A good death

Assisted dying bill: What Policy Exchange’s demolition job leaves out

A new report about the flaws in the Leadbetter bill raises valid arguments. But its missing some details about its author

November 18, 2024
Wes Streeting leaving 10 Downing Street last month. Image: PA Images / Alamy
Wes Streeting leaving 10 Downing Street last month. Image: PA Images / Alamy

This is Prospect’s rolling coverage of the assisted dying debate. This page will be updated with the latest from our correspondent, Mark Mardell. Read the rest of our coverage here


18th November

5pm

A leading expert on the ethics of assisted dying has attempted to perform a demolition job on the main arguments behind the Leadbeater bill. Indeed, in his very first footnote Professor John Keown calls even the phrase “assisted dying” “a vague and tendentious euphemism”. From that moment on, he pulls no punches. The report, for the conservative-leaning thinktank Policy Exchange, is subtitled “Improving the Quality of Debate”, which the author thinks is sorely needed. He looks in detail into the second reading of a previous (and obviously unsuccessful attempt) to pass such a law. He argues this matters because the Meacher bill from October 2021 is substantially the same as Leadbeater’s. 

Keown argues three fatal flaws were revealed in a 2021 debate that was “superficial” as well as erroneous and exaggerated. The speeches by four eminent judges are dismissed as “of disappointing quality”. Then there’s “the failure of the supporters of the bill to follow the obvious logic of where the principles informing the bill led”, which was “one of the most striking omissions in their speeches”.

 And that’s just the first page.

The three flaws he identifies are: 

1. The main argument is about preventing suffering, but the bill does not require that patients are suffering, and many who are suffering would be excluded from it. Baroness Meacher’s speech (“confusing”) failed to draw the logical conclusion that this would inevitably lead to an extension of the law.

2. The suggestion that the law, in particular the Suicide Act of 1961, effectively “condoned” suicide was an error, and therefore the argument that it was illogical to stop some helping with suicide was “misguided”.

3. There was an exaggerated respect for the principle of autonomy but little or no stress on “the principle of the sanctity of life”. This made the disabled and elderly vulnerable in a society that “prizes youth, appearance and productivity.”.

While the middle point is largely irrelevant wordplay, the first does identify a glaring problem and a logic deficit in the bill. Although I agree with his argument here, I’m coming at it from the opposite direction. His third and last point raises some very interesting issues, and I suspect why the report gets such enthusiastic backing from disability campaigner and former Paralympian athlete, Baroness Grey-Thompson. She writes that it “shows clearly the practical and moral difficulties that this drastic departure from current ethical norms on the sanctity of human life will entail”. 

Two things struck me about this clear and interesting report. The first was its tone—parliamentarians might take umbrage at the scorn he pours on the debating skills of their colleagues in the Lords, and the contempt he feels for their intellectual grasp of the subject. The politics of this is all in the big(ish) name endorsements, not in the arguments made in the paper—which are more likely to bolster existing convictions than make converts. 

Which brings me to that second thing. It is a shame Policy Exchange omits a few words from its blurb about the author. It says he “holds the Rose Kennedy Chair in the Kennedy Institute of Ethics at Georgetown University”. According to his university, the full job title is “Rose F Kennedy Professor of Christian Ethics”. Nothing wrong with that, of course, but it is nice to know. In a current job advert for the post what that means is laid out starkly—the successful candidate will “have a solid background in the study and development of Catholic thought and tradition applied to medicine, biology, human development, and related issues, … [and] demonstrate an appreciation of, and broad support for, the Catholic and Jesuit mission of Georgetown University”. If you want to apply you’ve got until the 10th December. I don’t think I’ll bother: I could do the scorn, but not the rest. 


4pm

I’m told more than 100 Labour MPs are undecided how to vote on Friday 29th November. This week both sides in the debate will be stepping up the pressure, polishing their best arguments and deploying their big guns. A very useful tracker, published by Labour List, suggests that of the 402 Labour MPs only 70 have declared how they will vote (48 for, 22 against).

Some of the most intense pressure is on Wes Streeting for sticking his neck out. The prime minister is said by the Sunday Times to have personally rebuked his overbold health secretary: “Senior Whitehall sources claim Starmer was irritated that Streeting had ignored the cabinet secretary’s instructions and his explicit appeal to cabinet ministers not to try to influence the vote.” 

Intriguingly, there is also a suggestion some civil servants are “dismayed”. The paper says: “There have been some informal discussions where staff have expressed their views... Staff have flagged that the call for a review does seem to cut across routine process. There are some concerns about Streeting the secretary of state expressing a view, rather than Streeting the MP.” 

Hefty political stories, particularly in the Sundays, are often weaved out of such thin material, and it is a matter of judgement whether to trust them. This one has the ring of authenticity.

After all, Starmer has previously been on the record quite clearly in favour of assisted dying and sees this debate as honouring a promise to Esther Rantzen. But he made it clear this week that because of his position he shouldn’t and wouldn’t be trying to influence the debate. And now former interim Labour leader Harriet Harman has doubled down on her previous criticism of Streeting.

This morning, speaking on the Today programme, Harriet Harman said that he had “crossed a line”. She told the Observer: “I think it is really important that the government is neutral on this and the two people whose neutrality is most important are the prime minister and health secretary. Keir has stuck to that—but Wes has not.” 

She has called on him to scrap the investigation into the impact the bill would have on the NHS.

“By commissioning work to assess the cost of facilitating assisted dying—which he will have to publish—he will then out of necessity have to balance that against the cost of the person staying alive. That leads you to the awful prospect that the research could find that it is cheaper for people to be doing assisted dying rather than staying alive, and that would really contaminate the argument.

“I think he should not go ahead with this research because either way it is problematic, especially if it finds that it is cheaper for the NHS for people to have assisted dying. That will taint the decision with the idea that people who voted for it are voting for it to save money.

“The most important thing is for him to cancel the work he has commissioned and henceforth… to say absolutely nothing.”

Will the voluble and media savvy Streeting be able to hold his tongue?

He can at least rest assured fellow opponents have been wheeling out some of their prominent supporters over the weekend. They are backing a very critical report of the Leadbeater bill by a top ethics professor for Policy Exchange. More on that later, but it all adds to the sense that “make-your-mind-up time” is fast approaching.

We are very used to colourful, often apocryphal, stories of the whips twisting the arms of MPs to get them into the right lobby, but with a free vote it isn’t like that. Obviously, both government and opposition whips have to ostentatiously sit on their hands, dark arts undeployed, while the rival teams gently stroke or poke their colleagues’ consciences. For one side this is all about raising fears, for the other calming and quelling worries. Persuasion with little room for pride or prejudice.

Kim Leadbeater’s team says she is having dozens of conversations every day—she can barely walk down a Commons corridor without being questioned about the bill’s implications. The early assumptions that this bill would pass easily have evaporated, but Leadbeater is buoyed up by the nature of her colleagues’ questions—detailed policy-driven concerns, suggesting they are thinking of voting for the bill but want reassurances. There’s no question that the next 10 days will be vital. When I suggest to a member of Leadbeater’s team that a defeat is on the cards, they sound horrified. “If we lose this the debate is over for another 10 years,” they said.