Assisted dying and coercion

[ArabellaScott]

This is live right now, so I'm not sure how well linking to it will work. Copy-pasting below, aswell.

https://www.bbc.co.uk/news/live/cy5k0qyled2t

'Rachel Clarke, a palliative care doctor, opts to answer a question about coercion and whether some MPs are right to feel concerned about this when considering the bill. (Earlier, MPs heard how medical and clinic staff are trained in safeguarding, though a retired GP acknowledged coercion was hard to spot.)
Clarke says she'd "strongly push back" on the suggestion coercion is something all medical staff are trained in spotting.
"I'm the kind of doctor who believes there is nothing to be gained by sugar-coating reality...about shortcomings, failings, areas where my profession the rest of the NHS are getting things wrong", she tells MPs.
"It is my clinical experience that not only are the majority of doctors not necessarily trained in spotting coercion explicitly, they're often not trained explicitly in having so-called advanced care planning conversations with patients around the topic of death and dying."'

For a very small amount of balance - many disabled people support assisted dying - whatever about the merits or demerits of the current bill, they support the concept. So do I, while completely respecting the opposing view.
The views of disabled people within the assisted dying debate - My Death, My Decision

I too agree with the principle of assisted dying but I've seen enough of humanity to believe it's impossible to write a watertight bill, this attempt is a dog's breakfast.
I recently watched an elderly relative die while receiving palliative care. He was refusing the morphine because he was terrified they were trying to kill him. That was the message he'd heard from the moment they asked him to sign the do not resuscitate form.

I think many people are somewhere in the middle, but most people do not believe that what is being proposed, will have any safeguards.

And that those most vulnerable will suffer.

Let alone the prospect of having the ever expanding criteria as in Canada.

If those behind these really care, they would scrap what is happening now, and put in motion having a proper discussion, via Government, not a Private Members Bill, and make absolutely sure that it is given enough time to be discussed properly.

I have absolutely no doubt, that given the current standards of care, far too many people will become victims of this bill.

Those with money will be able to exercise personal choice.

Very few others will.

Did anyone else spot the gem in today's newspapers about this subject.

Although they are going to go ahead with a debate on the subject (despite saying the bill is in much need of development etc etc), there's going to be a notable absence to the debate.

Apparently Keir Starmer is 'busy' and won't be attending.

This is code for 'this is a toxic area and PM doesn't want to touch the subject with a barge pole at the moment'.

I know it's supposed to be a subject that's free of the whip, but...

Starmer is trying to weigh up whether the idea is a good one and the delay to it all does suggest he's not altogether on board with the idea because he doesn't quite know how the public will receive it.

Apparently Keir Starmer is 'busy' and won't be attending.

You couldn't make it up. If this was a tv series everybody would be going but the character of the PM just isn't credible. No one could be that lacking in intergrity and accountability.

If not him personally, the whole reason this has been rushed through is because of "Labour Party approval".

This TUESDAY Scotland is considering its own 'turbo' version of the law: terminal illness loosely defined as in Canada, currently 16 year olds could seek death, no protection for those suffering domestic abuse or anorexia.

We ran some polling and 61% of Scots say they are concerned that a domestic abuse victim would be coerced into assisted death under the Scottish bill. Very striking that highest concern was in older adults (83% in over 75s, 69% in 65-74yos) and in those with disabilities (74% concerned) Polling link in Telegraph

We're asking people in Scotland to please write to your MSPs - tool here for emails

https://writeonad.theotherhalf.uk/

I support the idea of My Death My Decision, and there are people with disabilities posting on this thread. I haven't seen one post that is totally opposed to the concept in theory. It's the shenanigans going on to push this through, without it being properly drafted, that's of utmost concern.

There are STILL no proper safeguards to ensure that it would be MY decision and no one else nudging me off the cliff. And that my decision to go, is not because I'm a burden on the State, or my benefits have been stopped, or I've no decent palliative care, or I cost too much, or someone has an eye on my rare and valuable collection of odd socks, or my family think I'm a bloody nuisance, etc etc.

Anyone who criticises the shit show that has been going on to shove this Bill through in England and Wales without due regard to the concerns raised, incuding those around women and domestic violence, is accused of not being kind and cruel.

Which seems to be rather a theme in recent years when people speak up about safeguarding.

I'm in favour in principle, but in the current climate where the Government are implying that the disabled are a financial burden we can't afford, where it's going to become even more difficult to get good quality palliative care given the rumoured NHS cuts, and the removal of carers visas meaning home care will become harder to access it'd take a very good bill with strong safeguards to overcome my worries about societal coercion. And this is not a good bill with strong safeguards.

