As many people will be aware, I was recently involved in the London bus crash in Victoria where I suffered spinal injuries. I am thankfully recovering well after receiving excellent medical care, but, sadly, my injuries prevent me from being able to speak in the House of Lords during the debate on the assisted suicide Bill. This is an issue I have spoken out against for many years, and which is currently at its Second Reading Stage. I am instead publishing the speech here that I would have given at Second Reading had I been present in the chamber.
It is worth acknowledging at the outset that the issue Parliament is considering is not a new one. Euthanasia of the weak was practised in the ancient world but was rejected as we became more civilised and recognised the equal and inherent worth of each person, regardless of ability or disability, age or capacity. It was also practised in the mid-twentieth century in the name of eugenics.
But, of course, a practice cannot be dismissed simply because of the bad company it keeps. Assisted suicide or euthanasia — a difference without a distinction in many ways — has been reintroduced in a small number of countries in recent decades, and we can look at these jurisdictions to observe what has happened and inform our deliberations in the House of Lords.
And what we can observe from these jurisdictions is a pattern of creeping incrementalism, away from their original supposedly tight eligibility restrictions, and laws which put vulnerable people at risk.
In introducing the assisted suicide Bill at Second Reading, Lord Falconer suggested that assisted suicide laws which have started as terminal illness-only laws have remained that way. However, this is misleading.
Where assisted suicide has been legalised, however tight the initial safeguards and however sincere the assurances that it would be a narrowly defined law for rare cases, the practice has tended rapidly to expand.
Sometimes this is by a clear expansion of the law, such as in the Netherlands and Belgium where assisted deaths are now permitted for children of all ages and have been granted for tinnitus, autism and dementia; or in Canada where it only took five years from the introduction of euthanasia and assisted suicide in 2016 for those whose death was “reasonably foreseeable” — in other words, who were terminally ill — to an expansion to the ill-defined and subjective “serious and incurable illness” criteria in 2021. And Canada has now not only approved the euphemistically-named “Medical Assistance in Dying” for people with mental illness from 2027, but there is also a push to join the Netherlands in allowing infant euthanasia for severely disabled babies. This is not progressive but regressive, a return to pre-civilisation.
In other jurisdictions, the law has expanded by stealth, by the interpretation of “terminal illness” being broadened. For example, in Oregon in the US, a state held up as a model for the law proposed here, people have been approved for assisted deaths with diabetes, arthritis, a hernia and, perhaps most disturbingly, anorexia.
Even if we were to permit assisted suicide with an initially narrow scope, there is a danger of human rights challenges whereby courts rule it is discriminatory to allow assisted suicide for some groups of people but not others, similar to what happened in Canada. Once you permit the practice, you cross a moral and legal Rubicon and it is hard to control the consequences as different groups demand “access” to the same provision. Even last week in the House of Lords, one of my colleagues expressed support for a wider law.
The countries I have cited are not rogue states. In many ways, they are like ours. And yet they have not been able to prevent a rapid expansion in the law or increase in the number of people who die under laws that are sold as being for exceptional cases. In Canada, in 2023, nearly 5 per cent of all deaths were from euthanasia or assisted suicide — over 15,000 people in a country with a population smaller than ours. This is a warning to us.
Other countries have learned these lessons. In Denmark, in 2023 the Council on Ethics looked at this issue and concluded, by a majority of 16 to one, that it was “in principle impossible to establish proper regulation of euthanasia” and recommended to the Danish Parliament that the law should not be changed. We should heed their warnings.
In light of what we have seen elsewhere, I contend the only safe approach is to keep the current prohibition on assisted suicide
Indeed, during its inquiry into assisted suicide two years ago, Dr Lydia Dugdale, Director at the Centre for Clinical Medical Ethics at Columbia University, warned the Health and Social Care Select Committee that “As soon as [assisted suicide] is legalised it expands. The language shifts; it goes from ‘guardrails’ to ‘lack of access’. That is very pernicious. Guardrails are there to protect society more broadly and to keep us from becoming a death-inducing state”.
In light of what we have seen elsewhere, I contend the only safe approach is to keep the current prohibition on assisted suicide, while investing in improved palliative care to support the thankfully very rare cases of people who suffer greatly at the end of life.
I note that the House of Lords Constitution Committee has joined the Hansard Society in confirming that the House of Lords has every right constitutionally to reject this legislation if it believes, as I do, that it would endanger vulnerable people, whether those who may face subtle, often undetectable coercion, such as the victims of domestic abuse or people with Down’s syndrome, or the “self-coercion” of those who feel a burden and will think they have a duty to die if a so-called “right to die” is introduced.
In summary, Pandora’s Box has been opened in countries where assisted suicide or euthanasia have been legalised, and the sad consequences are plain for all to see. Once Pandora’s Box has been opened, there is no going back. We must not proceed along this path if we have any doubt about the consequences.
According to Greek mythology, when Pandora opened her box and unleashed all kinds of ills on humanity, she closed the box before the last thing was able to escape — that thing was hope. Hope is what we need to offer people instead. Assisted suicide is chosen by people who have lost hope — who lack any reason to go on living. Passing this Bill would send a tragic message that sometimes there is no hope and some lives are no longer worth living.
But it does not have to be this way. By investing in social care, by continuing to be a world leader in palliative care and expanding access to it, by being a society that respects life and upholds the dignity of the elderly and people with disabilities, we can give hope to the hopeless and create a society where people can die with true dignity, not by ending their own lives. That is the kind of society we ought to be striving for.
