The so-called "Death Wish Bill" should be opposed unequivocally as it introduces a deeply troubling framework for assisted dying, a policy that risks being a shortcut in place of providing meaningful end-of-life care and support. Legalising the option to end one's life under conditions of illness not only threatens to erode the sanctity of life but also places vulnerable individuals at risk of coercion, whether through explicit pressure or the subtle despair that arises when healthcare systems fail to support them adequately. There is no remedy to death—it is final, absolute, and irreversible. Rather than offering a compassionate choice, this bill risks normalising assisted death as an answer to suffering when society’s focus should be on remedying that suffering through comprehensive care, mental health support, and a humane commitment to preserving life.
To break down this bill’s proposed framework—all 38 pages, yes, 38 pages—which presents a structure not rooted in evidence but rather in the proposer's desire for relevance and an ideological disconnect from reality, I will illustrate just how poorly conceived and fundamentally flawed it truly is. By examining each component, I will demonstrate where it fails to address the complex realities of assisted dying. Each section will expose the bill’s lack of sufficient safeguards, inadequate oversight, and ethical failings, revealing why it falls disastrously short of any acceptable standard for such a critical issue.
The "Terminally Ill Adults (End of Life) Bill" (hereinafter referred to as "the Bill" or ‘#DeathWishBill’) aims to provide a legal framework for assisted dying in the UK. However, upon detailed examination, this legislation is found to be poorly drafted and insufficient in addressing the multifaceted issues of assisted dying. Its current form lacks rigorous safeguards, exhibits procedural ambiguity, and fails to protect vulnerable individuals, thus rendering it unfit for legislative enactment. This report critiques key areas of the Bill, drawing on specific clauses and language to demonstrate why the Bill should be rejected outright.
1. Prognosis and Eligibility Requirements
Flawed Clause: Section 2(1)(b) - Definition of Terminal Illness
The Bill defines terminal illness as "an inevitably progressive illness, disease or medical condition which cannot be reversed by treatment" and stipulates that the individual’s death "can reasonably be expected within six months" (Section 2(1)(b)).
Issues and Impact
This clause relies heavily on the accuracy of prognoses, which are notoriously unreliable, especially for non-cancerous conditions. A terminal prognosis is often subject to error, and predicting life expectancy within a six-month window is challenging for healthcare professionals. The failure to account for prognostic uncertainty introduces a significant risk of patients being approved for assisted dying prematurely, potentially leading to avoidable deaths.
Furthermore, the lack of evidence to justify the six-month timeframe raises ethical and practical concerns. Without robust studies or empirical support, this clause demonstrates a lack of foresight in drafting, as it fails to protect individuals who might outlive their prognosis due to medical variability.
2. Mental Health and Capacity Assessments
Flawed Clause: Section 3 - Mental Capacity and Optional Psychiatric Evaluation
The Bill references the Mental Capacity Act 2005 to determine if a patient has the mental capacity to make a decision to end their life (Section 3). However, a psychiatric evaluation is only mandated if the assessing doctor has "doubts" about the person’s capacity (Section 9(3)(b)).
Issues and Impact
The lack of a compulsory psychiatric assessment is a severe oversight. Unlike Canada’s MAID legislation, which mandates psychological evaluations, the Bill places undue reliance on the judgment of doctors who may lack psychiatric training. This introduces a serious risk that patients with treatable mental health conditions, such as depression, may pursue assisted dying as a response to psychological distress rather than a clear, stable decision.
Additionally, this discretionary approach undermines the Bill’s safeguards by allowing patients with fluctuating mental states to be assessed without a thorough investigation into their psychological well-being. The risk here is that the absence of mandatory psychiatric assessments could lead to cases where patients make irreversible decisions under treatable mental conditions, violating the ethical principles of autonomy and informed consent.
3. Coercion and Family Involvement
Flawed Clause: Section 1(2)(b) - Absence of Family Role in Consent Verification
While the Bill requires that patients "have a clear, settled and informed wish to end their own life" and not be "coerced or pressured by any other person" (Section 1(2)(b)), it fails to include family members in the formal decision-making process, leaving the detection of coercion solely to doctors.
Issues and Impact
This omission overlooks the role that family members could play in identifying potential coercion or undue influence. Without any mechanism for family members to raise concerns, the Bill effectively excludes those who may have the most insight into the patient’s circumstances. This failure to involve close associates in the verification process creates a loophole where subtle or hidden coercion could go undetected, particularly in cases involving elderly, disabled, or isolated individuals.
By not addressing family involvement, the Bill undermines the procedural checks needed to protect vulnerable individuals from making decisions under external pressure. The absence of this provision reduces the Bill’s robustness and places undue responsibility on medical practitioners to detect and assess the potential for coercion.
