On November 29, 2024, while introducing the Terminally Ill Adults (End of Life) Bill 2024-25 (The Assisted Dying Law) to the British House of Commons, the Member of Parliament, Kim Leadbeater told a rather distressing story of an “agonising death”.
A 47-year-old music teacher with a young son, Ms. Leadbeater said, had suffered from bile duct cancer which obstructed his bowel. On his last day, this saw him vomit faecal matter for five consecutive hours, before he choked and died. The vomiting was so violent that he could not be sedated and, what is worse, he had stayed conscious through the ordeal. All the while, his wife pleaded with doctors to help. But the physicians treating him were helpless. The look of horror on his face as he died, his family say, is something that will never leave them.
Ms. Leadbeater narrated the teacher’s case to illustrate the suffering that many others face from deadly illnesses, with no choice available to them to seek assistance in ending their pain. The draft law — which gives terminally-ill adults (in England and Wales), with less than six months to live, the right to die, once they have a request signed off by two doctors and a high court judge — was intensely debated. Eventually, the Bill was passed with a majority of 55 votes, with 330 members voting for it and 275 against.
In somewhat unusual circumstances, the Members of Parliament had been released from the tethers imposed on them by their party whips. They had been asked to decide as their conscience willed. As a result, what ensued was all manners of interesting voting patterns. Prime Minister Keir Starmer and his Conservative predecessor Rishi Sunak voted in favour. The Deputy Prime Minister, Angela Rayner, and the Health Secretary, Wes Streeting, rejected the draft.
The complexity of the issue
With its passing in the Commons, the proposal is now slated for review by a Public Bill Committee, which will scrutinise, fine tune, and suggest amendments to its various clauses, before it returns the draft to Parliament for an ultimate sanction. Therefore, there is still some way to go. But seeing how previous efforts, to bring about a law to allow assisted dying, have floundered, the Bill’s passing represents a milestone, a victory for those who consider the right to die, when faced with an intolerable ailment, as intrinsic to human liberty.
At the same time, the sharply divergent views expressed amongst lawmakers in Britain also shows us just how complex an issue this is. The debates contain in them lessons that the rest of the world can take, in deciding how best to allow people to both lead, and end, their lives, with dignity and compassion.
The opposition to the law primarily rests on two planks. First, opponents argue that the law is premised on a “slippery slope” — that it would be practically impossible to draw boundaries limiting the right to assisted death, and that the old and the disabled might be pressured into choosing to end their lives in the midst of fears that they might wind up becoming a burden on their loved ones.
Critics also claim that a similar law employed in Canada has produced worrying results. Originally, following a 2015 judgment of the country’s Supreme Court, the government opened up avenues to allow assisted dying for those whose death was “reasonably foreseeable”. But the law has since been expanded through judicial interpretation to make it applicable even to those facing a “grievous and irremediable medical condition”. In so doing, the bright lines of the rule, the Bill’s detractors say, have been dimmed.
‘There are legitimate cases’
Proponents of the law counter the criticism by pointing to how the very invocation of a slippery slope suggests that those making the argument are offering a concession: that there are legitimate cases where it might be justifiable to help someone die. Moreover, the law, as drafted, they say, is carefully tailored: it only includes adults competent to make decisions, who are ailing from a terminal diagnosis and who have less than six months to live, to seek assistance in ending their lives.
Additionally, the person making the claim will be independently assessed by two doctors, with a 14-day reflection time afforded to them, and no decision will be sanctioned without the High Court’s approval. Lord David Neuberger, the former President of the U.K. Supreme Court, argues that the Bill’s clauses are tightly worded enough to ensure that the law respects people’s right of personal autonomy, and that there really is no chance of its scope being enlarged through judicial challenge.
The second cause for opposition stems from rather more traditional, philosophical grounds, sometimes resting on considerations of religion and faith. The proposed law, these critics claim, is simply deceit disguised as compassion, and offends the inviolability of the right to life. In response, the Bill’s supporters concede that in most cases, there ought to be serious objections to the taking of one’s life, and to avoidably allowing people to die. In ordinary circumstances, objections founded on a person’s right to life would prevail. But the conflict here, as they demonstrate, is not especially irreconcilable. For, as Ms. Leadbeater and others have shown, the moral background in which the debate resides cannot permit a wholesale embargo on physician-assisted deaths. After all, every adult, we generally recognise, has the right to make significant decisions on how best to lead their respective lives. This freedom, grounded in the sovereignty of our bodies, may stem from religious faith or simply from conscience, but, regardless, it is something that is embedded in each of us as human beings.
The state, no doubt, owes to us a duty to ensure that we do not indulge in what Ronald Dworkin described as “irrevocable acts of self-destruction”. But, equally, the exercise of this duty can under no circumstances “justify forcing a competent dying patient to live in agony a few weeks longer”. To do so would impinge squarely on the freedom that each of us enjoys over our lives and bodies.
On choice and dignity
In many ways, the debates in Britain assume universal value. In India, the Supreme Court has previously recognised a limited freedom to die, a right both to passive euthanasia and a right to make an “advance medical directive” — that is a liberty to stipulate one’s preferences for medical treatment, or the withdrawal thereof, should one become incapacitated in the future. In its judgment in Common Cause (A Regd. Society) vs Union of India (2018), the Court found this right as essential to liberty, as “an element of the privacy of the being”.
The road from here to assisted dying is clearly a long one. But the reasons which compel one to hold in favour of individual dignity surely apply just as vigorously to how one might want to go about dealing with a terminal illness in their last days. The latter choice is as critical to one’s dignity and independence as it is to any other decision that a person makes over her body and life.
Deliberations made in Britain’s Parliament have shown us that making laws to govern assisted dying is a complicated affair. But the mere prospect of a slippery slope, or the possibility of abuse, cannot detract from the fact that at stake here is something central to human dignity — that is, the ability to allow people to make conscious choices to alleviate the most crushing forms of pain and suffering.
One can argue over the fine print of what a law that allows for assisted dying must contain. But there can be no doubt that the rudimentary principle on which such a legislation will inevitably rest is founded on ideas that are central to our existence, to our freedom to lead meaningful lives, and to the rights to privacy, dignity, and autonomy.
Suhrith Parthasarathy is an advocate practising in the Madras High Court
Published – December 12, 2024 12:16 am IST
