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
28th January
6pm
What did we learn from the first session of oral evidence to the assisted dying bill committee? Overall, that the medical establishment is broadly happy with the bill as it stands. This is hardly a surprise as Kim Leadbeater had clearly done her homework and built on previous bills to make sure it doesn’t cross any of the red lines of the main players whose support she needs.
Chris Whitty, the chief medical officer, wasn’t keen on more new rules: “The central figure is an average citizen in their last six months of life. We don’t want to create a system that is so complex they spend that entire time navigating bureaucratic obstacles. We need to keep it simple. In my view, the best safeguards are usually simple ones—overcomplicating things can make them less certain.”
This matters because some committee members are arguing for tighter rules around those with mental health problems, but Whitty said: “I’m relieved the bill sticks with the Mental Capacity Act (MCA). First, the MCA is used every day by doctors and nurses; they understand it, even though it’s large. Second, it has been tested in the courts—including the Supreme Court—so ambiguities have been clarified, making it feel robust and predictable.”
He rather skirted around whether “six months” and “terminal” were easy to define: “At one extreme, it is very clear that a person is not going to die imminently; for example, barring an extraordinary accident, someone with certain diseases could still be fine in a year.
“At the other extreme, there are people who are clearly dying and will die in the next two or three days, and nothing will change that reality. What this bill addresses is the stage in between those two extremes. People do reach a point where there is an inexorable and—importantly for this bill—irreversible decline toward death.
“Experienced clinicians can usually form a reasonable central view about when that death is likely to happen, although there is some variability around any estimate. I am sure the general public and members of parliament fully accept that it is not an exact science. The academic literature shows that some people will die significantly earlier than predicted, some at around the predicted time, and a small number significantly later. Still, the central view is usually reasonably accurate once someone is on that pathway from which there is no return.”
Next up was Dr Andrew Green, a retired GP, who chairs the medical ethics committee at the British Medical Association (BMA). He began by clarifying the BMA’s position: “In 2020, we conducted a large survey of our members. On the basis of that survey, the BMA moved from opposition to a neutral position on assisted dying. That means we neither support nor oppose changes in legislation.”
But he didn’t give much comfort to those who don’t want doctors to be able to raise the subject with terminally ill patients.
“A good doctor often has to read between the lines to uncover what patients aren’t saying explicitly,” he said. “In those circumstances, a doctor needs the freedom to open that door so the patient can step into a safe space for difficult conversations. It’s already challenging for clinicians to gauge when to do this; the last thing they need is legislation that makes it harder.”
The BMA does oppose the bill’s demand that doctors who have a moral objection to assisted dying provide a “referral” to another doctor, but it turns out that hinges on the technical use of the word and, after an intervention by Kim Leadbeater—who compared it to the laws on abortion—Green confirmed that patients wouldn’t be left in limbo: “In those situations, the doctor can provide the patient with alternative sources of information—perhaps through a receptionist, leaflets, or a phone number. You cannot simply abandon a patient; you must ensure they can pursue what they need. But it’s the act of direct referral that’s problematic for some doctors.”
This afternoon it is the turn of lawyers. Stay tuned.
4pm
The committee has begun hearing evidence from witnesses. First up was the chief medical officer Chris Whitty—with the proceedings showing none of the ire of the committee’s first meeting and the subsequent accusations of a stitch-up. Whitty made it clear he was neutral on the principles of the bill but didn’t think there was any need to tighten its principles around mental capacity, which are based on the Mental Capacity Act 2005. He said it was plain that the current guidelines on a person’s mental capacity worked well, were clearly understood and had been tested in the high court, and that they would be taken more seriously, the more serious the decision.
He also suggested the six-month requirement was fair: “People do reach a point where there is an inexorable and—importantly for this bill—irreversible decline toward death.” He added that experienced clinicians can usually form a “reasonable central view about when that death is likely to happen, although there is some variability around any estimate. I am sure the general public and members of parliament fully accept that it is not an exact science.” Whitty said that the academic literature shows that some people will die significantly earlier than predicted, some at around the predicted time, and a small number significantly later. “Still, the central view is usually reasonably accurate once someone is on that pathway from which there is no return.
