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."'

On 'being a burden':

'In all four jurisdictions that collect comprehensive statistics on this issue, a very large number of people opt for assisted suicide at least partly because they feel they are, or may become, a burden on others.

JurisdictionPercentage citing feeling a burden as a reason for AS
Canada
45.1 (Track 1), 49.2 (Track 2)
Oregon
43.3
Washington
59
Western Australia
35.2

This rises significantly over time: in Oregon, from 12% in 1998, to 17% in 2010, to 43% today. In Washington, from 23% in 2009 to 59% today. In Canada, from 34% in 2019 to 45-49% today. (Western Australia has only collected statistics for two years.)
This may be because the existence of assisted suicide changes people’s sense of what is reasonable and expected. Prof Cara Bailey, quoted above, predicts that the impact of a new law will change society’s “view of the older population, the infirm and dying – no legal safeguard can stop that.”'

'As for mental illness, the Royal College of Psychiatrists (RCPsych) has warned:

“The wording of the Bill could also be interpreted to include those whose sole underlying medical condition is a mental disorder. While anorexia nervosa, for example, does not itself meet the criteria for terminal illness as it is not an ‘inevitably progressive illness, disease or medical condition which cannot be reversed by treatment,’ its effects (malnutrition) in severe cases could be deemed by some as a terminal physical illness, even though eating disorders are treatable conditions and recovery is possible even after decades of illness.”

For this reason, several eating disorder experts – including the current chair of the RCPsych Eating Disorders Faculty, have signed a joint letter saying that the Bill should be rejected as it “fails the public safety test.” They note that in Oregon, “officials interpret ‘terminal illness’ as any condition expected to cause death within six months if untreated”. There are at least 60 cases around the world of people with eating disorders dying through assisted suicide, in jurisdictions where this is legal.'

Archive link for those who dont subscribe https://archive.is/UQujW

’on being a burden’ - chilling figures. And the quote about changing perceptions of the old and infirm. I really do not see how people do not see this. Or maybe the proponents of the bill already hold a negative view of the old and infirm so it does not matter to them.

I think they are assuming all criticism is in bad faith, and so discounting it. Self justification fallacy and righteousness.

It's awful.

Hope you don't mind if i share Alicia Duncan speaking to us about her mother Donna Duncan - she's incredibly brave and now campaigns as her mother was not terminally ill, and was given MAID in Canada after being released from psychiatric hold. Her mom would say she felt like a burden.

otherhalforg.substack.com/p/my-mom-said-many-times-that-she-felt

A horrifying story. Thanks, WomanDaresTo. Please do share anything relevant, I'm just sticking links here as I find them.

https://open.substack.com/pub/otherhalforg/p/every-day-they-have-to-wake-up-and

Another post from The Other Half, this time from Canadian feminists on MAID.

'These women are truly fabulous: clear talking, clear thinking, and absolutely on the side of women. They also do most of their work on MAID unfunded. Their recent discussion and paper says that MAID is “a modern form of eugenics”. In this wideranging discussion we learn:

• How MAID’s wild expansion was won through campaigning and courts: but ultimately the Canadian parliament decided to pursue each major expansion in the law.
• Those who deliver death have expanded the law even further in practice.
• The role of (male) mercy killers (of women) in the campaign for assisted death,
• What safeguards against coercion are
• That we won’t know about men who pressure family members into MAID unless someone speaks out.
• How death has become part of the menu of options proposed - pushed - to vulnerable people seeking healthcare. Even psychiatric care.
• The silence of the feminist organisations as MAID unfurled its horrors
• the weird funders of death including an airport authority'

https://www.theguardian.com/commentisfree/2025/feb/16/voices-that-oppose-the-assisted-dying-bill-arent-noise-they-are-vital-scrutiny

Good article here from Sonia Sodha on this shoddy bill:

'If it continues, the hyper-partisanship this benevolent self-delusion has produced will mean people will suffer wrongful deaths, and the buck for that doesn’t stop with Kim Leadbeater, but with Keir Starmer himself.'

And Janice Turner in the Times:

https://www.thetimes.com/article/ebc33d8a-fb65-4398-86c3-a8300cd81d3d?shareToken=ff1f67b8e061a370ccaee941edcaa231

'Is it sufficient to ensure that a person who wishes to die has not been “coerced or pressured” by anyone else? Naz Shah, a victim of and campaigner against domestic abuse, expressed concern that “coercive control” is a relatively new concept, which only became a crime in 2015. Various amendments from the antis wanted to add the word “manipulated” or “unduly influenced” or “encouraged” to warn doctors they should look for more subtle forms of pressure. But Malthouse and others worried that the state would then be required to police conversations between loving couples. When does supporting your husband’s choice tip into “encouraging” him to die?

Is it acceptable that someone is allowed to die solely because they feel a burden to their family? Amendment 94 sought to ensure a person “is acting for their own sake rather than the benefit of others”. For many antis this is their central worry, especially after the committee heard evidence from a doctor in Western Australia who was unfazed that 35 per cent of the state’s cases listed their reason to die as “being a burden”.'

