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."'

I'm still undecided. One parent with advanced Parkinson's would have had a less stressed and depressed quality of life had they known assisted suicide was an option - it would have given them peace of mind. And I still get cross about "better palliative care" when there are some kinds of pain no drug can reach, and the effect of a high dose of morphine is to send some into a deep, hallucinatory sleep - but I do accept that some of our (unfunded) hospices are excellent at compassion, reassurance and pain relief.

Agree.
Abortion is a feminist issue also because relating to your point about women not wanting fourth, fifth or sixth pregnancy etc in the early decades of legal abortion (and seeking out dangerous solutions prior to that) - there was/is then no societal pressure on men to address that issue and use condoms or have a vasectomy to avoid pregnancies (leaving STDs out of the equation).
Men can still pretty much have sex as they like and the consequences stay with the woman (pregnancy or abortion). It’s framed as reproductive choice for women but it’s still women who have to make the choice, have the surgery ot take the tablets, deal with the emotions. I am not saying men don’t care, in some cases they of course do, but at a population level, men don’t need to change their behaviour. And that’s before we even get to coercion and pressure.
That’s not an argument against abortion, but a recognition of where the burden of ‘choice’ falls.

Christine Jardine's body language towards a lib dem colleague here, who is making very valid points, is appalling https://x.com/treesey/status/1933456865469607970

Have you ever watched someone you love committing faeces?

Committing, not committing, bloody predictive text.

Oh for Christ’s sake, vomiting .

So the bill suffered it's first defeat yesterday. The proposer of the bill objected to an amendment that said it should be an option only available to over 18s. She lost.

This says a lot to me in terms of understanding where supporters of the bill stand with the concept of safeguarding and ensuring there are adequate protections for vulnerable people. Supporting assisted suicide for under 18s is horrendous. There's already a massive argument going on over ability to consent where you have a child with multiple complex needs, whether they are under undue influence from someone else and perhaps a SEN issue. We are clearly already failing this cohort and not recognising problems.

People concerned about a slippery slope effect will not be impressed by the fact that the default point for those pushing the bill was happy with the idea of under 18s having access to this and having to challenge it.

The defeat suggests massive concern and problems ahead for the bill. If those pushing it can't understand the problematic issues over safeguarding here, are they going to understand them for other vulnerable groups?!

The more I know of Jardine the more I think what an awful woman who says she cares but is totally blinkered to anyone vulnerable.

I thought I'd just add my own thoughts here, as an old person with chronic pain.

I'd like to live a bit longer, and might be lucky enough to do so. On the other hand, I might pop my clogs this weekend - I've got heart problems and many other deteriorating conditions that might just finish me off. If so, fine: I've had a decent life and couldn't complain.

But if not, I could be faced with a situation in which I want to end my life - if the pain gets too bad, or if one of the other things becomes so bad as to make me prefer not to hang on. Then, I'll just kill myself (I know how ...). That's fine, again, I think.

The one possibility that does scare me, though, is that I'll want to kill myself but am unable to do so, for some reason. I've seen this happen, to acquaintances and friends ... and also to someone I loved deeply. Horrifying. Awful. So I'd like to be able to ask my doctor and/or my children for help. Tough on them, sure, but in my personal experience not so tough as seeing one you love suffer so dreadfully and be unable legally to help.

Yes, I hope the proposed legislation manages safeguards for vulnerable ones, and to avoid possibilities of coercion and so on. But - baby and bathwater applies - mainly I hope it passes for selfish reasons, and on account of others like me. Why should we and our needs and autonomy - our free choice - be ignored just because of possibilities of abuse of others? Why do my wishes and clearly-worked-out choices count for less than their presumed welfare, however vulnerable and liable to abuse they may be?

Of course the whole thing needs careful safeguards. But, in the end, I do sincerely hope this country does what's so clearly right ... allow assisted suicide for people like me. It's time!

One of the problems is that there just aren't the safeguards in the Bill, especially for vulnerable people. You may not care so much about them, but as someone with an adult daughter with a learning disability who cannot work, I do. I am not convinced that she wouldn't be encouraged to ask for this. The Bill is deeply flawed and I don't feel it's wrong to say so.

Their complete dismissal of the voices of disability rights campaigners is the reason I hope this bill fails.

Philosophically, I am not against the concept of assisted dying, but I do not believe that Kim Leadbeater is competent.

In usual circumstances, someone who said they wanted to kill themselves and had a plan would be sectioned. If I recall, the Royal College of Psychiatrists very first concern in a list of reasons they cannot support the bill is because terminal illness is a risk factor for suicide and how would they meet their duty of care under existing legislation? How would they know who is the person who is suicidal but with care will wish to live what they can and the person who wants to die regardless? Even out of the context of assisted dying, there are ramifications for how we view suicide, and how that is prevented.

Secondly, to the question of why your choice should be limited because others might be vulnerable to abuse, surely the answer is because as a society we protect those who are vulnerable, not dismiss their needs? And for all you talk about your autonomy and free choice, none of what you say addresses the concerns about the erosion of autonomy for others,

Finally, I don’t think the state should be involved in providing assisted dying (suicide) because as I have said upthread, it fundamentally changes the social contract. And society is about more than one parson or group of people, however strongly held that person or group of people’s beliefs may be. And even if the government do wish to pass a bill on assisted dying (suicide), it should not come through the rushed vehicle of a private member’s bill. There are far too many professional organisations raising concerns to set these concerns aside and consider only your autonomy and free choice.

Difficult as this may be, it does not address the concerns raised about the bill. In the second reading, there were many such emotive and difficult stories but none of them address the concerns raised by the professional organisations who would be tasked with actually putting it into practice. Or any of the other concerns raised on this thread.