9am
If the chief medical officer notices an awkward atmosphere when he walks into the committee room to give evidence today, he needn’t worry—it has nothing to do with him. The work of the cross-party parliamentary committee for the assisted dying bill begins in earnest this morning as it hears the evidence of witnesses beginning with Chris Whitty, followed by the chief nursing officer Duncan Burton. MPs may be eyeing each other warily even as they listen attentively.
After the huge praise heaped on the November Commons debate on the assisted dying bill for its gravitas and civility, the very first meeting was quite a contrast—ill-tempered and pretty vicious, as I reported at the time. But I didn’t expect the outcry that followed from conservative media outlets, accusing Leadbeater of a “stitch up”. Until now, party has been irrelevant in this debate—but that seems to have changed.
The conservative media’s charge is that she has stuffed the oral hearings with supporters of assisted dying, held the meeting to discuss this in private, arranged a vote to exclude psychiatrists and then changed her mind after an “outcry”. In the words of the Spectator, she has “given up on any pretence of caring about scrutiny and fairness”. From GB News to UnHerd, they argued that Leadbeater is “shielding the assisted dying bill from scrutiny”. Spiked claimed that “Kim Leadbeater has pulled every trick in the book to minimise parliamentary scrutiny of her dangerous bill” by meeting in private.
That was not all the criticism. Disability News Service reported that she may have broken UN guidelines and the “duty it imposes to ‘closely consult with and actively involve’ disabled people through Disabled People’s Organisations when developing laws relating to disabled people.”
The news agency noted the main complaint about Leadbeater’s list of those giving evidence. “It emerged on Tuesday that nearly two-thirds of the witnesses who will give oral evidence to the committee in the coming weeks have previously expressed support for legalising assisted suicide.”
The exclusion of disabled groups does seem odd, and the list is clearly unbalanced. I can understand Leadbeater wanting to avoid witnesses who want to grandstand and rehash the old arguments rather than talk constructively about the actual bill and how it might be improved. But I very much doubt that explains the exclusion.
The most cogent and sophisticated criticism of Leadbeater’s approach comes from Nikki da Costa in ConservativeHome. As a former director of legislative affairs to both Theresa May and Boris Johnson, her experience presumably covers a wide spectrum of political morality. She writes that Leadbeater has been canny in picking the outspoken right-winger Danny Kruger as the main opponent: “No matter how reasonable the proposal, support will be portrayed as tribal transgression. He is to be their hate figure.”
Da Costa concludes: “In just two hours we saw the extent of the sponsor’s control of the Committee, the advantage of being able to choose every member and every witness, and how outgunned concerned MPs are…
“Whatever side you are on, this does not bode well for careful, considered line-by-line scrutiny and improvement of the bill.”
If the choice of witnesses was determined by a desire to focus on the committee’s actual job of scrutinising the bill line-by-line and avoid rehashing the arguments for and against, then it is a spectacular tactical failure. Janice Turner wrote in the Times that she had been narrowly in favour of the bill but “everything I read about the conduct of Kim Leadbeater’s committee is dismaying, from the mainly inexperienced MPs chosen to represent the anti side, to an initial vote against taking evidence from the Royal College of Psychiatrists, despite the insight it might have into coercion of the terminally ill.”
The latest ex Downing Street advisor to join the fray is Nick Timothy, who used to be Theresa May’s right-hand man. Writing in the Telegraph he is damning: “we know enough from this process already that it lacks the legitimacy promised when the Commons voted in November. The MPs who voted yes in the hope of a bill made better by an honest process should watch this committee very closely.”
They all have a point—Leadbeater clearly has some questions to answer (and I have asked them). But it is also interesting that until now this debate, morally and practically complex as it is, was not split on party lines. When I began this piece, I was convinced that there was some coordination from those opposed in principle to assisted dying—now I see the hand of the Conservative central office, spotting a way to embarrass and discredit the government.
Now both Leadbeater herself and the right-wing press have made sure that it will be split on party lines. It has become not just politics as usual but a particularly raw and harsh version of it, where winning is all.
