The decisions of whether, by what means and in which circumstances a person should be helped to take their life are among the most profound any nation can make. These are the quandaries the British parliament is grappling with.
Having voted in principle last summer to introduce assisted dying for terminally ill adults, MPs must now consider how in practice to achieve a system combining compassion with what has been promised as the most “robust” protections “in the world.”
To anyone without substantive religious objections, the opportunity to take the pain and trauma out of dying feels, on the surface, like an obvious step for a modern society blessed with advanced medical solutions to some of life’s — and death’s — indignities. However, as MPs wrestle with these existential questions, it has become clear that although the principle might be simple, the system for implementing it is far from straightforward. So far, 15 nations (and 10 US states) have gone down this path — it is not yet clear whether the UK would become the 16th any time soon.
Illustration: Yusha
As sometimes happens with moral matters, the proposed new law was introduced to parliament as a private members bill, rather than government legislation, in the name of the Labour backbencher Kim Leadbeater.
This week, Leadbeater surprised many by replacing a central tenet of the proposed law — signoff from a British High Court judge before an assisted death could be facilitated — with a “voluntary assisted dying commission,” a panel headed by a “legal chair” and including a psychiatrist and social worker. Leadbeater described this new system as “judge plus” — though to the bill’s detractors, it was more like “judge minus” — and faced a swift backlash from some colleagues. Her recalibration followed a quiet word from British Secretary of State for Justice Shabana Mahmood, who was spooked after MPs examining the bill were told the plan would put impossible strain on England and Wales’ already creaking judicial systems — the legislation does not cover Scotland or Northern Ireland. This included the evidence of retired British High Court judge Nicholas Mostyn, who said that “the High Court, trust me I’ve just come from there, has not got the capacity.”
It is true, Britain’s legal system is chronically underfunded and over-stretched — backlogs yawn into eternity, there is a barrister shortage in all but the most remunerative fields, there are not enough judges, the legal aid system is on its knees, and court buildings are dilapidated.
The additional strain on the court system of hearing thousands of assisted dying cases a year always felt unbearable. In Canada, about 4 percent of deaths are assisted, and already in the UK at least a thousand people a year are estimated to take their own life or be helped to do so illegally, so the numbers would not be small. It is commendable that Leadbeater has listened to the warnings — but her solution faces similar problems to her initial proposal.
Because the nub of the problem is this: The realities of delivering the service she proposes feel too complex and demanding for an increasingly fragile state to bear. Put simply, Britain is too broken to cope.
Take the suggestion that social workers be included in panels to consider assisted dying applications. This seems sensible given the holistic nature of the protection MPs seek to provide, but it is also wildly impractical.
With more than 10 percent of posted jobs unfilled, social work is in crisis, afflicted by rock-bottom morale and plummeting public confidence following a series of scandals dating back at least a quarter of a century involving the murders of young children on the watch of local authority social services departments. The COVID-19 pandemic exacerbated the issues in social work, leading to increased need but no real response to the existing challenges of low pay and poor working conditions. Given the pressures already gripping the system, should the UK be adding to the burden?
Then consider palliative care. The cancer charity Marie Curie estimates more than 100,000 patients a year die with unmet palliative needs, with the poor, inarticulate and those in rural areas most likely to miss out. Inadequate palliative care massively shifts the scales toward death — if you were in pain, immobile, incontinent and knew you could not access hospice care, would you not be tempted?
In social care too, demand has risen inexorably in the last decade, but provision has not. Thousands of family homes are sold each year to pay for elderly care. That raises the prospects of older people seeking an early death to protect their most valuable asset. Worse, what if cash-poor but property-rich grannies and grandads were encouraged to go down this route by ne’er-do-well heirs?
What of those without homes to sell — dependent on family, often for years, with all the accompanying indignities — might not an assisted death seem preferable?
As the Royal College of Psychiatrists put it: “We must ... consider whether a person is making the request because they consider that they are a burden, or because they do not consider that they have access to effective treatment or good quality palliative care.”
Legislating to permit assisted dying in these straitened circumstances verges on immoral, because the dice are loaded — the terminally ill patient has every incentive to opt for hurried death, an option they might not choose were we in a world of proper palliative and social care. Britain in 2025 is far from that world.
The list of failing state institutions in need of repair before assisted dying becomes viable goes on.
The Royal College of General Practitioners has said that family doctors advised by the National Health Service (NHS) to hustle patients through 10-minute appointment windows could not possibly be the first port of call for those seeking an assisted death — but where would the funds come from for a new body to administrate and facilitate what is proposed?
Whispers that an assisted dying regime would save the NHS funds, because British Prime Minister Keir Starmer has long been a supporter of assisted dying, encouraging Leadbeater to bring her bill. However, the prime minister is also well versed in his Labour Party’s conception of the welfare state as a safety net supporting citizens from cradle to grave. The net feels too frayed to bear the additional load.
There are lots of reasons to lament the pitiable state of Britain’s most basic public services. Not being able to provide a system capable of sustaining the provision of merciful death while protecting the most vulnerable is only one of them.
Rosa Prince is a Bloomberg Opinion columnist covering UK politics and policy. She was formerly an editor and writer at Politico and the Daily Telegraph, and is the author of Comrade Corbyn and Theresa May: The Enigmatic Prime Minister. This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
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