Similar to what has been said by @larklane17, @TakingMyChancesWithTheRabbits and others.

I'm very much in favour of assisted dying in principle. But in combination with the economic/political climate at the moment, and the somewhat fevered polarisation of anybody not blindly and unquestioningly on-board as ghastly old-fashioned religious right-wing bigots, this does not seem to be a productive atmosphere to produce good and safe legislation.

Royal college of Psychiatrists no longer supports the AD bill.

https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2025/05/13/the-rcpsych-cannot-support-the-terminally-ill-adults-(end-of-life)-bill-for-england-and-wales-in-its-current-form

Scotland's AD bill passed Stage 1 yesterday.

https://www.bbc.co.uk/news/articles/cp8yn2dd6peo.amp

The RCP concerns about consent linked to mental capacity are worrying me. If I have understood, they seem to be saying that the MCA doesn’t specifically cover the assessment of consent for assisted dying.

I’m slightly struggling here. Even though I broadly agree with their concerns around consent. Although not opposed to AD I think we need to tread very carefully and introduce it only if we are confident about the process and the safeguards. The proposed UK legislation isn’t well enough thought through. When palliative care is so poorly funded that good end of life care is unobtainable to many, there is no choice - so how can people consent?

But at the same time, are the RC Psychs really saying that the MCA doesn’t work for AD? If the MCA isn’t safe due to the risk of coercion & the potential for a mental illness affecting the decision making, doesn’t that apply in other circumstances? Wasn’t the Kiera Bell case about her ability to consent? And doesn’t coercion and mental ill health apply to gender dysphoria? Surely the MCA always needs to be used properly.

'The Mental Capacity Act does not provide a framework for assessing decisions about ending one’s own life: The Mental Capacity Act was created to safeguard and support people who do not have the capacity to make decisions about their care or treatment or matters like finances. Should the Bill become law in England and Wales, implications for both the Mental Capacity Act and Mental Health Act need to be considered. How would clinicians assess the new kind of capacity to decide to end one’s life that is framed in the Bill? How would clinicians protect and empower people with terminal illness to decide whether or not to end their own life, while at the same time detain those who are at risk of suicide so that they can be urgently treated?'

That bit? I don't know enough about how it works.

Yes - I’m still trying to reflect & process it. But where I keep coming back to is that the MCA needs to be applied properly and with care in all circumstances. Especially so where the patient/service user needs to weigh complex information to make a decision. If the MCA isn’t suitable for decisions around end of life care, is it suitable for other situations?

I think the issues is that, in usual terms, someone wanting to kill themselves would be sectioned, whereas the purpose of assisted dying is to facilitate them doing that. There are going to be issues of clarity around why people are making decisions if there is mental illness or distress which is obviously heightened if someone is terminally ill.

but I agree that in the absence of good palliative care and also sufficient funding to support this, there is no proper choice. It’s the same as people ‘choosing’ to have an abortion because there is no financial or other support to have a baby. You just need to look at all the responses on here telling pregnant women in less than ideal home or financial or relationship circumstances to have an abortion. The circumstances in which you ‘should’ bear a child become narrower from a societal point of view. I think the same would happen with AD.

It seems to me that fundamentally the problem is that in principle, the argument for assisted death is that:

1 - suicide can be a rational decision - some lives are not worth living.
2 - Fundamentally ending our lives if we choose is a human right
3 - whether our life is shit enough to end it is a subjective decision which can only be assessed by the person considering it.

This really leaves very little scope for restricting anyone's access, which is why limits like approaching death and mental illness or anorexia or whatever don't hold once the legislation is passed.

In fact, when there are cases like mentally ill people or children, the push becomes to allow for others who have a duty of care for them to make that decision for them, rather than leave them to suffer because they are unfortunately unable to consent on their own behalf.

The fundamental problem is that people say "I like the idea but it needs to be properly safeguarded to protect the most vulnerable"

Yet the whole principle is to aid the deaths of the most vulnerable.

This makes it impossible to safeguard because the people who would be most eligible are the very people are most vulnerable.

And you also risk the paradox of the most vulnerable who desperately want assisted dying are ultimately the ones banned from it. This meaning that the idea of helping those 'most in need' also becomes an issue this defeating the principle of the legislation anyway.

It's something you can't define well enough in order to safeguard precisely because it's open to interpretation and judgement calls.