27th January
4pm
There has been a great deal of criticism in the Conservative media about the way Kim Leadbeater has managed the committee and I have written a full piece about it for tomorrow. I think it’s worth posting this letter that she sent to all MPs this morning.
Dear Colleagues,
I wanted to take this opportunity to update you on the progress of the Terminally Ill Adults (End of Life) Bill.
The first formal meeting of the Bill Committee took place on Tuesday January 21st and the money resolution necessary for the progress of the Bill was agreed without a division in the House on Wednesday 22nd January. The initial formal meeting of the committee included a private session to discuss witnesses, which is normal procedure, as a many of you who have sat on committees will know. The committee then opened up to continue deliberations. There was nothing unusual about this.
This week will see a very full programme of oral evidence with some 50 witnesses due to appear before the committee. I added a third day of hearings to accommodate as many of the witnesses proposed by committee members as possible and on Tuesday we agreed to extend the timetable on the final day to allow for additional witnesses to be invited.
We will be hearing from people with a wide range of views on the Bill, some in favour in principle, others against and many with a neutral stance. However, they have been selected above all for their expertise and experience and the contribution they can make to help guide the committee towards whatever amendments may be needed to make the Bill as effective and workable as possible. I want to reassure colleagues that the whole committee is determined to work collaboratively and respectfully to reflect the very positive debate we had at Second Reading and to ensure that the best possible Bill is ready when it returns to the House at Report Stage later in the year.
The invitation for written evidence has produced a large number of submissions already, with more yet to come. I have consulted all members of the committee and in order to assist them in digesting both the oral and written evidence and to consider any amendments that might be forthcoming as a result, I will be proposing that the line-by-line examination of the Bill now commences on Tuesday 11th February. This will enable us to fulfil our duty to the House to scrutinise the Bill thoroughly and conscientiously, and meets my personal promise that it will receive significantly more scrutiny than any previous Private Members’ Bill, and indeed more than almost any government Bill of a similar length. As I said at Second Reading, the Bill already contains the strongest protections and safeguards anywhere in the world, but I remain open to any and all suggestions for how those safeguards can be made even stronger, while never forgetting the lack of clarity, pain and injustice that the law as it currently stands imposes on too many terminally ill people as they approach the end of their life.
The committee has a great deal of important work to get on with and I want to put on record my thanks to all of them for the time and energy they are committing to the task. I am very conscious that members across the House, and the public watching our deliberations from outside, continue to take a very keen interest in the progress of the Bill and I will do my best to keep everybody updated regularly so that our work is as open and transparent as possible.
On a personal level, I and my team have been extremely busy working to ensure the scrutiny process is rigorous and effective, but I will always try and find time to discuss particular details with individual members as we move forward. Please feel free to contact my office at any time.
Best wishes,
Kim
Kim Leadbeater MP
1pm
Canada has become the favourite poster child of those opposed to assisted dying, who argue that the country is on a slippery slope away from common sense and decency. They’ve even got those, like me, on the other side of the debate using the term. Opponents have yet to turn their propaganda victories into political victories—but that maybe about to change, in a modest way. There are straws in the wind suggesting at a national level that a plan to further liberalise the law may be dropped, and one important state might impose stricter rules.
Earlier this month Justin Trudeau, Canada’s long-serving but increasingly unpopular prime minister, resigned. Among those celebrating will be the church leaders who blame him for “leaving a legacy marked by this unmistakable opposition to Catholic teaching and priorities,” according to the Catholic Register—by which of course they mean “his policies and advocacy for the advancement of abortion and euthanasia rights.”
This forthright assessment is typical of the feisty debate in Canada. While Canada’s Medical Assistance in Dying (MAID) programme has widened its scope, its opponents have been remarkably successful in highlighting both the alleged abuses and the rapid extension of assisted dying.
They’ve made much of the fact that the most recent figures suggest nearly one in 20 deaths in Canada were due to MAID. Last month Health Canada released its fifth annual report, which showed that in 2023 4.7 per cent of the 326,571 deaths in the country were medically assisted. Only in the Netherlands is this higher—5.4 per cent as of 2023. Why the Dutch escape the disapproving headlines isn’t really clear, but it’s probably because it has taken a lot longer to reach that percentage and because the Catholic Church doesn’t hold much political sway in Holland.
