Earlier this month, the Committee scrutinising Kim Leadbeater’s assisted suicide Bill rejected proposals to strengthen the safeguards despite warnings from a group of leading psychiatrists.
Writing in a letter to The Times earlier this month, 24 psychiatrists expressed concern both about the “haste” of the assisted suicide legislation and the consequences of the Bill becoming law which, they argue, could put pressure on vulnerable people to end their lives.
The week following the letter’s publication, the Committee rejected amendments that would have strengthened the Bill. The Committee voted down an amendment that would have raised the bar of the Mental Capacity Act to ensure an appropriately high test for mental capacity; rejected an amendment to make it explicitly illegal for someone to ‘encourage’ another person to seek an assisted suicide; and rejected an amendment to protect people from choosing assisted suicide because they feel they are a burden. The Bill’s supporters on the Committee also spoke against attempts to protect prisoners, where suicide rates are already high, and the homeless.
Calling for the Bill to be “overwhelmingly rejected”, the psychiatrists warned that the legislation would undermine their work, which includes suicide prevention, and put vulnerable people under considerable pressure to opt for assisted suicide instead of seeking medical or psychiatric solutions.
They wrote “A law on doctor-assisted suicide will undermine the daily efforts of psychiatrists across the United Kingdom to prevent suicide. Those who have suicidal ideation at any time in life may be vulnerable to pressures to take their own life by the introduction of doctor-assisted suicide”.
“Vulnerability can arise due to external factors such as lack of decent palliative or social care; overt coercion or undue influence; personal losses including bereavement, poor housing or financial hardship. Internal factors may include major depressive disorder, a sense of burdensomeness, loneliness and social isolation. Understanding and responding to these vulnerabilities is at the centre of suicide prevention”.
External factors mentioned in the psychiatrists’ letter, including housing and burdensomeness, were both highlighted in last week’s Committee as serious concerns but supporters of the Bill rejected the need for stronger safeguards.
Committee reluctant to include Royal College of Psychiatrists
MPs gave in to pressure and allowed representatives from the Royal College of Psychiatrists to appear before the parliamentary committee scrutinising the assisted suicide Bill, despite the fact that, hours earlier, MPs on the Bill Committee had voted against their involvement.
The psychiatrists criticised this “reluctance” of the Committee scrutinising the Bill to involve the Royal College of Psychiatrists in its discussions, describing the decision as “shocking”.
The psychiatrists wrote “The initial reluctance of the committee to see the need to call the Royal College of Psychiatrists to give evidence is in itself shocking and betrays a lacking understanding of the job that we do in understanding suicide and its prevention”.
Psychiatrists give evidence against the Bill
The letter to The Times came after the Committee met to examine witnesses who gave evidence on the content of the Bill, in which a number of psychiatrists shared a variety of concerns about the Bill. Emeritus Professor of Psychiatry, Professor Allan House, expressed significant concern about the adequacy of the assessment proposed by the Bill. He stated that, in cases of assisted suicide, a psychological assessment would need to go beyond assessing mental illness and explore social issues like poor housing and financial insecurity, which can be related to feelings of worthlessness and low mood. Additionally, he said that the Bill does not acknowledge peoples’ psychological state. Depression is well known to be difficult to detect among the elderly, as they do not express distress as openly and obviously as younger people do. Depressive disorders are also far more common among people with a serious physical illness compared with the general population.
Sojan Joseph MP notably quoted the Royal College of Psychiatrists, stating “65% of psychiatrists are not confident that consent can act as an adequate safeguard”. Consultant psychiatrist, Professor Gareth Owen, agreed that this is important evidence for the Committee to consider.
In its written evidence submitted to the Committee, the Royal College of Psychiatrists noted that “a wish to hasten death is strongly associated with depression” and highlighted the importance of providing people at the end of life with “high quality psychiatric treatment”.
During the Committee sessions, Dr Annabel Price, representing the Royal College of Psychiatrists, related her experience of how people who want to die often change their minds when they get adequate pain relief. She said that “Unresolved physical symptoms make people want to die, and when that pain is better, people no longer feel that way”, reminding the Committee that even if someone decides to have an assisted suicide, they can change their minds when adequate support is provided. She added that depression is “common” near the end of life. However, if depression is treated, there is often a “significant change” in a wish to hasten death.
Spokesperson for Right To Life UK, Catherine Robinson, said “Psychiatrists are right to strongly object to this dangerous Bill in their letter. If it becomes law, it will do great harm to their efforts to prevent suicide. It is shocking that, despite the evidence, witnesses and letters from psychiatrists, the Committee failed to pass amendments to protect the homeless, those who feel like a burden or those who may be being encouraged to choose assisted suicide, as well as rejecting an amendment that would have strengthened the mental capacity safeguard, protecting vulnerable people”.