It's a bad law charter

I continue to have the same problem I've always had with your second point, Tempest. Attempted suicide was decriminalised in 1961; the right to end your own life is free and clear.

It is still a criminal offence for a third party to assist or encourage another to commit suicide. (Or murder them, depending on point of view.) That's what is actually under debate - not the 'right to suicide', which we already have, but the right to make someone else die.

I'm really fucked off with the many intensely topical issues being misleadingly framed as basic rights, which are really asking for rights to control others and remove others' rights. Insist on accurate language, please.

Decriminilization isn't the same as saying something is a basic right. We might potentially decriminalize all kinds of things that we think are terrible if it seems like using the law as a means to prevent it is undesirable in some way. Like prostitution. It's not an assertion that people have a right to sell sex, it's because using legal means to put women who do it in jail, or fine them, doesn't really address the problems involved.

Similarly, it really isn't sensible to lock up or fine someone who is suicidal.

That being said, there is a distinction between the kinds of things we have the right to do, and the ones the state is obligated to help us with. And in this case, they are saying the state should has an obligation of some kind to help people die and that choosing to die is an important part of our human autonomy.

the state has an obligation of some kind to help people die and choosing to die is an important part of our human autonomy.

I'm never going to agree with the first part of that. I think it's outrageous to imagine the state has an obligation to "help people die"! It doesn't have that obligation at any level, but think where it leads - if the state were to have such a duty, would it not follow that the state should also be responsible for the timing of our deaths? A state's duty should always be considered in its widest context: to "help us die" as best we can, taking full consideration of our circumstances, it should "help us" to die at the time, and in the manner, the state chooses to provide.

I agree that choosing to die is an important part of human autonomy. Lots of things are important parts of human autonomy; the state isn't obliged to provide or even facilitate them. Smoking's an important part of my autonomy. The state permits it, but doesn't send me cartons of fags. Driving's an important part of most people's autonomy, but the state tries to make sure you're competent and will revoke permission if you aren't. It has no obligation to ensure everyone has a car. Should it?

You're talking rubbish imo.

We have assisted dying here in Australia and it's fine adults should have the option to end things if they don't want to be here why force them to live in pain! Also people on here acting like you just click your fingers and get it your idiots 😆 😆 😆 here I think it's three doctors have to agree to it even then it takes about two years before it happens

I don’t agree that choosing to die is an important part of human autonomy. I think assisted dying changes massively how we view life if we think that as a society. I suppose I still hold to the view that the role of society is to improve life/lives and if someone is suffering, to look for ways to make it better or support that person. I can see that a counter argument might be that supporting that person is ending their life, but I just cannot see how you put any boundaries on that - you either value life or you don’t, the state and society either value life or they don’t.
The only time I can think of that the state makes decisions over people’s death (since the abolition of capital punishment) is more indirectly in war - and while I am a pacifist I can accept that there could be a defensive nature for this to prevent greater loss of life and liberty. I am not sure what the greater good of assisted dying is, unless it is economic and a cost saving of care (similar to abortion lowering welfare bills), at which point we have to lose the pretence that assisted dying is always going to be an autonomous decision.

Aside from the fact that your timeline is wrong, just a quick search throws up research which problematises your view - for example this article in the BMJ (2023) which is based on interviews with palliative care nurses in Queensland and highlights uncertainties and moral distress, concerns about AD breaching their personal duty of care, the impact on medical professionals’ psychological well-being and that these issues, among others, need ethical deliberation and critical reflection. It’s not a straightforward issue and if medical professionals realise and express that, we should pay attention to them. In the U.K. context, medical bodies have withdrawn support for the bill on assisted dying as it stands, hence the debate here.
It would be preferable to engage with this debate if you are going to post, and not just call people who do think about it ‘idiots’, or at least get your facts right before judging others’ views.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10410955/

The Royal College of Psychiatrists (RCPsych) is calling on MPs to consider serious concerns about the Terminally Ill Adults (End of Life) Bill for England and Wales, ahead of the pivotal Commons Report stage debate and Third Reading.

With too many unanswered questions about the safeguarding of people with mental illness, the College has concluded that it cannot support the Bill in its current form.

RCPsych is once again sharing its expert clinical insight to support MPs in making informed decisions ahead of the debate in Westminster on Friday 16 May 2025.

Continues at https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2025/05/13/the-rcpsych-cannot-support-the-terminally-ill-adults-(end-of-life)-bill-for-england-and-wales-in-its-current-form

Thank you for highlighting this, it never occurred to me before, but now it seems obvious.