The NHS Mortal Coil Hub

The Terminally Ill Adults (End of Life) Bill

The votes (330-275 in favour) in the momentous Second Reading debate on the Terminally Ill Adults (End of Life) Bill had not even been counted before a war of words broke out inside and outside the House of Commons debating chamber. Shortly after 10.30am, Danny Kruger MP, speaking in opposition to the Bill, had just reached the words it is what happens everywhere suicide is legal when he was interrupted by calls of “point of order”.

Hansard records the following

Cat Eccles

(Stourbridge)(Lab)

On a point of order, Mr Speaker. The hon. Gentleman is using incorrect language. It is not suicide. That is offensive. I ask him please to correct his language

Mr Speaker

That is not a point of order.

Danny Kruger

I am sorry if offence is given, but the fact is that the value of having a Bill in black and white is seeing what the law really is. What the Bill would do is amend the Suicide Act 1961 [At this juncture Cat Eccles MP could be seen shaking her head, in apparent disagreement]. It would allow people to assist with suicide for the first time. I respect the hon. Lady’s concern, but I am afraid we do need to use the proper language here.

Danny Kruger is quite right, of course. Clause 24 of the Bill amends the Suicide Act 1961, in order to remove what would otherwise be criminal liability for the specific form of assistance to a person to end their life that the Bill proposes to put in place. This is the Bill’s most important legal consequence, and it has to be spelled out in terms in the language of the legislation. It is bizarre to see a Member of Parliament in the course of a debate in the House of Commons shaking her head in disapproval of the use of the language of the law. This goes far beyond shoring up the currency of the euphemism “assisted dying” in any reasonable attempt to distance it from the risk of contagion of suicidal ideation in the wider public. In a later post on X Ms Eccles repeated what she had said in the Commons: It’s incorrect use of language and offensive. The Samaritans advice says this. But this is itself incorrect. Nothing in the Samaritans’ published media guidelines for reporting suicide advises against this use of the word in this context.

Danny Kruger concluded his speech with a plea for the start of a proper debate about dying well, in which we have a better idea than a state suicide service.

His phrase a state suicide service was rapidly subjected to criticism outside the Commons, with News Agents journalist Lewis Goodall posting to X a few minutes later, describing it as pretty inflammatory language and continuing

See all the famously robust Elon fans are annoyed by this.

What is being proposed is not a “state suicide service”

It is for a very small number of people with judicial and medical safeguards. It does not provide for suicide on demand. Its opponents have good arguments. They don’t have to resort to outlandishly mischaracterise what is being proposed.

If you don’t like the word inflammatory, fine. Let’s agree on crude? Crass? Inaccurate? It implies something about the bill which is not correct

He then pursued this as a talking point in his News Agents interview with Kim Leadbeater MP shortly after the vote

Lewis Goodall: Danny Kruger talked about the idea that this will establish a state suicide service. What’s your reaction to that?

Kim Leadbeater: I love Danny, Danny texted me last night, we will be friends. We met before I came into Parliament but I’m uncomfortable with that language. I don’t think that’s helpful. I think we need to come back to the fact that these are people who are dying who want the choice and the dignity and the autonomy that this Bill would give them. So I think we need to be careful about the language that we use and I think it needs to stay compassionate and respectful

Lewis Goodall: Because people are repeating it online. Online is online, Twitter is Twitter, whatever, but is there a bit of a danger that this gets taken out of context and proportion, that sort of language, because people pick up on it and they start to get afraid of it

Kim Leadbeater: I think people will feel very emotional today for lots of different reasons and I would ask people, particularly on social media, just think about the consequences of what they say, because words do have consequences, and social media can be a pretty horrible toxic place ... so let’s try and keep things respectful

I’m against outlandish mischaracterisation, and absolutely deprecate comparisons between the effects of the Bill and the Nazi crimes of Tiergartenstrasse 4 and the like, but the person who is incorrect here and who has taken a phrase out of context and proportion is Goodall. The Bill does enable the creation of a state [assisted] suicide service, although of course that would never be its official name. But as a matter of literal interpretation and understanding of the effect of this proposed legislation, suicide is the intentional act by which terminally ill people who comply with the requirements of the new law will end their lives. And the state will assist them to do so. Clause 32 of the Bill is in a section headed Provision through NHS etc. and is itself headed “Secretary of State’s powers to ensure assistance is available”. It is no more than an outline which leaves a great deal still to be worked out, but it enables the government to make arrangements for the provision of assistance to people in England and Wales to end their lives in accordance with the new law, and in particular enable the provision of such assistance as part of the health service in England and the health service in Wales.

