netherlands) art 2.
Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2001 (Netherlands) art 2 paras 3–4.
Cases:
Pretty v United Kingdom (2002) 35 EHRR 1 (ECtHR).
Parliamentary Materials:
UK Parliament, ‘Terminally Ill Adults (End of Life) Bill’ (12 February 2025)
<https://bills.parliament.uk/bills/3774/publications> accessed 28 January 2025.
Books and Journal Articles:
Madeline Jordon, ‘The Ethical Considerations of Physician-Assisted Suicide’ (2017)
<https://digitalcommons.acu.edu/cgi/viewcontent.cgi?article=1049&context=dialogue> accessed 9 April 2025.
James Mildred, ‘Arguments for and against Assisted Suicide’ (Christian Action, Research and Education) <http://bit.ly/3RHj1r9> accessed 1 April 2025.
News Articles:
Toby Helm, ‘UK Justice Secretary Attacks Assisted Dying Bill as ‘State Death Service” (The Guardian, 23 November 2024) <https://www.theguardian.com/society/2024/nov/23/uk-justice-
secretary-attacks-assisted-dying-bill-as-state-death-service> accessed 17 January 2025.
Jennifer McKiernan, ‘Gordon Brown Declares Opposition to Assisted Dying’ (BBC News, 5 April 2025) <https://www.bbc.co.uk/news/articles/c207yjrn7r6o.amp> accessed 17 January
2025.
Textbook:
Baruch A. Brody, ‘The Sanctity of Human Life’ in Michael J. Cholbi (ed), Medically Assisted Death (Cambridge University Press 2015) 61.
Websites:
Dignity in Dying, ‘Public Opinion on Assisted Dying’
<https://www.dignityindying.org.uk/assisted-dying/public-opinion-on-assisted-dying/> accessed 17 January 2025.
Dignity in Dying, ‘Assisted Dying Around the World’
<https://www.dignityindying.org.uk/assisted-dying/assisted-dying-around-the-world/ >accessed 17 March 2025.
Dignity in Dying ‘Tony Nicklinson’<https://rb.gy/tlvdcd> accessed 20 January 2025.
1 UK Parliament, ‘Terminally Ill Adults (End of Life) Bill’ (UK Parliament, 12th February 2025)
<https://bills.parliament.uk/bills/3774/publications> accessed 28th January 2025.
2 Madeline Jordon, ‘The Ethical Considerations of Physician – assisted Suicide’, (Digital Commons, 2017)
<https://digitalcommons.acu.edu/cgi/viewcontent.cgi?article=1049&context=dialogue> accessed 9th April 2025.
3 ibid.
4 Toby Helm, ‘UK justice secretary attacks assisted dying bill as ‘state death service’ (The Guardian, 23rd November 2024) <https://www.theguardian.com/society/2024/nov/23/uk-justice- secretary-attacks-assisted-dying-bill-as-state-death-service> accessed 17th January 2025.
5 ibid.
6 ibid.
7 Suicide Act 1961, s1.
8 ibid.
9 Dignity in Dying, ‘Public opinion on assisted dying’ (Dignity in Dying)
<https://www.dignityindying.org.uk/assisted-dying/public-opinion-on-assisted-dying/> accessed 17th January 2025.
10 ibid.
11 ibid.
12 Madeline Jordon, ‘The Ethical Considerations of Physician – assisted Suicide’, (Digital Commons, 2017)
<https://digitalcommons.acu.edu/cgi/viewcontent.cgi?article=1049&context=dialogue> accessed 9th April 2025.
13 ibid.
14 ibid.
15 ibid.
16 ibid.
17 Dignity in Dying, ‘Public opinion on assisted dying’ (Dignity in Dying)
<https://www.dignityindying.org.uk/assisted-dying/public-opinion-on-assisted-dying/> accessed 17th January 2025.
18 ibid.
19 ibid.
20 ibid.
21 ibid.
22 ibid.
23 James Mildred, ’Arguments for and against assisted suicide’ (Christian Action, Research and Education) <http://bit.ly/3RHj1r9> accessed 1st April 2025.
24 Jennifer McKiernan, ’Gordon Brown declares opposition to assisted dying’ (BBC News, 5th
April 2025) <https://www.bbc.co.uk/news/articles/c207yjrn7r6o.amp> accessed 17th January 2025.
25 ibid.
26 ibid.
27 ibid.
28 ibid.
29 ibid.
30 Madeline Jordon, ‘The Ethical Considerations of Physician – assisted Suicide’, (Digital Commons, 2017)
<https://digitalcommons.acu.edu/cgi/viewcontent.cgi?article=1049&context=dialogue> accessed 9th April 2025.
31 ibid.
32 ibid.
33 Dignity in Dying ’Assisted dying around the world’ (Dignity in Dying)
<https://www.dignityindying.org.uk/assisted-dying/assisted-dying-around-the-world/> accessed 17th March 2025.
34 ibid.
35 ibid.
36 ibid.
37 Pretty v United Kingdom (2002) 35 EHRR 1 (ECtHR)
38 Pretty v United Kingdom (2002) 35 EHRR 1 (ECtHR)
39 ibid.
40 ibid.
41 ibid.
42 ibid.
43 ibid.
44 ibid.
45 Dignity in Dying, ’Tony Nicklinson’ (Dignity in Dying) <https://rb.gy/tlvdcd> accessed 20th January 2025.
46 ibid.
47 ibid.
48 ibid.
49 ibid.
50 ibid.
51 ibid.
52 ibid.
53 ibid.
54 ibid.
55 Equality and Human Rights Commission ’Terminally Ill Adults (End of Life) Bill – House of
Commons Second Reading’ (Equality and Human Rights Commission)
<https://www.equalityhumanrights.com/our-work/advising-parliament-and- governments/terminally-ill-adults-end-life-bill-house-commons> accessed 17th January 2025.
56 ibid.
57 ibid.
58 ibid.
59 ibid.
60 ibid.
61 ibid.
62 ibid.
63 ibid.
64 Baruch A. Brody, ’The Sanctity of Human Life’ in Michael J. Cholbi (ed) Medically assisted death (Cambridge University Press 2015) 61
65 ibid.
66 ibid.
67 ibid.
68 Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2001 (Netherlands) art 2.
69 ibid.
70 Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2001 (Netherlands) art 2 paras 3–4.
71 ibid.
72 ibid.
73 Dignity in Dying ’Assisted dying around the world’ (Dignity in Dying)
<https://www.dignityindying.org.uk/assisted-dying/assisted-dying-around-the-world/> accessed 17th January 2025.
74 ibid.
75 ibid.
76 ibid.
