While many people support a right to medical assistance in dying for terminally ill patients, there are many reasons why its implementation may not be advisable. The Terminally Ill Adults (End of Life) Bill introduced in the parliament (the Assisted Dying/Suicide Bill) introduced by Kim Leadbeater MP in the UK Parliament seeks to allow patients with a terminal illness (any inevitably progressive [and irreversible] illness that can be reasonably be expected to cause the death of the patient within 6 months) to be provided with assistance to end their own life on request. The Bill purports to provide for adequate safeguards to prevent abuse and ensure that patients with terminal illnesses are afforded complete agency over their lives.

The issue of safeguards is itself a problematic framing of assisted dying. Acknowledging that safeguards are necessary concedes that the societal space in which this legislation is enacted is not neutral. Foremost, the need for safeguards indicates that this is a space in which abuse can and is likely to occur without such safeguards. It is an acknowledgement that the space has a power hierarchy, which has been abusive and needs caution/restriction. 

For assisted dying, one of the abusive power structures impacted by the enactment of this bill is disablism. This includes admitting that institutional disablism within the medical profession, cultural disablism within our communities, and interpersonal disablism that affects the interactions between individuals—in this case, between doctors and patients—are all relevant to the bill.

An assisted dying bill cannot be safely implemented within a disablist society, and Britain is both systemically and institutionally disablist. Austerity and spending cuts for over a decade have all but decimated support for disabled people and have caused hundreds of thousands of avoidable deaths. Disabled people’s needs were ignored by policymakers during the Covid-19 pandemic. The attitude of policymakers was further exacerbated by medical professionals, with doctors pressuring disabled patients to add “do not attempt resuscitation” orders onto their files, and some doctors unlawfully doing so on some patients without their (or their carers’) knowledge or consent. One of the principal backers of the bill, AC Grayling, has previously called for the bill to include non-terminally ill “wheelchair bound” and depressed people. 

This attitude and the belief that disabled people are ‘suffering’ because of our impairments (as opposed to being oppressed by disablist attitudes and institutions) is pervasive within society and the medical fraternity. None of this inspires faith in the capacity of an institutionally disablist medical fraternity to adhere to safeguards within the proposed Assisted Dying bill.

For responses to the bill in its current state, the bill provides explicitly, under section 4(2), that a registered medical practitioner may exercise their professional judgement and decide if and when it is appropriate to “discuss” the matter of assisted dying with a patient. This section does not impose any duty on the doctor but permits doctors to raise the issue at an appropriate time. The bill’s focus here is on permissibility towards and subjective reasoning of medical practitioners rather than on patients’ agency. It ignores the history of doctors pressuring disabled patients (in Britain and elsewhere) into accepting their subjective beliefs about our medical needs and our agency to choose (or not) what kinds of lives we wish to lead.

Evidence from countries which have already legalised some form of medically assisted dying has not been promising. For example, in Canada, where Medical Assistance in Dying (MAiD) legalised assisted suicide for terminally ill patients in 2016. This was watered down in 2021 to include those suffering from grievous and irremediable conditions that were not terminal, and pro-MAiD organisations are advocating for eligibility to be extended to mature minors too, demonstrating the very real slippery slope Canadian policymakers have been sliding down since the enactment of MAiD. While the legal criteria require medical reasons for seeking MAiD, in practice, many disabled people have sought it due to social reasons such as homelessness and isolation, some citing that they did not want to be a burden. 

This is concerning, not just because we live in a capitalist society that forces us to internalise value hierarchies and are made to feel unworthy of living if we cannot perform labour for capital, but also because society is responsible for alleviating suffering rather than excusing itself of this responsibility by eliminating those who suffer. Some of the evidence submitted before the committee for the assisted dying bill disclaims any harm resulting from the legalisation of assisted dying in Canada, choosing to ignore rather than address the problems that many disabled people have raised.

Arguments in favour of legalisation often conclude by claiming that the notion that disabled people are vulnerable to undue influence and need protection from themselves patronises disabled people and, therefore, should be ignored. This misunderstands why so many of us (as disabled people) are against the legalisation of assisted dying. Ironically, many of us are using our voices and agency to fight against this bill but are ignored by people who care more about libertarian notions of freedom than systemic problems of abuse that already exist and will only get worse. Indeed, one of the major concerns is not that we will be subject to undue influence but that we have been given ample evidence that medical professionals cannot be trusted to respect our choices when they do not match their ideas.

In deciding whether to support the passing of the Assisted Dying Bill, I would urge citizens and lawmakers to seriously consider the kind of society in which this bill is discussed. As the cost of living keeps rising, austerity continues to decimate our social support systems. Health Secretary Wes Streeting has already (rightly) expressed that palliative care in Britain is not in a place where the choice of assisted dying may be considered truly ‘free’. 

This extends to disabled people more generally: society systemically devalues several classes of people: poor, disabled, non-white, trans, queer, and many others. We live in a system that treats our productivity as our inherent worth, forces us to internalise shame for simply resting, and forces us to work even if doing so may kill us. In a system that regularly makes us feel like people who are sick are burdens on society, there is no way to safely implement a right to assisted suicide without risking further devaluation and abuse of the most marginalised people. 

If you wish to get involved, please consider submitting evidence to the select committee (see details in this article by Susan Moore) or writing to your MP about their vote on the bill.