I really don't want disabled people to be unconsidered.

However I have to say it as I see it. Too often it appears to me disabled and/or other vulnerable people's needs are held to trump those of people like me. And - no surprise - I don't like that.

Work hard for safeguarding (other) vulnerable people, of course. I'm all for that and will back you all I can. But please don't let your justified concern for such people overcome your concern for people like me, who may need - really, really need - assistance in putting an end to extreme suffering at life's end.

Please support assistance for people like me. Please.

Some writing and discussion that may be of interest:

At least three articles by Kathleen Stock in UnHerd:
"There’s no dignity in assisted dying Politicians are full of bogus compassion"
"The assisted-dying lobby has already won"
"A father battles Canada’s suicide machine His autistic daughter has been cleared for MAiD "
(I think she has also written a book soon to come out or already out?)

A discussion on Moral Maze in January 2024 featuring a guest academic on disability (himself having a disability and requiring 24-hour assistance)

Various other programmes on Radio 4 featuring views of psychiatrists and palliative care consultants among others, e g a series by Sonia Sodha

An article in the Sunday Times News Review 1 December 2024 by Lord Sumption: "A change that will transform our society forever'

A letter in Metro by a psychiatrist responding to a 'tv' doctor:
cdn.metro.co.uk/e-edition/2025-06-11/MTA/spread/10-11

"In usual circumstances ...," you say. And you may well be right.

But, in the end, isn't it a question of simple human rights and autonomy? If so, could it not be that what happens 'in usual circumstances' might actually be, in some cases, immoral?

After all, back in the day, long ago, in usual circumstances you could buy a slave (if you were wealthy enough) and treat that slave however you wished. But that was wrong, wasn't it? I'm saying your denial of my personal autonomy in disallowing any request, say, to my daughter to organise to help me die is likewise wrong.

There's an argument to be had about state and social contract, sure. And, yes, we are different in our beliefs and habits. But currently my beliefs about personal autonomy and human flourishing are ignored when it comes to how I'm treated at the end of life. I want the state to fulfill its side of the social contract with respect to my rights and autonomy.

(And, yes, I've read J-J Rousseau and many others on the Social Contract. Might I suggest others do likewise before fulminating?)

(And, yes again regarding helping people who need looking after (in other words 'vulnerable' people). I might need your help to end my life; can I rely on you to look after me if I'm vulnerable in that way?)

I'm sorry to be so blunt. It's just not nice to have one's needs and concomitant choices so blatantly ignored, especially by those who claim to be concerned with the 'vulnerable' of our society.

I think when you accuse another person of fulminating, you disincentivise them from engaging with you, I am afraid. I stopped there. Good luck with everything.

I too am very much in favour of the bill being passed.
But I can't agree that we don't allow other animals to suffer unnecessary pain: we absolutely do imo. And only a tiny percentage of those are prosecuted (much of the time it's unintentional and prosecution may not be the best option).

I think this would be better addressed to the people making a hash of the bill.

its not a question of whether there should be safeguards - of course there should. it’s the fact that Leadbeater et al have been so dishonest about acknowledging why people have concerns.

They have demonstrated that they are not competent to make good legislation.

.

We are crossing into unchartered waters with this bill. There are many reasons society has traditionally been against assisted dying, not all of them religious as some critics like to claim.

We can't always get what we want because there are other, competing rights to consider.

The extreme pro assisted dying advocates seem utterly uninterested in the possibility of harm to the vulnerable. Just look at the body language of Christine Jardine yesterday while Sarah Olney was speaking. It was an outrageous way to behave. I have no faith that vulnerable people's rights are protected under this bill. It focuses more on their rights to request assisted dying than on protecting them.

My daughter will say yes to anything. It is simply not good enough to shrug and accept that people like her could indeed be harmed to get what you want.

I'm sorry. I tried. But I can't resist:

You are fulminating against the use of "fulminating".

Would you also inveigh against the use of "inveigh", I wonder? Or complain if someone used the word "complain"? ... Or ...

I know. I know it's a serious matter (none more than me, really, I guess). Sometimes people are so funny, though. Sometimes you just have to smile.

Do you think sneering at people is the best way to persuade them? No one is “fulminating”. They have their opinions, just like you. There are a range of reasons why people do and don’t support this Bill. They have a right to disagree with you.

but I do not believe that Kim Leadbeater is competent.

This really is the heart of the problem...

There are any number of very unpleasant, painful, or otherwise really unwanted situations that people can find themselves in with their health.

It doesn't mean they lack dignity.

There are always hard cases. However, I read an article in the Critic yesterday pointing out that the real victims of Assisted Dying are the people who have no agency. The lonely old woman with no family around her who goes into a nursing home at local authority expense; the elderly man with Parkinsons whose care is eating up the equity in the house his family hope to inherit; the dysfunctional young man, a drug addict, victim of rape, earning a living as a rent boy and terminally depressed; the disabled man who needs daily care to make life liveable; the anorexic girl slowly starving herself to death. These are the people who are on the spectrum of those who will be offered 'assisted dying' because they are costly to maintain and many see their lives as pointless - and the danger is that 'assisted dying' legislation is pushing the idea that some lives are pointless and worthless. I see this Bill as a cost-cutting exercise and the mainly middle-class people who support it have no idea of the dangers it presents to those less fortunate than them. The safeguards are not there to protect the vulnerable, and once the Bill is on the books widening its scope will be pressed for - making the marginalised more marginalised, more vulnerable because 'assisted dying' can be used to remove them.
Disabled charities have pointed out the dangers and had their fears dismissed, which I think supports my thesis of 'cost cutting' tbh.
https://thecritic.co.uk/the-grim-reality-of-assisted-dying/