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
21st December
A Christmas present for hospices... Hospices in England are to receive £100m of government funding over two years to improve end-of-life care, Health Secretary Wes Streeting has announced.
20th December
There is no appetite among the political classes in Japan for a debate on assisted dying—and some argue several of the central arguments against the policy are magnified by that country’s very particular culture. But is this the result: a hefty jail term for a doctor who fulfilled a dying woman’s wish? Perhaps, but it is more complicated than that.
Some of the headlines only have parts of the story but I’ve pieced it together for you. A Japanese court has upheld an 18-year prison sentence for a doctor who helped a woman end her own life. Doctor Yuichi Okubo was convicted of murdering 51-year-old Yuri Hayashi, who had ALS (amyotrophic lateral sclerosis, a degenerative neurological disease that progressively paralyses the body.) He and another doctor, Naoki Yamamoto, administered a lethal dose through a gastric feeding tube. Okubo admitted he killed her but said he did so to “fulfil the woman’s wishes”.
According to one Japanese daily newspaper, the woman first wrote on social media: “It is very odd that there is not a single healthcare professional (in Japan) advocating the necessity of euthanasia.” The article continues: “Okubo’s reply to this post, which was made anonymously, is believed to be their first exchange. Okubo approached the woman regarding the topic of euthanasia about a week later, saying, ‘I would like to help you if I won't get prosecuted,’ to which the woman responded, ‘It made me cry from happiness.’”
But as another newspaper reported about the High Court appeal judge’s conclusion: “Hiroshi Kawakami said Okubo did not meet the essential obligations for medical personnel concerning patients who sincerely want to end their lives, including undertaking all possible treatments and providing thorough explanations.
Kawakami added that Okubo was not the woman’s primary doctor, and that he interacted with her through social media without ever meeting or seeing her in person.”
In a bizarre twist, which perhaps puts a different complexion on the case, the doctor was separately convicted of killing the father of his fellow accused Dr Naoki Yamamoto. He denied killing the 77-year-old man who had just emerged from a long stay in hospital. In an echo of what some campaigners claim could happen here legally, prosecution claimed: “Okubo held the belief that elderly people who are exploiting medical expenses and patients with incurable diseases who wish to die should be actively targeted for death.”
If the prosecution’s allegations are true, they play directly into strong fears in Japan about the medical profession and society at large.
Some have long called for a debate in the Japanese parliament, but there’s strong resistance among MPs. A couple of regional courts have ruled in favour of what they call “voluntary euthanasia” and set out, in great detail, what the rules should be. The trouble is apparently their rulings don’t create a precedent, nor have they been backed by the Supreme Court, let alone politicians. It is little wonder, then, that one eminent professor of law writes: “It is now disputable whether the act is lawful or unlawful, and if unlawful whether it is excusable or not.”
Japan has a complex, ambivalent attitude towards suicide, let alone assisted dying. In the past there was at least tolerance and often occasional outright admiration for Seppuku or Harakiri, the Samurai’s grisly ritual suicide. It was seen as an honourable death in the face of defeat and disgrace—but not if carried out for less martial reasons. In any case this sneaking regard for those who kill themselves, seems to have been erased by alarm about Japan’s high suicide rate, particularly among the young.
It is fascinating that when it comes to assisted dying one finds familiar fears the world over. But according to the authors of one detailed study, there are particular cultural aspects that exacerbate those worries.
They write that in Shintoism and Confucianism, “death is regarded as the ultimate impurity and considered a serious taboo, and any discussion of death is still highly discouraged and met with great resistance.”
They argue, even, that where patients make a clear refusal of life-prolonging treatment, this is “often not accepted by the physician or family. Furthermore, there is no definite concept of an afterlife. Therefore, it should be noted that in many cases, doctors, families, and society still prefer to keep patients alive, regardless of their wishes or suffering."
