Currently, as I’m sure you know, assisted dying is banned in all forms throughout the British Isles and carries a potential maximum prison sentence of 14 years. Repeated attempts have been made to legalise assisted suicide, without success, but this week the Isle of Man, a self governing UK Crown dependency, has come a step closer to becoming the first part of our islands to legalise it for terminally ill and mentally competent people. And Scotland is hard on its heels with the formal introduction of a new bill to their parliament on 27 March.
Isle of Man
Assisted Dying AGAIN!
Yep, it’s not going away!! The United Kingdom is yet again up to its neck in controversy and debate about life and death.
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It’s eighteen years since my own book on assisted dying was published, and precious little has changed. 
Hospices are still seriously underfunded and understaffed. Palliative care is still a postcode lottery. There is still no consensus within the UK. Doctors are still challenged by the prospect of extending their role to include assisting death. The public are still divided. Emotions still run high. Patients are still dying in circumstances not of their choosing.
Not that the subject has been swept under the carpet. No. Indeed, the Isle of Man and Jersey have now passed legislation to legalise assisted dying. Scotland has tried three times now to do so, but the Bill was rejected again at its final stage on the evening of 16 March – two days ago – albeit by a very narrow margin.
Parliamentarians for England and Wales have strenuously debated their version of the Bill and last summer the Commons passed it. However, since then it’s got stuck in the House of Lords. With hundreds of amendments still to be dealt with, it looks highly likely to run out of time before the end of this session of Parliament, in which case it will need to go back to the Commons to begin again, but perhaps with provision made this time to stop the Lords repeating their blocking of it.
OK, it’s highly emotive and divisive stuff. And life is sacred and precious. There will always be detractors and critics and fierce opponents. There will probably also always be mistakes made. It behoves those who have agreed to allow the practice to tread warlily and monitor progress from the outset. And it behoves those who have not taken the decision as yet to listen, watch and learn.
One of the most heartening aspects of this whole issue is the big message coming across is: all parties need to up their game to ensure better palliative care is available. And I’ve been encouraged too by the sensitivity and respect and graciousness both sides demonstrate when these particular Bills are under discussion. Would that parliamentarians could bring the same gravitas and courtesy to other agenda items!
A first! … maybe …
Well, after all these years of talking and debating and campaigning it has finally happened: the Isle of Man has just become the first place in the UK to make Assisted Dying legal.
However, it’s by no means a done deal yet. Right now it just means the Manx parliament has agreed to pass this law allowing terminally ill adults with legal capacity, who have lived on the island for a minimum of five years, are registered with an Isle of Man GP, and who now have a life expectancy of 12 months or less, to end their lives, subject to the approval of two independent doctors.
But that’s not the end of the matter by any means. Right now, it’s essentially theoretical. Before this legislation can become operational, it has first to go for Royal assent. If that’s granted, it could become law later this year and an assisted dying service could be in place by 2027 – both these steps will involve a lot of work and discussion and close scrutiny. And there are no foregone conclusions.
Oh, and there’s another complication: three quarters of doctors who responded to an Isle of Man Medical Society survey in 2023 said they were opposed to assisted dying, and a third would consider leaving the island if the legislation were introduced. Now that feels to me like quite an obstacle.
And now, in the same week, we hear that the proposed bill for England and Wales, which has met with enormous problems since it passed the first stage in the Commons last year, has been kicked into the long grass after its Labour sponsor, Kim Leadbeater, proposed delaying it for two years until after the next election. There is a distinct possibility it would be dropped altogether by a different government.
I’m sure, you like me, have heard plenty of Joe/Jessie Bloggs stating their absolutely views with supreme confidence, but actually finding an ethical, safe, workable method of implementing change, and enshrining it in law, is fraught with problems. Not surprisingly really; after all, life itself is sacred, and feelings run high on both sides of the arguments.