Health Canada’s report concludes: “The Government of Canada will continue its work to help ensure that the framework for MAID in Canada is safe, reflects the needs of people in Canada, protects those who may be vulnerable, and supports autonomy and freedom of choice.” Which does sound a bit smug, given the disapproving headlines the report has prompted around the world.
Even the Economist gets in on the act with an article headed, “Canada has adopted assisted dying faster than anywhere on Earth”. It points out the Canadian province of Quebec now has the highest share of doctor-assisted deaths in the world—7.2 per cent in 2023.
Religious campaign groups claim these figures show MAID is “skyrocketing” out of control.
The Association for Reformed Political Action, a grassroots Christian political advocacy organisation, argues that sickness and suffering are not the only reason for patients choosing to die—“so are loneliness, dependence, and a faulty view of human dignity. And these social factors are increasingly contributing to euthanasia deaths in Canada as euthanasia becomes more normalized.”
It adds: “Suffering is real and can be caused by various factors. But the response should never be to offer to kill those who are suffering… ultimately, the government’s approach reveals an emphasis on autonomy over protecting anyone from euthanasia.”
This seems to me to unwittingly put its finger on the problem behind those alarmed headlines. It is essential to highlight failures in care leading people not only to wish they were dead, but to act upon it. But the often-unspoken assumption that the high percentage is a problem is based on the idea people need “protecting” from such a death. It might look rather different if the statistic was labelled “4.7 per cent of Canadians avoid painful death”.
Indeed, those in favour of assisted dying can point to the fact of its rapid expansion as proof that people want it. It is certainly true that, everywhere in the world that it has been adopted, the criteria have only ever been made more liberal, never tighter.
Perhaps Canada might be about to buck that trend and generate new headlines.
Trudeau’s resignation means that Canada’s general election due to be held in October could now come as early as March. The man opinion polls suggest will be the next prime minister, Pierre Poilievre, was raised a Catholic, although there’s little suggestion faith plays a major part in his life these days. Despite a spate last summer of campaigning in evangelical churches, the Conservative leader is pro abortion and gay marriage. But, last year, he forcefully condemned a government plan to expand Canada’s medically assisted suicide law to include people suffering from non-terminal mental illnesses. Trudeau put the idea on hold until 2027, and if the Conservative wins it seems highly likely it will be dropped altogether.
Poilievre, a low-tax economic libertarian, certainly knows how to weave his main talking points into this evergreen debate.
“After eight years of Justin Trudeau, everything feels broken and people feel broken,” Polievre said in 2023. “That’s why many are suffering from depression and they’re losing hope. Our job is to turn their hurt back into hope—to treat mental illness problems rather than ending people’s lives.”
While Quebec has hit the headlines for plans to expand MAID there’s been little written about new restrictions in the pipeline in the province where Poilievre was born. Last year, Alberta’s government asked the public what they thought of the province’s euthanasia policies.
Mickey Amery, Alberta’s minister of justice and attorney general, said the governing United Conservative Party recognises “that medical assistance in dying is a very complex and often personal issue and is an important, sensitive and emotional matter for patients and their families. It is important to ensure this process has the necessary supports to protect the most vulnerable.” The consultation ended just before Christmas. Possible changes include the creation of a new public agency and legislation to provide oversight, the creation of a MAID decision dispute mechanism for families and eligible others, a framework for appropriate sharing of confidential medical information related to MAID determinations and limitations on criteria for MAID eligibility and on MAID as an option for patients.
There is little there to satisfy implacable critics, but in politics the direction of travel is hugely important. What happens next is pretty vague. The government website says merely, “Your feedback will help inform the Alberta government’s planning and policy decision making, including potential legislative changes to medical assistance in dying in Alberta.” Which may be a bland and bureaucratic way of saying “don’t hold your breath”.
Equally, Canada might become the first country in the world to tighten, rather than loosen, its rules on assisted dying. Climbing back up a slippery slope is never easy, but it can be immensely satisfying for those who want to stop the slide. If this does happen, opponents would celebrate with even greater enthusiasm than they did for the political downfall of Trudeau.
