Brexit and the waning days of the United Kingdom

[Sheilbh]

I thought this was interesting in their letter - as I say I think the procedural approach has really not helped supporters of the bill:

Writing from opposite benches as the father and mother of the house, our concerns are twofold, relating both to the process regarding the bill and its likely practice once implemented. Regarding the process, we have seen our fair share of bills over the years: some good, some bad. Whatever the merits of a bill, laws are always better if there is proper scrutiny and plenty of expert advice has been sought. This is particularly the case with private members' bills, which often do not enjoy the independent scrutiny that government lawyers can offer.

When MPs last voted on this issue less than a decade ago, in 2015, Rob Marris published his private member's bill a full seven weeks before MPs voted on the proposal at second reading, providing time for scrutiny and debate. In contrast, Kim Leadbeater's bill was published just 18 days ahead of second reading.

The inadequacy of this timescale is heightened by the unprecedented number of new MPs. Parliament will have sat for just 12 weeks by the time MPs vote on what is, quite literally, a matter of life and death; many MPs are still relatively unfamiliar with normal parliamentary procedure, let alone for private members' bills, of which this will be the first in this parliament. There is more than a suspicion that the pressure groups behind this proposed change have sought to take advantage of an inexperienced new parliament. Either way, the flawed process has been lamentable and wholly unacceptable for a matter of such importance.

Abbott abstained in 2015 but is now voting no. There's a few who have gone from supporting assisted dying in 2015 to opposing this bill, like Wes Streeting. I think there was a deliberate attempt to do it early and do it quick which has backfired - Leigh is a very right-wing Conservative (who will have religious objections to this) and Abbott is a very left-wing Labour MP. So them making a joint intervention is striking.

I think that section's context is important:

Evidence from elsewhere suggests those most at risk when assisted suicide is legalised are vulnerable minorities. Such people, unlike privileged elites who are used to exercising autonomy over every part of their lives and who can afford good-quality social and palliative care, are most likely to resign themselves to an assisted death against their will because they are unable to access the support they require.

Imagine the pensioner whose children cannot afford houses of their own watching her limited savings, earmarked for those children, disappearing on social care and so feeling a "duty to die". And, sadly, it is not impossible to imagine a malevolent family member tacitly pressuring a disabled terminally ill relative to consider an assisted death, either because of the time-consuming and emotional burden their care has become, or even to be able to access the assets they will inherit more quickly. Or consider the elderly widow who has been hospitalised and worries she is taking up a valuable bed in an NHS under significant strain and would be better off dead.

I'd add on that last example I've had at least one elderly relative who we later found out was told by an NHS staff member how much the hospital bed she was using cost the NHS. When I was in hospital with an injury for a week just before covid I overheard staff talking about "bed-blockers".

The intervention by four new MPs was also striking:

The four new Labour MPs who have spoken to the Guardian said they were convinced by Streeting's argument that NHS care was not good enough to allow assisted dying to be legalised.

Antonia Bance, a former senior aide at the Trades Union Congress who became an MP in July, said: "We were elected to fix the NHS – but it will take time. Yet somehow we are in a position where we may legalise assisted dying, knowing that many people may opt for it because they can't get the care they are entitled to from our broken NHS."

James Frith, the Bury North MP who returned this year, said he had deep concerns about the quality of palliative care, and said that good care was "undervalued". He said a member of his family was facing terminal cancer and the legislation did not address his concerns around coercion and doubt.

"I think this risks feeling rushed and not the right time," he said. "It's also a door I don't want opened by a new parliament learning its skill, given too little time and with much that can be added once the principal shift happens. For me, this is protecting our most vulnerable groups as well as all of us at our most vulnerable."

Mel Ward, the former chief executive of Medical Aid for Palestinians who is now the MP for Cowdenbeath and Kirkcaldy, said she had spent time listening to arguments on both sides before deciding to vote against.

"The strongest argument in favour of the bill is about personal choice and freedom, that has come across really clearly. But my concern is in seeking to do that, we are going to put at risk a much larger group of vulnerable people," she said.