This is interesting, but even more significant than this resistance is the amplification of shared concerns through specific aspects of Japanese culture, such as “an emphasis on family-centred decision-making and filial piety; an emphasis on the importance of harmony; obedience to authority.”
They find this could grease the slippery slope of any new law.
“Japanese citizens tend to assume a stance of ‘once something is decided for the public, we must strive to follow this as much as possible.’ If Voluntary Assisted Dying were to be legalised, the public scrutiny that could potentially imply ‘why aren’t you dying/why aren’t you allowing them to die?’ may inevitably be directed at patients or families who find themselves in situations in which VAD might be an option, but may not be representative of the patient’s desire to hold on to their life until a natural death occurs.”
The combination of this potential societal pressure and Japan’s demographic crisis, a rapidly ageing population and dwindling birth rate, forms the background to last year’s award-winning film, Plan 75.
The Guardian explains the title. “Instead of being a burden, a bother, a resource-draining nuisance, anyone aged 75 can simply place themselves in the calm, efficient hands of the state and painlessly slip away. Those with money and family can do so at the end of a two-day premium package, after spa treatments and special meals. Those without are given enough cash to pay for basic funeral costs before lying down on a camp bed in a dark, silent room divided by curtains where they quietly acquiesce to being gassed to death.”
The director Chie Hayakaw says: “A state-sanctioned solution like Plan 75 is far from impossible in a country that is growing ever more intolerant to socially weak people: the elderly, the disabled and the people who have no money.”
Given that Japan’s problems with a potential demographic time-bomb are common to many parts of the world, and not just what used to be called “the west”, this will resonate with campaigners against the bill here. Those on the other side of the debate in Japan should perhaps note that the major justification for Seppuku was to avoid torture at the hands of a victorious enemy: not in most people’s terms a “good death” but a better one than the torment they would otherwise have suffered.
18th December
After politicians voted yesterday, assisted dying is a step closer to becoming legal in one part of the British Isles. Nothing to do with the Leadbeater bill, which covers England and Wales—this is about the Isle of Man, the British Crown Dependency in the middle of the Irish Sea, with a population of just under 85,000, and which covers almost 230 square miles. Members of the delightfully named House of Keys voted in July for their assisted dying bill, and yesterday’s vote was in the upper house (called, in what seems to be a verbal balancing act between obscure romanticism and dull description, the Legislative Committee—LegCo to its friends). This is equivalent to the committee stage in Westminster and some important changes were made.
The biggest difference with the Leadbeater bill is that the terminal diagnoses may be longer—12 months rather than six.
An amendment to shorten this to match the UK bill was rejected.
Other important votes:
The residency requirement was cut from five years to 12 months. The idea is to ensure that residents are able to access assisted dying if they become terminally ill, while still protecting against “death tourism”.
- A requirement was added that those requesting an assisted death should be registered with a GP on the island.
- Members voted for specific training for healthcare professionals to identify coercion, duress or pressure.
- They also passed an amendment that would ensure a referral to a psychiatrist is made if there are doubts about the patient’s mental capacity.
- But an amendment which would have banned the main hospital from allowing assisted dying was rejected.
In January LegCo will vote on the whole bill and it will go for a third reading vote in the House of Keys. If it passes all these stages, it will become law after royal assent by the Lord of Mann, or as he’s better known, King Charles III.
16th December
MPs opposed to the assisted dying bill are furious about the make-up of the committee chosen by Kim Leadbeater, as it excludes some of the most prominent of their number. You heard it here first, even before the announcement. One strong opponent, Labour’s Rachael Maskell, knew she wasn’t on Leadbeater’s list and told me she wanted to know why. Her Conservative opposite number, acting as chief whip for the antis, Danny Kruger, had a list of nine names he wanted on the committee. Only two were chosen. One was, presumably, him, and I am not clear who the other was.
But really, this shouldn’t come as a surprise. This is a matter of immense sensitivity and importance. Nevertheless, it’s still politics. Why would Kim Leadbeater, having achieved such a victory for the bill, go out of her way to select people who might destroy it? That said, it’s interesting to examine those she has chosen.
