Doctors will be permitted to raise the issue of assisted suicide with patients unprompted after MPs voted against an amendment earlier this week that would have prevented doctors from doing so.
During the fourth week of Committee deliberations on the Terminally Ill Adults (End of Life) Bill, MPs on the Bill Committee rejected an amendment that would have protected patients against a registered medical practitioner raising the option of assisted suicide without the patient raising it first.
Under the Bill in its current form, a doctor is permitted to use their “professional judgement” to raise the topic of assisted suicide with a patient proactively. This would permit a doctor to initiate a conversation about assisted suicide with a vulnerable person who has not given any indication they are interested in the idea.
While this remains hypothetical in England and Wales, where assisted suicide is not yet legal, it has occurred in Canada, where the practice has been legal for almost a decade.
The amendment to prevent doctors from raising assisted suicide unprompted was tabled by Chris Webb MP. However, Bill sponsor Kim Leadbeater and her colleagues voted 13 to 8 against amending her Bill in this way.
Shortly after the vote at Second Reading on 29 November 2024, a source revealed that Leadbeater would be looking into the issue of doctor-initiated discussion about assisted suicide.
The amendment Leadbeater subsequently introduced on this issue has been criticised as “very insubstantial” since it mirrors what is already required in the Bill along with GMC guidance.
Rejection of amendment to prevent doctor raising assisted suicide unprompted could cause some MPs to reject Bill
MPs from across the political spectrum have expressed serious reservations about the possibility of doctors raising assisted suicide with patients unprompted, and it is possible some MPs will change their vote in light of Leadbeater’s rejection of this safeguard.
Lead signatory on Amendment 8 and Labour MP for Blackpool South Chris Webb, told the Guardian last year “I’m uncomfortable that it allows doctors to suggest to patients they could take their own lives and believe this needs to be removed from the bill”. Similarly, fellow Labour MP Mike Tapp, said to BBC News “It should only be discussed if it is raised by the patient”.
Liberal Democrat MP Roz Savage said “I’m especially concerned that healthcare professionals must not proactively suggest assisted dying as an option – it should be left to the individual to make that suggestion”.
During Second Reading, Conservative MP David Davis said a change to this provision in the Bill was a condition of his further support. “Clause 4(2) appears to give doctors the right to initiate the process [of assisted suicide]. But after the ‘Do not resuscitate’ scandal during the covid crisis, I do not want that at any price—I do not want the state initiating this process. That is critical for me. I am really making the point that the decision on Second Reading is about principle, not outcome”.
Speaking in favour of the amendment to prevent a doctor initiating a conversation about assisted suicide, Juliet Campbell MP said “The doctor’s position is one of knowledge and expertise that far exceeds that of their patient, and that places them in a position of power and influence over their patient. Given that power imbalance, the doctor’s suggestion seems like a recommendation. If an individual chooses assisted death because it feels like a recommendation, that decision is no longer autonomous”.
Fellow Labour MP Naz Shah said “I urge Members to support the amendment, because it would provide another safeguard for vulnerable people. Many people affected by the Bill will be isolated; many will be poorly informed on medical matters and reluctant to ask questions of doctors”.
Bill opponent, Danny Kruger said “It is either the case that [doctors] must offer [assisted suicide] or they must not. There is no grey area. If they do not have to suggest it in any case, that implies that assisted dying is unnecessary in all cases and there [are] no cases where it should be used. I would like to hear from any Member who has an answer to this: in what circumstances might it be appropriate for a doctor to suggest assisted dying?”.
During the assisted suicide Bill Committee hearing at the end of January, palliative care doctor Rachel Clarke told MPs about the potentially coercive nature of doctors even mentioning assisted suicide to a patient.
“If, for instance, you say to a vulnerable patient who has just been told they have a diagnosis of terminal cancer, ‘Have you thought about assisted dying?’, I would suggest that stating it broadly like that is a form of pressure and that you are potentially unintentionally coercing that patient. The very act of raising assisted dying in that way will make that vulnerable patient think, ‘God, is this doctor telling me that my life is not worth living any more?’”, she said.
Baroness Ilora Finlay, a consultant in palliative care, has warned that a doctor’s suggestion of assisted suicide might lead patients to feel their lives are undervalued, stating “If a doctor suggests something to a patient they will often take the advice as the best thing to do. The subliminal message is very coercive”.
The British Geriatrics Society (BGS) has said that some patients are now hesitant to engage in advance care planning due to fears that such discussions might lead to suggestions of assisted death. This reluctance indicates a growing mistrust and concern among patients regarding the potential for perceived pressure from healthcare professionals.
Spokesperson for Right To Life UK, Catherine Robinson, said “Given the state of the NHS, the pressure on beds and the cost of treating terminally ill people, it is not difficult to imagine conversations in which a doctor raises the prospect of assisted suicide based on their ’professional judgement’. Many patients, used to accepting a doctor’s recommendations, may feel they are being encouraged to die even if assisted suicide is only presented as one of a number of options”.
