Why is the UK government so desperate to rush through its "assisted dying" bill?

Strange goings-on in Parliament.

I haven’t written anything before on this substack about the proposed new law colloquially known as the “assisted dying bill” - now formally the Terminally Ill Adults (End of Life) Bill - though it is a subject in which I do take a keen interest.

HART - the group I co-chair together with

Clare Craig

- expressed its opposition to the bill before the vote last year.

Last week we sent this letter to the Committee currently debating the finer points of the bill:

Terminally Ill Adults (End of Life) Bill 2024-25

Do we expect the Committee to take any notice? No, not if yesterday’s events are anything to go by.

It’s worth recapping here what is meant to happen at the Committee stage.

According to this article by The Institute for Government:

A public bill must undergo five steps in each House of Parliament – first reading, second reading, committee stage, report stage and third reading – before the two Houses resolve any differences between them and the bill receives royal assent to become an act, and law.Committee stage is where detailed examination of the Bill takes place.

Of the Committee stage:

This is generally the longest stage of a bill’s passage and where the most thorough scrutiny takes place. Most bills are referred to a public bill committee. The membership reflects the party composition of the House, and a majority government therefore rarely loses a vote in committee. Constitutional bills, bills of major importance and highly controversial bills are taken in a committee of the whole House, meaning all MPs can contribute.

MPs conduct clause-by-clause scrutiny and public bill committees can also take oral evidence from key stakeholders. Each clause must be agreed to, amended or removed and new clauses may be proposed and agreed to. The government tables almost all of the amendments made. If it agrees with the idea behind an opposition or backbench amendment, it will normally try to introduce an amendment on the subject at report stage.

Bottom line: deep scrutiny, calling for expert evidence where needed.

So what happened yesterday?

The committee voted - 14 to 8 - NOT to hear evidence from the Royal College of Psychiatrists.

This is against a backdrop of concerns expressed in relation to this bill in the areas of:

• the role of coercion and other forms of psychological manipulation in the decision-making process for whether to end one’s life

• whether those deciding to end their own life have proper capacity - in a legal sense - to make that decision

• the possible (some would say likely) expansion of eligibility criteria to include those suffering from psychiatric disorders

Here’s an extract of a video of the committee’s deliberations (in relation to the inclusion of RCPsych), including the vote itself. The argument against was basically:

• Psychiatrists are regulated by the GMC

• We are calling the GMC

• So this would double up expertise and in the interests of time we shouldn’t do that

Make of that what you will. As the person responding to that argument states: “all psychiatrists are regulated by the GMC but not all doctors are psychiatrists”.

With respect to the GMC in my original post of this, I should really have said more about exactly why they are totally unsuited to fulfill this role anyway - see Anne’s comment (reproduced below):

Remember, the GMC are a general regulator, not an academic college. There is no reason to think that their presence is in any way a substitute for an academic college of psychiatrists. Moreover, their behaviour in relation to doctors speaking out over various aspects of the covid debacle marks them out clearly as an institution which will willingly do the government’s bidding, rather than an independent body applying professional expertise to a complex issue.

It seems completely ridiculous not to call representatives with (as generally believed) deep relevant subject matter expertise, just in the interests of time.

This is a hugely impactful bill on many levels - legal, financial, cultural, ethical, practical. Why rush it?

(By the way, I should make the point that I don’t think that psychiatrists have recently shown themselves to be any more worthy of our trust than most of the other medical specialties, but that’s not relevant to the point I’m making here.)

The bill - as it stands now - actually puts psychiatrists at the heart of an important part of the intended process:

And “appropriate specialist” is defined thus:

So the unwillingness to call the relevant representative body seems strange, to say the least.

Could the actual reason be to avoid hearing evidence they don’t want to hear? After all, in their November 2024 statement, the College had a lot to say about their concerns about the above aspects of the bill.

It’s worth reading the statement in full. Notably, they said:

As the Bill progresses to the next stage, RCPsych is urging parliamentarians to carefully consider outstanding questions about whether a person’s capacity to decide to end their own life can be reliably assessed and the adequacy of consent as a safeguard against coercion in this context.

“It is also important to consider the potential implications for those with mental disorders, intellectual disabilities and neurodevelopmental conditions (who do not always have good access to palliative care), as well as on suicide prevention efforts, palliative care and the NHS.

Majority of psychiatrists are not confident that consent can act as an adequate safeguard. Almost two thirds (65%) of respondents were not confident that consent can act as a safeguard against people making unfree choices, including, for example, those made due to lack of information, coercion or the effects of psychopathology on decision making. Almost one third (31%) were confident.

This Bill does not address these more subtle forms of coercion such as where a person may internalise a feeling of being a burden to others. How might such internalised pressure be identified or responded to in this context? At what level would implicit or internal pressures amount to coercion? At what point would supporting a person to have capacity to make a decision to request assistance to die constitute coercion?

Importantly, under the Bill as introduced, a person with a co-occurring mental disorder that is impacting their wish to end their own life would not necessarily be deemed ineligible; only those whose mental disorder was deemed to impair their capacity to make a decision to end their own life would be excluded.

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.

They also said this:

The College will continue to work closely with Parliamentarians and other stakeholders on this important issue

It’s a pity that Parliamentarians don’t appear to want to reciprocate.

I will leave you with this gift of 2 minutes of wisdom from the late Rabbi Sacks, recorded 8 years ago while Canada was discussing introducing its MAID legislation:

(I updated this article at 12.55 UK time to expand on the GMC’s role, having read Anne McCloskey’s comment below.)