Her hands were hardly tied. Hansard only says blandly, “The member sponsoring the bill must provide the selection committee with the names of members willing to serve on the PBC [public bill committee]. The selection committee will then formally nominate those members.” Parliament’s own website says: “This list must reflect the party balance in the House and should also reflect a balance of views on the bill.” It isn’t clear if that “balance of views” should reflect just “for and against”, or something more nuanced.
Nine of those who voted against the bill are on the committee—two Conservatives, one Lib Dem and six Labour MPs. Most of them have either a professional or personal interest in the bill and five are new MPs. Now here’s the interesting bit: at least five suggest they aren’t against the principle of assisted dying and haven’t ruled out voting for the bill in the future. That matters hugely: once the committee has done with the bill and made detailed changes, there’ll be another vote in the House of Commons. Think how powerful a speech might be from a committee member who has changed their mind.
Let’s look in more detail at those “no” voters.
The sole old hand among the Labour antis is Bradford MP Naz Shah, who was elected in 2015. Before then she was the chair of the mental health charity Sharing Voices Bradford, and had previously worked as a carer for disabled people and as an NHS commissioner. In a three-page letter to constituents she explains, “In its current form, I believe safeguards in the bill remain inadequate… the safeguards are insufficient, and the risks to vulnerable groups are too great. Our priority should be strengthening palliative care to ensure every patient receives compassionate, high-quality care.” She appears to be the least persuadable of the Labour MPs.
Persuadability rating *
At the other end of this narrow spectrum is the new Ipswich MP Jack Abbott. He writes: “I feel an enormous sense of duty being asked to join this committee.
“This is one of the most consequential decisions I’ll likely have to make as an MP, and I will work tirelessly over the coming months to ensure this bill has strong protections and safeguards so we can minimise risk and eliminate any unintended consequences.”
Which doesn’t sound like a wrecker’s approach. Before the vote he explained: “Although I am supportive of the principle of assisted dying, I do not feel able to support the second reading… I feel that voting for this law change now, in its current state, presents too many risks. I am not prepared to take such a gamble over an issue that will have such a profound effect on people in this country.”
His conclusion could not be clearer. “I believe in the principle of assisted dying, and if these risks were properly assessed and minimised, I would likely make a different choice in the future. Should the bill advance, I will review my position if my concerns are addressed.”
Persuadability rating *****
For another Labour new boy, Sean Woodcock, it is personal. He describes his mum as a carer and writes: “A close member of my family has a long-term condition for which there is no cure. Whilst now they are in every other way fit and healthy one day, no doctor knows when, their quality of life will likely seriously diminish. And it will continue to do so. One day it may come to them wanting to make the decision on how they want to deal with death.
“Yet I still find myself struggling on the issue and continue to look at all the issues being raised by both sides. A year ago, I knew where I stood very definitely; we should have some form of assisted dying. Now, I’m less certain.”
He continues: “I went to a Church of England school and was very actively religious growing up. But I lost my faith over a decade ago. So, my internal conflict is not because of faith or religion.”
However, he adds: “In the debate on assisted dying we hear a lot about safeguards, but any safeguards introduced won’t be as strong as the current law.
“It remains possible, even likely, that those safeguards will occasionally fail and that someone will end their life through either coercion or lack of information…the reality is that [suicide] is something that across the board the state actively tries to prevent from happening and perhaps we should look at and improve end-of-life and palliative care before resorting to legislation for assisted dying.
“To close, all of the above are reasons I along with many other MPs are struggling to decide on this issue, which may be a decision in itself.” But “struggling” on the committee may be rather different.
Persuadability rating **
For the MP for Bexleyheath, Daniel Francis, another “no” voting committee member freshly elected in July, there’s a personal element in his campaign for those with a disability. One of his children has cerebral palsy and is in a wheelchair. Just before the vote he went on Instagram to say: “I’ve wrestled with this decision for many months, considering the feelings and arguments from both sides of the debate.