Polly Billington, the MP for East Thanet and former special adviser to Ed Miliband, said her concerns were "the risks around internalised pressure and the problems of capacity combined with some of the considerations for our healthcare professionals and medical teams".

"None of that has been articulated and it needs to be," she said. "Far too many people are saying: 'Oh, don't worry about that, let's agree the principle and we can sort out the practicalities later,' and that's just not good enough," she said.

[Tamas]

Evidence from elsewhere suggests those most at risk when assisted suicide is legalised are vulnerable minorities. Such people, unlike privileged elites who are used to exercising autonomy over every part of their lives and who can afford good-quality social and palliative care, are most likely to resign themselves to an assisted death against their will because they are unable to access the support they require

Oh FFS I missed that part. Does really EVERYTHING have to be made into a race thing?

[garbon]

Evidence from elsewhere suggests those most at risk when assisted suicide is legalised are vulnerable minorities. Such people, unlike privileged elites who are used to exercising autonomy over every part of their lives and who can afford good-quality social and palliative care, are most likely to resign themselves to an assisted death against their will because they are unable to access the support they require

Oh FFS I missed that part. Does really EVERYTHING have to be made into a race thing?

[Valmy]

Evidence from elsewhere suggests those most at risk when assisted suicide is legalised are vulnerable minorities. Such people, unlike privileged elites who are used to exercising autonomy over every part of their lives and who can afford good-quality social and palliative care, are most likely to resign themselves to an assisted death against their will because they are unable to access the support they require

Oh FFS I missed that part. Does really EVERYTHING have to be made into a race thing?

In the United States fucking race pervades everything, you don't have to say a damn word about race for it to end up being about race. It is just our curse.

The UK clearly feels jealous about that because they seem to keep trying to adopt our own terrible qualities just to be more like us. At least that is what it seems to me.

[crazy canuck]

Evidence from elsewhere suggests those most at risk when assisted suicide is legalised are vulnerable minorities. Such people, unlike privileged elites who are used to exercising autonomy over every part of their lives and who can afford good-quality social and palliative care, are most likely to resign themselves to an assisted death against their will because they are unable to access the support they require

Oh FFS I missed that part. Does really EVERYTHING have to be made into a race thing?

I assume he means that it is not just "minorities" who are not privileged elites.

[Sheilbh]

I did not read "minorities" as being about race or ethnic minorities.

[Barrister]

Evidence from elsewhere suggests those most at risk when assisted suicide is legalised are vulnerable minorities. Such people, unlike privileged elites who are used to exercising autonomy over every part of their lives and who can afford good-quality social and palliative care, are most likely to resign themselves to an assisted death against their will because they are unable to access the support they require

Oh FFS I missed that part. Does really EVERYTHING have to be made into a race thing?

So I think I've talked about the Canadian experience in assisted suicide (MAiD in Canuckistani-speak).

But yeah - it seems to lead to a lot of subtle pressure on more vulnerable groups to agree to MAiD, even if perhaps that might not be their first wish.  More about concerns about being a burden on kids, or society at large, and often tied up with issues of poverty - and not any particular desire to end their life at that exact time.

[Tamas]

At the very least that's a very condescending view of those vulnerable groups. As if you are poor or such you don't have the mental capacity to make decisions about your life.

[Tamas]

Plus, again, how is that not a argument against abortion as well?

[Valmy]

Plus, again, how is that not a argument against abortion as well?

Oh it gets used about abortion all the time.

[garbon]

I did not read "minorities" as being about race or ethnic minorities.

Agreed.

[Sheilbh]

But yeah - it seems to lead to a lot of subtle pressure on more vulnerable groups to agree to MAiD, even if perhaps that might not be their first wish.  More about concerns about being a burden on kids, or society at large, and often tied up with issues of poverty - and not any particular desire to end their life at that exact time.

Yeah that is what I think has changed a lot of the debate in the last few years. I'd also add covid - there is still a slightly unresolved question around the use of "do not resuscitate" forms in the NHS during covid. That's something that was explicitly called out in the leading disability rights group coming out explicitly against the legislation today:

Although there is talk of the robustness of checks and balances in the assisted dying bill to prevent Disabled people being coerced, as a leading organisation for Disabled people in Britain we know from bitter experience that words and laws do not always add up to protecting Disabled people.