4. Limited Role of Palliative Care
Flawed Clause: Section 4(4)(c) - Optional Discussion of Palliative Care
The Bill mandates that doctors discuss "any available palliative, hospice or other care, including symptom management and psychological support" during preliminary discussions (Section 4(4)(c)). However, it does not require patients to explore or attempt palliative care before pursuing assisted dying.
Issues and Impact
This lack of a mandate for palliative care exploration reveals a significant flaw. Without requiring patients to first exhaust palliative care options, the Bill may lead individuals to choose death over life-sustaining treatments. In Canada, for instance, palliative care consultation is essential, ensuring that individuals consider all available support before making a final decision.
The absence of a robust palliative care requirement contradicts the Bill’s implied commitment to patient welfare and undermines the ethical principle of ensuring a full understanding of available alternatives. By failing to prioritise palliative care, the Bill may normalise assisted dying without a comprehensive examination of less drastic options, a clear weakness in its structure.
5. Administrative Burden and High Court Involvement
Flawed Clause: Section 12 - High Court Approval Requirement
The Bill requires patients to obtain a declaration from the High Court confirming that they meet eligibility criteria for assisted dying (Section 12).
Issues and Impact
This step, while intended as a safeguard, introduces a significant administrative and logistical burden on terminally ill patients. Requiring judicial approval adds a layer of complexity that could delay the process and create unnecessary distress for individuals in advanced stages of illness. In Oregon’s Death with Dignity Act, for instance, only medical assessments are required, streamlining the process and reducing bureaucratic barriers.
The judicial requirement may lead to procedural delays, exacerbating the suffering of terminally ill patients and potentially undermining the Bill’s intent to offer a dignified end-of-life option. This added burden indicates poor drafting, as it fails to balance effective safeguards with practical accessibility.
6. Witness and Doctor Conflicts of Interest
Flawed Clause: Section 5(3)(d) - Limiting Witnesses and Coordinating Doctors
The Bill disqualifies immediate relatives and beneficiaries from serving as witnesses or coordinating doctors (Section 5(3)(d)). However, it does not exclude doctors with indirect institutional conflicts of interest, such as NHS practitioners who might be influenced by budgetary constraints.
Issues and Impact
While disqualifying direct relatives or beneficiaries is a necessary precaution, the Bill overlooks the potential influence of systemic or institutional pressures on healthcare providers. In an underfunded NHS environment, there may be subtle economic incentives to approve assisted dying cases to alleviate long-term care costs. The failure to address these broader conflicts of interest weakens the integrity of the decision-making process and opens the door to potential abuses driven by financial motivations.
7. Insufficient Post-Death Review Mechanisms
Flawed Clause: Section 29(1) - Exclusion of Coroner Investigation
The Bill excludes assisted dying cases from coroner investigations, stating that a person is not to be regarded as having died in circumstances requiring coroner involvement simply because they died "as a consequence of the provision of assistance to that person" (Section 29(1)).
Issues and Impact
This exclusion reduces accountability by limiting post-death reviews, which are crucial for ensuring that each case complied with procedural safeguards. In Canada, deaths resulting from assisted dying are subject to extensive documentation and review, providing a layer of accountability missing in the UK Bill. By failing to mandate a post-death review, the Bill potentially conceals procedural lapses or instances of non-compliance, undermining public confidence in the assisted dying framework.
8. Appeal Process Asymmetry
Flawed Clause: Appeal Limitations in Section 12
The Bill allows for appeals if a patient’s request is denied but does not permit appeals against approvals, creating an asymmetrical appeals process (Section 12).
Issues and Impact
This imbalance prioritises approvals over rejections, effectively lowering the threshold for acceptance. Family members or healthcare providers concerned about a flawed approval have no formal recourse, increasing the risk that improper cases might proceed unchallenged. This lack of balance reveals a poorly considered approach to appeals, which should be impartial and available for both approvals and rejections to uphold rigorous standards.
What Does This Mean?
The "Terminally Ill Adults (End of Life) Bill" is fundamentally flawed, with insufficient safeguards, a lack of robust mental health provisions, and burdensome bureaucratic requirements that undermine its effectiveness as a compassionate end-of-life option. Its reliance on inaccurate prognoses, discretionary psychiatric evaluations, and inadequate oversight reflects poor drafting and an incomplete understanding of the complexities of assisted dying.
