As the Assisted Dying Bill inches closer to parliamentary debate, it has ignited a fiery discourse on its implications, particularly the risk of enabling non-voluntary euthanasia (NVE). Critics warn, and rightly so, that the bill’s passage could erode safeguards and lead to dangerous expansions of euthanasia practices. Historical and international examples underscore these concerns, painting a sobering picture of how such legislation might unfold.
Non-Voluntary Euthanasia: A Rare but Real Concern
Non-voluntary euthanasia occurs when life-ending decisions are made for individuals unable to provide informed consent due to unconsciousness, severe cognitive impairments, or infancy. While advocates of assisted dying argue for robust safeguards, the experience in jurisdictions like the Netherlands and Belgium suggests that initial limitations can erode over time. In these countries, criteria for euthanasia have expanded to include individuals with dementia or psychiatric disorders, raising troubling ethical and legal questions.
For instance, the Netherlands’ Groningen Protocol allows euthanasia for infants with severe disabilities, explicitly bypassing the need for consent. Similarly, cases in Belgium have seen family members and medical professionals making life-ending decisions for patients with advanced dementia based on prior directives. These examples highlight the slippery slope from voluntary euthanasia to practices where consent is ambiguous or entirely absent.
The Risks of Legislative Drift
The Assisted Dying Bill proposed ‘safeguards’ - are no safeguards at all; they do not exist, and the procedural framework being promoted is fraught with unsubstantiated risks that will only undermine whatever credibility exists for preserving life.
The argument for informed and voluntary consent is another façade; critics argue that such protections are often the first to erode. Once the principle of assisted dying is established, the scope of eligibility can widen through legislative amendments, judicial interpretations, or shifts in societal attitudes.
In Canada, for example, Medical Assistance in Dying (MAID) was initially limited to terminally ill adults. It now includes individuals with chronic illnesses and, controversially, mental health conditions. Such expansions illustrate how incremental changes can fundamentally alter the practice, potentially paving the way for NVE.
Vulnerable Populations at Risk
One of the most pressing concerns is the impact on vulnerable groups, including the elderly, disabled, and those with chronic mental health conditions. The cultural and economic pressures to choose assisted dying—whether to alleviate perceived burdens on families or reduce healthcare costs—can create an environment where opting for death feels less like a choice and more like an expectation.
Existing disparities in healthcare access further exacerbate this risk. When palliative care options are limited or inaccessible, assisted dying may be seen as a “solution” rather than an informed and voluntary choice. Critics argue that legalising assisted dying without addressing these systemic issues effectively undermines the dignity and autonomy the bill purports to protect.
Legal and Ethical Intersections
The Assisted Dying Bill does not exist in a vacuum; it interacts with existing laws governing mental capacity, advance directives, and judicial decision-making. These intersections create opportunities for misuse or unintended consequences. For example:
Mental Capacity Laws: Decisions made under the guise of “best interests” could lead to life-ending actions for individuals deemed incapable of consent, as seen in some UK cases involving withdrawal of life support.
Advance Directives: Ambiguous or outdated directives could be interpreted in ways that contravene the individual’s current wishes, as evidenced by contentious cases in the Netherlands.
Judicial Strain: Courts tasked with reviewing assisted dying applications may become overwhelmed, leading to rushed or poorly scrutinised decisions.
Lessons from Abroad
International precedents provide cautionary tales. In Belgium, the expansion of euthanasia criteria to include minors and individuals with psychiatric disorders has sparked global criticism. Similarly, the Dutch experience with dementia patients highlights the ethical dilemmas of relying on advance directives in non-voluntary contexts. These examples reveal how even well-intentioned safeguards can fail, enabling practices that undermine the sanctity of life.
Erosion of Trust in Healthcare
Perhaps the most profound risk is the potential erosion of trust in healthcare systems. When doctors transition from being healers to enablers of death, the fundamental relationship between patient and physician shifts. Vulnerable individuals may avoid seeking care out of fear that they could be pressured into choosing assisted dying. Moreover, prioritising assisted dying over investments in palliative care risks creating a two-tier system where death becomes the “easier” or more cost-effective option.
A Call for Robust Safeguards
The Assisted Dying Bill must be rejected, and attention should instead be focused on addressing the lack of palliative care in the UK. The bill risks creating a framework that prioritises death over dignity. Key measures must include:
Comprehensive access to palliative care to ensure assisted dying is a true choice rather than a necessity born of systemic failures.
Regular review and oversight of cases by independent bodies to prevent abuses.
Clear, enforceable guidelines for advance directives to minimise ambiguity.
Ongoing public and parliamentary scrutiny to prevent legislative drift.
Without these measures, the Assisted Dying Bill risks opening the door to practices that could fundamentally undermine the dignity and protection of vulnerable individuals. The lessons from other jurisdictions are clear: once the line between voluntary and non-voluntary euthanasia is blurred, it becomes nearly impossible to draw it again.