This was evident during the pandemic, where we were often denied life-saving care, and where 60 per cent of all deaths from Covid were those of Disabled people, who comprise 24 per cent of the population. We have huge empathy for Disabled people who live with pain and wish to make an informed choice to have control over the end of their lives.

However, given the severe inequalities for Disabled people within society, especially relating to the quality of health and independent living support, we can no longer maintain a neutral stance, and believe that upholding quality of life should be the focus of the government.

Giving us dignified and equitable lives should come before putting in place ways of assisting us to die.

Kamran Mallick

Chief Executive, Disability Rights UK

The Institute for Government (which is very process based think-tank) also did a bit report on how this has been totally the wrong approach for this type of legislation. Very short time to review the bill, very short debate, up-down vote - which wasn't the only approach.

As I say, I think there was a strategic decision taken early to do it quick and do it early which has backfired. I still wouldn't be surprised if it passed but the legislation is really under sustained criticism from all sides as legally not robust enough, not enough time to consider and people's concerns being dismissed (lots of focus from Dignity in Dying on churches opposing it when about 5% of the country go to church).

This issue comes up for a vote in parliament every 10 years or so. If it fails I think there'll be a fair amount to learn from the way this proposal was handled.

[Barrister]

At the very least that's a very condescending view of those vulnerable groups. As if you are poor or such you don't have the mental capacity to make decisions about your life.

Is it condescending, or realistic?

We have lots of regulations to protect people from themselves, on topics much less important than ending one's own life.  We have lots of regulations about, say, advertising.  Is it condescending to people to think they won't read the fine print which contradicts what an ad clearly says?

Let's take a not uncommon situation.  You're in your 70s.  You have a chronic illness (I dunno - COPD or something) but nothing that's going to kill you right away.  A very nice doctor comes by and says "so when should we schedule you for a MAiD consultation?", despite you never raising the issue yourself.  You think to yourself - your meagre savings are going to be exhausted sooner or later, and maybe it would be better to just die and leave that money to your kids and grandkids.

So despite the fact you don't really want to die, you agree to the MAiD consult - who promptly schedules your death a few weeks later.

I don't think it's "lacking mental capacity" to acknowledge all of the pressures someone who is old and/or ill might feel about committing suicide if and when it is offered.

[Barrister]

Plus, again, how is that not a argument against abortion as well?

Oh it gets used about abortion all the time.

Absolutely.

I am not a strict pro-lifer.  Abortion has its place.  MAiD has its place.

What I am very much against is the complete normalization of either procedure - that it should be seen as no different than having a tooth pulled or something, instead of the end of a human life.

Again when it comes to MAiD - every once in a while we gets these stories about someone with a chronic illness who elects to commit medically-assisted suicide because of reasons that obviously have everything to do with poverty.

[Sheilbh]

Is it condescending, or realistic?

Yeah I think their phrasing and point is right. Some people are used to exercising individual autonomy and being heard - frankly people like me. Middle class, educated professional, white man, comfortable disagreeing with a medical professional or pushing back - but many people don't have that experience. They're either not heard, they're not comfortable disagreeing with a medical professional, they don't want to cause a fuss etc. This is all stuff we've said in this thread about the need to self-advocate (or have someone who can advocate for you) in the NHS.

I think it is just applying that to assisted dying and making sure there are really strong, robust safeguards in place to make sure an individual's choices are really being heard. I don't think that's been taken on board by Leadbetter in drafting this legislation.

We have lots of regulations to protect people from themselves, on topics much less important than ending one's own life.  We have lots of regulations about, say, advertising.  Is it condescending to people to think they won't read the fine print which contradicts what an ad clearly says?

Yeah I mean the government restricts buy one get one free offers or advertising for high fat, salt or sugar goods. We acknowledge social pressure in lots of legislation and, broadly we should even if I think we can sometimes go too far.