Given these issues, the Bill in its current form cannot ensure the safety, autonomy, or well-being of vulnerable individuals. Therefore, it is imperative that this Bill be rejected outright, as any attempt to amend it would require extensive restructuring, ultimately revealing it to be woefully inadequate for providing a humane and ethically sound framework for assisted dying in the UK. This critique is grounded in legislative concerns alone. Yet, to be blunt, this Bill should not even be debated. It fundamentally violates the Hippocratic oath, which binds medical professionals to "do no harm," and undermines the sanctity of life—a core value that transcends legal frameworks.
As Cicero once asserted, “The health of the people is the highest law,” a reminder that legislation must prioritise the welfare and dignity of individuals. Similarly, Viktor Frankl, a survivor and profound thinker on human suffering, warned against taking life casually: “Our greatest freedom is the freedom to choose our attitude, whatever the circumstances,” and “In some ways, suffering ceases to be suffering at the moment it finds a meaning." Assisted dying, especially when institutionalised, risks stripping suffering of its deeper significance by offering an illusory “solution” that ignores the complexities of human resilience and the possibility of finding meaning, even in life’s darkest hours.
The Hippocratic oath itself, the cornerstone of medical ethics, declares: “I will give no deadly medicine to anyone if asked, nor suggest any such counsel.” This ancient vow, upheld across centuries, recognises that life’s sanctity is a principle not to be breached, even under the guise of compassion. In legalising a framework for assisted dying, we move dangerously close to trivialising the role of healthcare as a guardian of life, regardless of circumstances.
International Comparisons and the Consequences.
Several countries that have legalised assisted dying have witnessed a significant rise in the number of assisted deaths over time, often accompanied by an expansion of eligibility criteria. This trend indicates that the legalisation of assisted dying frequently leads to a shift in definitions and broader criteria, raising concerns about potential abuse and unintended societal impacts. The experience of these countries highlights the potential risks of adopting assisted dying legislation without robust safeguards, particularly in environments where political or healthcare pressures undermine the capacity to provide adequate support for vulnerable populations.
The Netherlands: From Terminal Illness to Non-Terminal Suffering
Initial Legislation: The Netherlands legalised euthanasia and assisted suicide in 2002, initially limiting eligibility to adults experiencing “unbearable suffering with no prospect of improvement,” typically for terminal or severe medical conditions.
Expansion of Eligibility: Over time, eligibility criteria have broadened. Today, Dutch law allows euthanasia for chronic suffering, including cases of severe psychological distress without terminal illness. Even minors over 12 can request assisted dying with parental consent. Most controversially, discussions are ongoing about extending assisted dying to individuals over 75 simply due to “tiredness of life.”
Increase in Assisted Deaths: Since legalisation, cases of euthanasia have steadily increased. In 2022, there were over 8,700 reported euthanasia deaths in the Netherlands, up from approximately 1,800 in 2003. This rise reflects both an increase in public acceptance and a gradual expansion of who qualifies for assisted dying. The broadening criteria raise ethical concerns, particularly regarding non-terminal suffering cases, suggesting that definitions of unbearable suffering are subject to drift, often expanding to include individuals with complex, non-terminal conditions.
Risk of Abuse: The Dutch example demonstrates how vulnerable populations, particularly those facing psychological distress, might be drawn to assisted dying due to inadequate mental health support. As definitions expand, there is a risk that socio-economic pressures and healthcare constraints will drive patients to view assisted dying as a solution to challenges that might otherwise be addressed through comprehensive support and care.
Belgium: Slippery Slope of Expansion and Societal Impact
Initial Focus on Terminally Ill Adults: Belgium legalised euthanasia in 2002, similarly restricting eligibility to adults experiencing unbearable physical suffering in terminal conditions.
Expansion to Non-Terminal and Psychiatric Cases: Over time, Belgium’s criteria expanded to include those with severe psychiatric conditions, such as depression and personality disorders, regardless of terminal illness. Additionally, euthanasia is now legally available for minors of any age, with parental consent.
Alarming Increase in Euthanasia Cases: The number of euthanasia cases in Belgium has climbed significantly, with nearly 2,700 cases reported in 2022, compared to just over 200 in 2003. These figures reflect a shift from rare, carefully regulated procedures to a more routinised aspect of end-of-life care, often with less scrutiny.
Healthcare System Pressures: Belgium’s expanded eligibility for psychiatric suffering raises concerns that patients with treatable mental health issues may choose euthanasia due to the lack of accessible mental health services. In cases where healthcare systems fail to provide adequate care, euthanasia could become a pathway for patients suffering from manageable conditions, effectively institutionalising assisted dying as an alternative to proper healthcare, particularly for individuals facing systemic barriers to support.
