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

Submission to the Public Bill Committee

Terminally Ill Adults (End of Life) Bill 2024-25 Submission to the Public Bill Committee from the Health Advisory and Recovery Team

Introduction

We are submitting this response as co-chairs of the multidisciplinary professional body, the Health Advisory and Recovery Team, HART, comprising healthcare professionals, ethicists and psychotherapists who have grave concerns about the bill and want to ensure the debate includes a comprehensive evidence-base. This Bill crosses ethical red lines and will mean changes that challenge the foundational moral frameworks upon which our society rests. It also exposes a concerning lack of understanding of the broader implications of such legislation for vulnerable individuals.

While the Bill claims to prioritize autonomy and compassion for terminally ill individuals, it risks undermining core principles that safeguard the dignity and sanctity of life, eroding trust in our institutions and healthcare systems.

Detailed Issues of Concern

1. Erosion of Foundational Moral Principles

The Bill fundamentally undermines the principle of the sanctity of life, a cornerstone of ethical and legal frameworks which ensure that all lives are valued equally and that intentional harm is prevented. Legalizing assisted dying creates exceptions to this principle and establishes the troubling precedent that some lives are less worth protecting than others.

By framing death as a solution to suffering, the Bill shifts societal priorities away from alleviating suffering and toward facilitating death. Such a change represents a profound moral and cultural shift, eroding the shared values that uphold dignity and communal responsibility for life.

2. Disconnection from Reality

Advocating for euthanasia overlooks key realities about how terminally ill individuals often respond to their circumstances. For instance, Esther Rantzen, a prominent advocate for autonomy in end-of-life decisions, recently celebrated her life being extended by a new medical treatment, demonstrating the value of advancing healthcare rather than promoting death. Despite holding a Dignitas membership, she has to date demonstrated no serious intent to use it. The dying frequently change their minds as treatments, care, or their emotional states evolve. This raises a critical concern: euthanasia could result in individuals being killed prematurely before breakthroughs in treatment or interventions become available, cutting short lives that could otherwise be improved or extended.

Moreover, suicide rates among the elderly are at historic lows, highlighting that most individuals, even in difficult circumstances, choose life when they feel supported. The idea that there is an unmet demand for assisted dying among the terminally ill does not align with this reality.

3. Risks to Vulnerable Populations

Vulnerable people will be put at risk from this Bill.

• Coercion and Pressure: External pressures and a sense of being a burden could cause vulnerable individuals with disabilities, the elderly, or those experiencing socio-economic hardship to feel compelled to choose assisted dying, even when it is not their genuine wish to die. Half of those dying (with medical assistance) in Canada perceived that they were a burden. Worse, there is evidence from Canada that cases exist where incapacity was ignored or financial hardship and lack of access to care influenced such decisions​.

• Psychological Vulnerability: The Bill does not provide sufficient measures to identify and address psychological factors, such as depression or anxiety, which could significantly impair an individual’s capacity to make an informed decision.

These risks demonstrate how the Bill could inadvertently normalize the idea of ending life as a response to systemic failings, rather than addressing the root causes of suffering.

4. Inadequate Focus on Palliative Care

The UK’s palliative care system remains underfunded with only 30% of hospice funding provided by the government. This Bill diverts attention and resources from addressing these deficiencies. Instead of providing terminally ill individuals with the support and care they need to live their final days with dignity, it risks creating a system where death is presented as the only viable option for those in pain or distress.

5. Public Misconceptions About Pain and Suffering

The public’s fear of a painful and undignified death is often rooted in misconceptions or inadequate knowledge about the capabilities of modern palliative care. In reality, palliative care prevents almost all such deaths. While there are cases of suffering before death, the proposed bill, in an attempt to alleviate that suffering, has disproportionate negative societal effects.

By promoting assisted dying, the Bill reinforces these fears instead of dispelling them. A robust public education campaign focused on the efficacy of palliative care and available support options is crucial to addressing this issue.

6. Lack of Broader Understanding and Oversight Challenges

Evidence from jurisdictions with similar laws highlights systemic failures and gaps in oversight:

• Judicial Overload: Robert Jenrick MP has highlighted that the judiciary is ill-equipped to manage the additional burden of assisted dying cases. With an already overstretched Family Division, requiring an additional 34,000 sitting hours annually would result in rushed decisions or delays, leaving terminally ill individuals in legal limbo. Such delays could prompt calls to remove or weaken the court approval step early in the Bill’s implementation. This would dismantle a crucial safeguard, leaving the process more susceptible to misuse or coercion. The reliance on an already overstretched judicial system does not seem sustainable without significant investment and reform​.

• Failure of Safeguards in Other Jurisdictions: In Canada, 428 cases of legal non-compliance were identified in a single province over five years, yet none were referred for legal action​. The proposed safeguards are likely unfeasible in the UK where healthcare and judicial systems are already under strain.

• Inadequate Consideration of Alternatives: The Bill does not address whether existing palliative care and mental health support services are sufficient to meet the needs of those seeking assisted dying. Evidence suggests that many individuals who pursue assisted dying do so because of inadequate access to care, not because death is their true preference.

7. Slippery Slope: Evidence from Other Jurisdictions

Countries like Oregon and Canada, often cited as examples of “successful” assisted dying laws, reveal concerning trends:

• Broadening Eligibility: In Oregon, individuals with non-terminal conditions such as anorexia and arthritis have been granted assisted dying, contrary to initial restriction. In Belgium, children are also eligible for assisted dying, undermining the requirement for ‘capacity’ when giving informed consent.

• Complications in Deaths: The romanticized narrative of “peaceful deaths” is undermined by cases involving prolonged suffering, with some individuals experiencing convulsions or requiring hours to die after ingesting life-ending drugs.

• Cultural Normalization: Data from Canada shows that euthanasia has been normalized, with alarming public support for expanding its use to non-terminal reasons like poverty and homelessness. Eligibility criteria has become increasingly permissive over time. By 2023, one in 21 deaths were medically assisted deaths.

Conclusion

The Terminally Ill Adults (End of Life) Bill poses a grave threat to the foundational ethical principles that underpin our society. By legalizing assisted dying, it risks dismantling the moral framework that protects the vulnerable, undermining trust in healthcare and legal systems, and prioritizing death as a solution to systemic failings rather than addressing those failings directly.

Evidence from jurisdictions with similar laws demonstrates how such measures can spiral into broader, unintended consequences, including expanding eligibility to non-terminal conditions, eroding safeguards, and normalizing death as a response to suffering. This Bill reflects a troubling disregard for the complex realities faced by terminally ill individuals and the evolving nature of their needs.

We urge the Committee to reject this Bill in its entirety. The focus must remain on life-affirming measures that strengthen palliative care, provide equitable access to support, and educate the public about their options for living their final days with dignity and hope. The moral and societal costs of passing this Bill far outweigh any perceived benefits.

Thank you for considering this submission. We remain available to provide further input or clarification as needed.

Yours sincerely,

Dr Clare Craig Dr Jonathan Engler

Co-Chairs HART, www.HARTgroup.org