The Complex Debate Around Assisted Dying: For and Against

Kim Leadbeater’s “Terminally Ill Adults (End of Life)” Bill states that it would “allow adults who are terminally ill, subject to safeguards and protections, to request assistance to end their own life”. When presented to parliament, it drew the highest in the private member’s ballot for the 2024-2025 session and has caused much controversy amongst the general public. With Dignity In Dying, an organisation advocating for choice over where and how we die and easily accessible expert information on our options and good quality end-of-life care, growing in support, organisations like Care Not Killing, advocating against assisted dying, are also on the rise. This article delves into the key arguments on both sides, exploring the impacts the passing of this bill will have on individuals and society as a whole.

Those in support of assisted dying’s fundamental belief is the desire to alleviate the pain and discomfort of those who suffer from terminal illness. Despite access to specialist palliative care, some dying people would still experience excruciating physical pain and this pain can take a toll on their mental health. When suffering from such severe pain, people often feel isolated as their pain can limit the things they can do. It can also cause trouble sleeping which only worsens the discomfort they are already in, leading to increased risks of anxiety and depression. By not legalising assisted dying, those with terminal illnesses are forced to suffer against their wishes and therefore are denied the right to their human autonomy. This can be viewed as inhumane and inconsiderate. Furthermore, the current UK law doesn’t seem to be working. When faced with such agonising pain, UK citizens often travel to Switzerland to make use of the services provided by facilities like Dignitas to have physician-assisted dying. On average, every eight days, one UK citizen travels abroad to end their life. However, this service is not cheap and affordable ( > £10,000 ) and so is limited to only those who have the money to do so. [1] This evasion of the law speaks volumes as healthcare in the UK is supposed to be available to everybody and by not legalising assisted dying, the class divide within our society is worsening and it can fuel the belief that the current government is cruel and lacking compassion for barring people who cannot afford the services provided at Dignitas from receiving assisted dying. Additionally, people can often be stuck in situations where they are forced to end their lives sooner than they would’ve liked because they must be fit enough to travel. Finally, those who are competent and well-informed regarding their condition and the palliative care options they have should be provided with a sense of empowerment by being allowed to make the choice of how they would like to die. Depriving them of the right to exercise their autonomy can be seen as heartless and dismissive of their pain and suffering. [2]

One of the major arguments against assisted dying is that ethically, ending a person’s life- even upon that individual’s request- is wrong and the legalising of assisted dying could be dangerous for society. Despite the “safeguarding procedures” mentioned in Leadbeater’s bill, which should ideally be upheld, we do not live in a world where this bill could possibly include every scenario that could take place during the stresses of real-world clinical practice. A patient’s primary healthcare provider may or may not know the family dynamics of the individual so the doctor chosen for the patient’s second approval is even more likely to have a lack of knowledge about the ins and outs of the patient’s life. These doctors and other healthcare providers who have to face the ethical dilemmas of assisted dying and the psychological stress of having to decide whether or not they have made the correct decision regarding the ending of a life could take a serious toll on their mental health and could impact their day-to-day lives. Additionally, it is very hard to tell if all the decisions the patient is taking are completely voluntary or not- many terminally ill patients suffer from SPB (self-perceived burden) which can affect a patient’s decisions regarding their care [3] as they may feel guilt, pushing them to go through with this. This is a form of coercion and it’s the doctor’s responsibility to detect any signs of it. Furthermore, the existence of the legislation could create a slippery slope for the erosion of protections for the disabled and elderly as the process becomes more normalised and it becomes easier to widen eligibility criteria through the use of anti-discrimination legislation. [4] An example of this is the progression of euthanasia criteria in the Netherlands. Beginning in 2001 where it was legalised for mentally competent adults (16+) with unbearable physical pain and no prospect of a cure as well as children aged 12-16 with parental consent. In 2006, the Groningen Protocol enabled euthanasia for infants under 1 year old with parental consent. Then, the criteria of “unbearable physical pain” was also extended to psychiatric pain and so included mentally incompetent patients. In 2017, the association “De Laaste Will” began advocating for “the right to die with dignity”. With 3500 members and an average age of 70 years old, a law was drafted for euthanasia on request for people aged 75 and older. This led to the new “Completed Life” Bill in 2020 introduced to parliament for over 75s. [5]

The debate about assisted dying is incredibly complex and only a handful of arguments both for and against have been explored in this article. On the one hand, some believe denying someone their right to human autonomy is wrong. On the other hand, some believe that the ending of someone’s life, even if they make the informed decision to do so, is unethical and that alternative palliative care options must be improved. Ultimately, the decision of whether or not to legalise assisted dying will require careful consideration of these competing values and must be approached with respect and sensitivity towards those with terminal illnesses. 

Written By: Aditi Singh

Sources:

[1] Dignitas (2018) Dignity in Dying. 

Available at: https://www.dignityindying.org.uk/why-we-need-change/dignitas/ (Accessed: 22 December 2024). 

[2] Key arguments used in the debate on physician-assisted ... (2021) BMA. 

Available at: https://www.bma.org.uk/media/4394/bma-arguments-for-and-against-pad-aug-2021.pdf (Accessed: 22 December 2024). 

[3] Gudat, H. et al. (2019) How palliative care patients’ feelings of being a burden to others can motivate a wish to die. moral challenges in clinics and families, Bioethics. 

Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6594221/#:~:text=The%20feeling%20of%20being%20a%20burden%2C%20or%20self%E2%80%90perceived%20burden,%2C%20chronic%20pain%2C%20and%20frailty. (Accessed: 26 December 2024). 

[4] Key arguments used in the debate on physician-assisted ... (2021) BMA. 

Available at: https://www.bma.org.uk/media/4394/bma-arguments-for-and-against-pad-aug-2021.pdf (Accessed: 26 December 2024). 

[5] Euthanasia in the Netherlands (2019) Alliance VITA. 

Available at: https://www.alliancevita.org/en/2017/11/euthanasia-in-the-netherlands/ (Accessed: 26 December 2024).