Disability and Assisted Dying
The topic of a good death just won’t go away, will it?! But this week there’s tangible progress to report.
But of course, as ever, these attempts to change long established laws in such a sensitive and nuanced area, prompt strong opposition from some parts of the medical profession, disability and human rights groups, and religious communities, with concerns that it might put pressure on vulnerable people to end their lives for fear of being a financial, emotional, or care burden on others, compromise the ethical standards of the medical profession, and create fear and mistrust among the patient population.
So, I was fascinated by a BBC documentary, Better off Dead?, which devoted an hour to the topic on Tuesday this week (14 May, 9pm). It was written and presented by actor and disability rights activist, Liz Carr, who is herself disabled and in a wheelchair. A recent poll found that 73% of Britons support doctor-assisted suicide for the terminally ill, but Liz and many other disabled people fear their lives will be put at risk if it is legalised. She says:
Too many disabled people will have had the experience of someone, often a complete stranger, telling them, ‘if I was like you, I’d rather be dead’.
But she says with a grin, disabled people are the toughest people out there! To which her friend adds, ‘Cockroaches! Evolved for survival!’ And Liz certainly comes across as a feisty, articulate, and knowledgeable campaigner.
The pandemic cast a bright light on the inequalities in care, and the practice of ‘Do Not Resuscitate’ orders being placed on the medical notes of older or disabled patients, without their consent, also implies a low value is attributed to their lives. This documentary challenges the assumptions behind these actions, and shines a light on the many grey areas in this often one-sided debate. Seen through the eyes of those being discriminated against, it packs a hard punch.
In the course of making the programme, Liz also travelled to Canada to explore the repercussions of some of the most permissive euthanasia laws in the world, laws which include people who are disabled, not just the terminally ill. For me, seeing the illustrated information pack for children explaining what MAID (Medical Assistance in Dying) means in simple language, chilled the blood.
A palliative care specialist drew attention to the paucity of such care, and her cry to protect the vulnerable struck a particularly deep cord when we had this vivid image of assorted people with disabilities in front of us. Why don’t we hear more about the serious underfunding of this service, I wonder? Is this where we should be devoting our energies?
Even if there are to be changes in the UK law – which seems highly probable, they won’t be 100% safe. They can’t be. But the more practical question is: How safe is acceptable?
Back to my pile of books on the subject which I’m ploughing through systematically. But now with this niggle about disabled people’s perspective a much bigger alarm call.
The pace of change
Thirty years ago, when I first started writing novels set in the world of medical ethics, I had an abiding horror of someone else writing on the same theme and publishing before me, or real life medicine coming up with something new that rendered my plotting obsolete – or that made it look as if I’d copied from real life, or the topic simply becoming old hat in some way. In reality the reverse has happened: real life has occasionally mimicked my fiction. And not one of the eleven novels I’ve published has actually gone out of date. Such is the enduring nature of ethical issues.
This week I’ve been following up an ongoing story in the Isle of Man – a self-governing UK dependency in the Irish Sea between Great Britain and Ireland – where a Bill is going through Parliament designed to legalise assisted dying. The first reading of the Bill was approved by 22 to 2 votes. In the second reading at the end of October, 17 members voted for, 7 against. It now faces three more stages: a clause stage – where each clause is independently scrutinised; a potential committee stage, and a third reading. If it survives these obstacles it goes to the Legislative Council where it could be signed into law and could be available as early as 2025. If it is, the island will be the closest place to mainland Britain where this service is available, although it should be noted, tourists will not be able to take advantage of it.
It’s fifteen years now since my novel Right to Die was published – hard to believe! But the issues remain the same; the complexities and caveats are still confounding the process of actually enshrining a practical workable solution in legal language; patients and families are still facing horrendous choices. Could it be that an island 426 times smaller than the UK will blaze a trail for its neighbours?
Whatever, the wheels of law turn oh so slowly. I shall not be short of potential material in my lifetime!