On being a burden I would add in the commitment of visiting the elderly relative. My dad is in end of life care. He is in Scotland, we live in London. We are coming up every other week, driving as we have dogs, and my daughter and her boyfriend fly up every other weekend. We are really happy to do this, but I can imagine that some people won't be able to do it, or want to do it. The guilt of not visiting might lead to some relatives wanting it all to end ASAP, to have a ceremony and then the assisted death, then go back to their own lives. It isn't just about money.

I'm so sorry, Arran. That sounds really tough, but it's lovely you are able to visit.

I too am sorry to hear about your father. It is very difficult having a relative in end of life care.

But you seem to be saying that because some relatives cannot visit, they may wish their end of life relative to take the assisted suicide path to relieve the relatives of the guilt they may feel about not visiting. I might not understand you correctly (and I am not sure if you think this is a good or a bad thing or just are making an observation), but if I do understand, is this not the very definition of someone feeling like a burden? The proponents of the Bill argue, as I understand it, that the person should make a free, clear and informed choice, without influence of pressure.

And while I have every sympathy with your situation and that of your family, I actually see your point as suggesting that assisted dying will be about assuaging the emotions or needs of relatives and not to do with the free choice of individuals. (This may of course be the point you wish to make, that such a choice is not free)

This idea that there is somehow a ceremony (for what? What would that look like?) and then you conveniently die - I find that quite chilling, that once you get to a stage where you need a certain level of care, then you book the death celebrant/officiator, because that would be the expectation: end of life care or leave this world now? You can very easily see that in a context of increasingly privatised health care and reduced health services, it will be the poor and more vulnerable who take the leave this world now route, except they probably won’t even have the money for the ceremony or want to waste money on that part.

I'm saying that some people won't want to visit, yes. Not me. I'm visiting as much as I can. But I can do it. I'm just saying, finances aren't the only issue. I'm so glad I am getting to see my dad. If I couldn't see him and he was lying alone in a hospice bed, well, I suspect that some people would feel so guilty they would rather have everything done with. It's just a possibility I'm raising.

Thank you for the further explanation.
I hope that everything goes as peacefully and smoothly as it can for you and your family.

On being a burden, absolutly no way would I want to make my children's lives difficult, no way would I want them having to look after me. I have seen the horrible stress and exhaustion adult children can go through trying to look after elderly parents. Along with the pain and suffering I would be going through at end of life, why couldn't I make the choice to end my life? The only prize I would win streching my life as long as possibly is pain amd misery for me and stress, guilt and exhaustion for my children.

It's up to others what they think and want to do. I know some people think completely differently and beleive the very oppersite. That's fine, they can do what they want.

People still think this thread is about opposing the right to die don't they?
Because they can't be bothered to read any links.

If they did, they would see it was a thread about safeguarding, and the need for good palliative care.
All the checks and balances need to be there and thought properly through to ensure that it's the individual's decision and no one else's.

That's it.

Thank you for this thread. I've just been released from the Fife threads so catching up. I posted before the bill was debated on a previous thread that it was sending off so many alarms for me because it so reminded me of the trans debate. No rigour and 'be kind'. I got a bit of a pile on for it. I honestly wished I'd been wrong but the whole thing has been a lesson in how not to legislate. I'm praying it doesn't go through on third reading, but no doubt it will and we'll be dealing with the consequences for decades.

I'm scunnered at how this is being crashed through.

There's money to be made and a lot of money to be saved.

I'd really like to believe that wasn't the motivation.

And there is part of me that thinks Labour will stoop to anything and are probably relying on whose private members bill it is, to make it easer to push through.

What more could they ask for in terms of PR than a well loved TV presenter suporting it and the sister of an assassinated woman MP presenting it.

I agree @IwantToRetire

I think there are a lot of questions people have about assisted death.

In part it's about the whole idea of "the right to die." Is there any such right?

And if there is, does society have the obligation to be involved in order to realize that- it's not obvious that society is obligated to make sure all things we have the right to pursue are actually provided for us. I have the right to accumulate billions of dollars, or have a spouse, but society has no obligation to provide either.

It's also about what it would mean to go from a paradigm which seems human life as fundamentally a good, and in a sense, a sacred value, to one which seems the value of human life as relative, and sometimes not worth living.

Many people seem to really struggle to see that if those kinds of basic changes are made to our values, they will have effects on many different areas of ethics, and lots of fall-out on other questions.

So I had a look for literature on this very briefly

https://healtheconomicsreview.biomedcentral.com/articles/10.1186/s13561-024-00547-x

This is an analysis of existing literature on economic analyses of assisted dying and euthanasia. There is an overview section at the end which summarises the strengths and weaknesses of their study. They say there is a lack of data about this, if I understand correctly, and more fiscal data is needed (they only identified eight papers which fulfilled their criteria). Where there is data, it shows an average 87% reduction in costs of end of life care compared to what was spent on palliative care and that health insurance companies would rather fund assisted dying over potentially life-saving treatments. This is within the context of a demographically aging population.
The authors argue that more economic data is needed to ensure that assisted dying laws are safe and robust and to inform discussion about practices and laws which change what medicine at end of life is. They also say that overall there is a lack of literature on assisted dying. I think this is note-worthy given the number of jurisdictions they list at the beginning with this (it is more than I thought).

This paper doesn’t speak to the money to be made part of the equation, aside from the savings to health insurance companies briefly. But the drugs need to come from somewhere.