Nathaniel Dye knows death will soon be upon him with cancer spreading to his liver, lungs and most recently his brain. He knows too that with a mother and fiancé succumbing to the disease, his passing, even with palliative care, could be deeply troubling.
The assisted dying bill that will be voted on in the UK parliament this Friday could help Nathaniel and hundreds of others with terrible conditions “avoid that worst-case scenario of a horrific death”, he said. Allowing someone in acute pain, with death the only possible outcome, would seemingly be a straightforward vote for MPs.
But The National has spoken to those on both sides of debate, exposing views that suggest not only empathy for the terminally ill but also a worrying direction that legitimising death can take.
With a younger generation of MPs, there are surveys that show 54 per cent support the legislation, with 35 per cent opposed and the rest undecided. Outside parliament, polling by the KCL Policy Institute found that 63 per cent of people in England and Wales were in favour of assisted dying. Also, the British Medical Association has switched its previous opposition to neutrality.
Justice Secretary Shabana Mahmood is among those in opposition. As a Muslim, she said, “I have an unshakeable belief in the sanctity and the value of human life”. She is also against the idea that “death is a service that the state should be offering”.
Ms Mahmood’s view is shared by Health Secretary Wes Streeting, a committed Christian, who believes the already stretched NHS does not have the capacity to deal with assisted dying. Instead, he wants more to be invested in palliative care, which is desperately underfunded in many parts of Britain.
Shockat Adam, an independent MP who is a Muslim, told The National that while it was “an extremely emotive, sensitive issue” and those advocating for it “have sincere reasoning”, he was voting against, mainly in light of representations from his constituents.
He highlighted an increase in deaths in other places where legalisation has happened, including Canada and the Netherlands, saying “legalising suicide” is “the beginning of a slippery slope”. Mr Adam thinks that Britain should instead concentrate on end-of-life care, “which is appallingly funded”.
Suicide culture
One result of legitimising assisted death, its detractors say, is the permission culture that evolves, with more suicides, as well as those with mental problems demanding their right to die. “We fundamentally believe that we shouldn't change the law, because what we see around the world is where the law has changed there has been an incremental expansion of laws over time that have been extended to include non-terminally ill people,” said Alistair Thompson of the Care Not Killing pressure group.
The Netherlands and Belgium have allowed people with mental health problems such as depression, anorexia and bulimia “to be euthanised”, he said. “Once you say we should be killing people in certain circumstances, then it's very difficult to limit it, which is the experience of other countries,” he added.
Terminally Ill Bill
The UK’s Terminally Ill Adults (End of Life) Bill will allow adults who are dying to express a “clear, settled and informed wish to shorten their death”. They must have the mental capacity to make that decision.
They must also have a terminal illness and be expected to die within six months, as assessed by two independent doctors and a High Court judge. The lethal medication would have to be self-administered.
“Too many dying people in Britain are choosing between suffering unbearably in their final days and weeks, or trying to find £15,000 for an assisted death in Switzerland, or taking matters into their own hands behind closed doors,” said the Dignity in Dying pressure group. On average 650 terminally ill people take their own lives every year, it added, as currently “assisting a suicide” is a crime with a maximum sentence of 14 years.
Dignified death
The clearest reason in favour is giving people the choice to end unnecessary suffering, said Trevor Moore of My Death My Decision. “When their suffering gets too much, they can ask for medical help to die,” he says, adding that currently many in that situation “take things into their own hands and come to a bleak end, often in secrecy, rather than in calm circumstances”.
The way in which people die is “so much more measured” in assisted dying, he said. It also helps the victim to know that they are going to have “a dignified death” and the “grieving process is so much better for those left behind”.
There is already a law in place under which patients can state they no longer want to receive life-saving treatment, which medics have to obey. This happened to Mr Moore’s mother-in-law, who was suffering from an incurable illness, but rather than ending her life in a calm manner she was “really frightened, not knowing what was happening”.
Poor at risk
A major concern for Dr Nadia Khan, of the British Islamic Medical Association (Bima) is that marginalised groups and the poor would “end up disproportionately accessing assisted dying” because the healthcare system was failing them. “We're concerned that assisted dying will have a similar impact where certain people's lives are not deemed as worthwhile living as others,” said the palliative care doctor.
She too warned that once the legislation was in place people outside its scope will go to court to demand assisted dying. “It's very hard to draw a line to say one person’s suffering warrants assisted suicide and not another’s. That will inevitably be shifted.”
Bima, which represents 8,000 Muslim healthcare professionals who voted against the legislation, also called for more funding for palliative care as Dr Khan argued that “a lot can be done” to address physical pain. “I think some of what drives the assisted dying debate is the fear, and I do worry that actually, with this legislation, we are creating more fear of dying,” she said.
The vote
It will be down to MPs, many of them new to parliament, to decide on what will be a momentous decision as each has a “free vote”, with no party whip. The last assisted dying ballot was in 2015 when 329 opposed and 117 were in favour, including the current Prime Minister Keir Starmer.
Aware of the sensitivities – a number in his cabinet oppose the bill – Mr Starmer has yet to declare his position, although it is unlikely he will change his stance.
Faiths against
All mainstream faiths are against suicide, including Islam, with the Quran stating: “Do not take life, which Allah made sacred, other than in the course of justice.” The Bishop of London, Dame Sarah Mullally, decried the “very short period of time” of just five hours' debate being given to MPs on Friday during which “to consider the most complex and emotive of all issues”.
She also warned of “unintended and serious consequences for the whole of society”, especially for those at the most vulnerable point of their lives. The Roman Catholic church argued that “compassion is under threat” in the legislation.
“Compassion means to enter into and share the suffering of another person,” it said in a statement. “It means never giving up on anyone or abandoning them. It means loving them to the natural end of their life, even if and when they struggle to find meaning and purpose.”
Manner of death
But George Carey, the former Archbishop of Canterbury, is a strong supporter of assisted dying, arguing that there is no theological reason to oppose it. He has recently argued that it is “necessary, compassionate and principled” and has condemned church leaders who “have often shamefully resisted change”.
Mr Moore argued that he did not believe “religious views should dominate the rest of us – assisted dying is something whose time has come.” Ultimately, it will be down to Westminster’s 650 MPs to decide on the future options for Britain’s 69 million people.
While Nathaniel Dye is not afraid of dying, he knows that their choice will mean that his family have the opportunity to “live with the manner” of a calm death rather than a “horrific” passing.