“In the last few days, I’ve written to constituents who contacted me regarding the bill. I outlined a number of concerns I have related to specific clauses within it, particularly regarding the assessment of mental capacity and the potential for coercion.
“My role as an MP is to scrutinise legislation, not necessarily to decide whether I support the principles or aims of a bill in its entirety. As a result of the concerns I’ve raised, I cannot in good conscience support the bill as it currently stands, and I will be voting against it.”
Persuadability rating ***
Sojan Joseph, the newly elected MP for Ashford, says he believes—in principle—people should have the right to choose how to end their life when living with a terminal illness.
But he adds, “I do not believe that there are enough safeguards in place for vulnerable people—especially those with mental health issues.
“Fluctuating capacity is something I witnessed first-hand when working in the NHS, and until preventative measures and more safeguarding are put into place, I wouldn’t feel comfortable voting on a bill like this.”
Persuadability rating ****
Our final Labour opponent of the bill, Juliet Campbell, is also a new MP and was a senior manager in the NHS, “where I shaped new approaches to patient engagement, coordinated a project to address high-levels of teenage pregnancy, and wrote the first Carers’ Charter in the hospital I worked at”, she writes.
“Education is what brought me into politics; specifically, how we educate neurodiverse people. My son is dyslexic and I wanted to help other families struggling against the system.” Beyond that I have failed to find anything remotely relevant, and far as I can see she has made no public comments on the bill—at least none that are on the internet, which is fairly unusual. I’ve asked her office for a comment.
Persuadability rating ?????
The sole Lib Dem is Sarah Olney, who was first elected to her Richmond seat in 2016, lost it in the snap election the next year and regained it in 2019.
In a letter to constituents, she says she has taken a long time to reach her decision, but concluded:
“I know I’m instinctively against the idea of assisted dying. I believe that as long as there is the ability to have meaningful human interaction and the capacity to feel joy, then life is always worth living… But there is a clear case for assisted dying. If assisted dying is allowed, will those suffering from terminal illness feel that, by not choosing assisted dying and instead choosing to continue living, they are perceived as a burden on their families?”
She goes on to argue that this should be a government bill because private members’ bills frequently fail due to the time constraints on them.
“This is a flaw in the private members’ bill process as much as the bill itself. It doesn’t inspire confidence that we have the time to fully consider all the implications. To ensure the vulnerable are fully protected, the process will need to be robust.” Now she will be there to make sure it is.
Persuadability Rating ***
The most senior Tory on the committee, Danny Kruger, is implacably opposed and not even his mum Prue Leith can persuade him.
Persuadability Rating: no stars. Unpersuadable.
The second Conservative on the bill, Rebecca Paul, is another MP newly elected this year. Before the vote she did a piece with BBC News saying she was “daunted” by having to make such a consequential decision so soon after becoming an MP, but she had researched it in detail. After revealing that she would vote against she stressed she was open-minded, and thought the issue would come up again. She hoped that some of the unanswered questions would be looked at in more detail. Now it is her job to do exactly that.
Persuadability Rating ****
This deep dive took a while, but I think was worth it to discover most of the “no” voters are new MPs who’ve struggled with the decision but aren’t fundamentally opposed to assisted dying. Like many of their colleagues, they are looking for stronger safeguards.
If you’re opposed to the bill, you could argue these are newbies too wet behind their ears to know their Hansards from their Erskine Mays, handpicked for the possibility they might change their minds, and at very least won’t make a fuss or deliberately embarrass Leadbeater.
On the other hand, if like me you support the bill, but do have practical questions about the safeguards and worry about those who feel vulnerable, this is likely the bunch you’d pick. People who may have to bone up on parliamentary procedure but who know what they are talking about, and come with both open minds and profound concerns. They should allow the committee to make good choices and turn this into the best possible law. Or does that make me naive?