Canada: Medical Assistance in Dying (MAID) and Escalating Concerns
Legislative Changes: Canada legalised Medical Assistance in Dying (MAID) in 2016, initially restricting it to individuals with a “reasonably foreseeable” death. In 2021, eligibility expanded to include people with chronic suffering, even if their death was not imminent, leading to a substantial increase in cases.
Rapid Growth of Assisted Deaths: By 2022, over 10,000 Canadians died via MAID, representing approximately 3% of all deaths in Canada that year. This reflects a rapid rise from around 1,000 cases in 2016, evidencing how quickly assisted dying can shift from a rare exception to a more common outcome.
Expansion to Mental Health Conditions: New amendments planned for 2024 will expand MAID to individuals whose sole underlying condition is a mental illness, further broadening eligibility. This shift is particularly alarming in light of Canada’s strained healthcare system, where patients frequently report difficulty accessing mental health services.
Socio-Economic Pressures and Risk of Abuse: In some cases, Canadians have sought MAID due to socio-economic hardships, such as homelessness, poverty, and lack of access to adequate medical care. This trend indicates a disturbing direction where MAID may serve as an alternative to addressing the social determinants of health. The Canadian case illustrates the risks that arise when assisted dying becomes a response to structural inadequacies, effectively enabling the state to bypass responsibilities for providing comprehensive support to vulnerable citizens.
Switzerland: Assisted Suicide as a Broad Right
Long-standing Permissiveness: Switzerland permits assisted suicide without the requirement of terminal illness or unbearable suffering, as long as there is no selfish motive involved. The country’s laws enable foreign nationals to travel to Switzerland for assisted suicide, creating a phenomenon known as “suicide tourism.”
Increase in Assisted Suicides: Assisted suicide has become more prevalent, with organisations like Dignitas reporting a steady increase in cases annually. The lack of restrictions has fostered a normalisation of assisted dying, where people from various countries, including those without terminal illnesses, view it as an option for conditions such as chronic pain or psychological suffering.
Risk of a Commoditised System: Switzerland’s approach highlights how unrestricted assisted suicide can become commoditised, with minimal oversight on the motivations of individuals seeking death. Without safeguards, such a system risks treating life-ending assistance as a service, accessible by those who might be influenced by transient suffering, economic limitations, or inadequate healthcare.
Lessons for the UK and the "Terminally Ill Adults (End of Life) Bill"
The experiences of these countries indicate a worrying trend: once assisted dying is legalised, eligibility criteria often expand, and the number of assisted deaths rises considerably. This expansion raises ethical, practical, and societal concerns, including:
Broadening of Definitions: Countries that initially limited assisted dying to terminally ill individuals with physical suffering have increasingly expanded to include non-terminal cases and mental health conditions. This “slippery slope” suggests that the initial limitations within the UK Bill may also be subject to future amendments, leading to a potential rise in cases and a normalisation of assisted dying as a solution to broader health and socio-economic issues.
Healthcare System Strain and Socio-Economic Pressures: In Canada and Belgium, cases have emerged where individuals pursue assisted dying due to socio-economic hardships, lack of access to healthcare, or chronic psychological suffering. Should the UK’s healthcare system continue to face resource limitations, particularly within mental health and palliative care, the existence of assisted dying as an option may unintentionally create a pathway where vulnerable individuals opt for death over inaccessible care.
Ethical Risk of Coercion and Normalisation: As assisted dying becomes more common, there is a risk that society increasingly views it as a viable option for individuals who may feel pressured by their socio-economic or health
circumstances. The potential for implicit coercion grows, particularly when health services fail to provide comprehensive support, and individuals perceive assisted dying as a solution to suffering rather than an informed, voluntary choice.
Potential for Systemic Abuse in Times of Crisis: Economic downturns or healthcare crises may incentivise governments or healthcare providers to passively encourage assisted dying to reduce long-term care costs for chronically ill patients. This risk is particularly relevant given the underfunded NHS, where financial pressures could drive an environment in which assisted dying is promoted over expensive, long-term care.
The international experience demonstrates the challenges and risks inherent in legalising assisted dying, with many countries experiencing a rise in cases and an expansion of eligibility criteria. The "Terminally Ill Adults (End of Life) Bill," in its current form, fails to establish the robust safeguards required to prevent these issues, particularly in a healthcare environment vulnerable to strain and socio-economic pressures. The trajectory of assisted dying legislation worldwide suggests that once such laws are enacted, they tend to broaden, often creating ethical and systemic dilemmas that go far beyond the original scope. Given these international lessons, the Bill should be rejected, as it is insufficient to protect against the unintended consequences and societal shifts that often accompany the legalisation of assisted dying.