The fact that only a limited cohort of people will be eligible for this assistance at any particular time does not prevent it from being a “state [assisted] suicide service”. Many state services have limited eligibility criteria, such as NHS Continuing Healthcare Funding which pays on a strictly defined and controlled needs-tested but not means-tested basis for long term care outside hospital. Those who are eligible for assistance and comply with the formal requirements of the new assisted dying law, if it comes into force, will be entitled to assistance on demand. The safeguards involving two doctors and the High Court are compliance checks for eligibility and not genuine discretionary decisions about whether an eligible person is entitled to assistance in dying or not. In some respects the Bill even goes beyond demand. Clause 4(1) dealing with initial discussions with registered medical practitioners allows them to use their professional judgement to decide if and when it is appropriate to discuss the provision of assistance in dying with a patient – in other words to introduce the subject to someone who may not have been thinking of it or even aware of the possibility. And clause 18(6) permits the doctor who is present at the moment of assisted dying to positively assist the patient to ingest or otherwise self-administer [the approved drugs for ending life].

It is not only reasonable but important that people understand that this is what a change in the law to introduce assisted dying means. Retired Supreme Court justice Jonathan Sumption wrote in an article in The Times on 30 November 2024

If the bill is passed in its current form . . .terminally ill patients will be able to call for professional assistance to kill themselves. The impact of this change is softened by reassuring euphemisms. The words “euthanasia” and “suicide” will not be found in the substantive provisions of the bill. Instead it is all about “dying” or “end of life”, the most natural thing in the world. But anyone supporting a measure like this must be prepared to face up to the reality of what is happening and not take refuge in circumlocutions”

He is right. Terminally ill people approaching the end of their lives deserve compassion and respect. None of us know what we will face at the end of our own lives. Limiting the risk of contagion of suicidal ideation beyond the terminally ill who seek assistance in dying, and upholding suicide prevention in that wider population justifies a measure of euphemism. But compassion and respect should never preclude the use of literal and accurate legal language by law-makers, commentators and anyone who seeks to understand the law as it may affect their own life or that of someone in their family.

Meanwhile, Esther Rantzen, who has been the celebrity figurehead of the campaign for the Bill, and to whom Keir Starmer promised the debate and vote on it, was interviewed by the BBC for her reaction. She has always recognised that any change in the law might come too late to make any difference to her, and that she would choose to travel to the Dignitas clinic in Zurich for an assisted death there instead. Both on the BBC’s Radio 4 PM and BBC2 Newsnight programmes of 29 November she speculated that the vote for the Bill meant that her family could accompany her to Switzerland without fear of prosecution on their return home. But nothing in the vote changes their legal position in any way. The Bill has further stages of Parliamentary scrutiny before it can become law, and when and if it does become law, it will only apply to England and Wales and make no difference to anyone assisting a suicide abroad – other than possibly to make prosecution of accompanying family members more rather than less likely. Under current guidelines it is unlikely that her family would face any investigation or prosecution simply for helping her to make travel arrangements and accompanying her to Dignitas. It is obviously a positive thing for her and her family that they should feel they can accompany her to the end of her life, but producers of serious BBC news programmes can and should do more to explain the true legal position to the public. People need to consider not only the risk of prosecution for assisting suicide, but of forfeiture of inheritance by family members who have assisted a suicide, whether prosecuted or not, and the need to apply to the High Court for discretionary relief from forfeiture, which has been granted in some similar cases. Esther Rantzen also said to Newsnight that compassion is replacing a cold, hard, legal framework. A dying woman is entitled to indulge herself with that view. But what is the Bill (or any legislation) but a hard legal framework, and what should Parliament be doing but making a durable legal framework? Too cold and hard in the view of Jonathan Sumption, who described its vaunted “robust safeguards” as over-engineered, bureaucratic, and coldly inhumane. Parts of it read like the protocol for an execution.

Esther Rantzen told PM that she and her family would buy a cuckoo clock and a box of chocolates and enjoy my assisted death – a light-hearted and curiously dated cliché of Switzerland. Zurich is more a city of banking, reinsurance, and pharmaceuticals than cuckoo clocks these days. The author Julian Barnes, an advocate for assisted dying, wrote in the Guardian on 15 June 2024 that The flight to Zurich sounds like the worst mini-break possible...and imagined that if his last journey was to Zurich he would have a brief farewell to the paintings of Felix Vallotton. These elegiac visions of a terminal mini-break are far removed from the likely reality of a state suicide service in England and Wales. If and when the law comes into force, one day we will be able to wait our turn for our assisted dying appointment at the NHS Mortal Coil Hub in a car park on the suburban ring road of the nearest city.

Barbara Rich

Illustration: detail from Felix Vallotton: The Invalid (1892) Kunsthaus Zurich