A plea for removing the "Medical" from Medical Aid in Dying

By Gordon Friesen
President, Euthanasia Prevention Coalition

Gordon Friesen

It is a singularity of the British debate on assisted suicide, that considerable attention has been given to the possibility of creating a non-medical framework for this practice.[1] [2] In what follows we will briefly review the "why" and the "how" of such propositions.

Protecting majority patient interest

In most discussions of medically assisted death, very little concern has been shown for the quality of future care available to those who wish to go on living.

This is a truly extraordinary omission, because although there are some people who might surely wish to die, most of us will not. Nor is this last statement born of speculative opinion. It is an observed fact.

For example, the iconic terror of terminal cancer accounts for roughly 70% of euthanasia deaths in Canada, Belgium, and the Netherlands. And yet, as a share of all cancer deaths, that number is only 1 in 10.[3] Which is to say that only 1 cancer patient in 10 will consent to die by euthanasia (and far fewer in any other group).

In truth, the principal concern of typical dying patients is not suffering. Their main fear is of death itself. And their main comfort, faced with that mortal inevitability, lies not in the willingness of others to cut life short, but in the trust and confidence that family and professionals will value what life remains; and foster that life to the end, allowing them to die without precipitation, in their own time.

Traditionally, this patient confidence has been founded upon a multi-millennial promise affirmed by each individual physician: "I will do no harm or injustice... Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course."[4]

In the opinion of many, the removal of that positive certainty cannot possibly occur without a radical destabilization of doctor-patient relationships.

Assisted suicide and traditional care: mutually exclusive paradigms

Promoters of MAID, for their part, deny that the medically assisted death of willing individuals will have any effect upon the care provided to anyone else.

And yet it seems impossible to believe that physicians (or nurses) who participate in any form of medical homicide might still be considered appropriate caregivers for patients of the non-suicidal majority. One cannot be all things to all people. It would appear frankly inconceivable that the same doctor might pass from one patient to the next --presenting medically in precisely the same manner-- but to change so radically between times in his professional opinions, as to honestly favour the death of one but not the other.

In truth, euthanasia and traditional medicine are not only different, but mutually exclusive visions of patient care, and are practiced by individuals who are different also. Plainly stated: assisted death cannot be "added" to Hippocratic medicine any more than steak can be added to a vegetarian diet.

It is our most emphatic conclusion, therefore (and especially considering the one-sided quantitative division noted above) that any minority accommodation of assisted suicide should be provided apart from existing medical practice, in separate spaces and by separate professionals; that such accommodation must not be allowed to compromise --for others-- that precious clinical culture of trust and safety which physicians have so carefully cultivated over the past 2400 years.

What a non-medical regulating body might look like

In essence, a non-medical framework for assisted suicide would require the creation of a dedicated judicial authority like the Landlord and Tenant Board, or the Food Standards Agency: to evaluate requests, authorize procedures, license providers, regulate practice, and analyze reported data.

To explain the relative advantages of such a system, we will compare its projected operation with that of the most coherent system of medical euthanasia thus far established, that of Britain's close Commonwealth partner, the former Dominion of Canada.

The institutional "footprint" of medically assisted death

In Canada, "Medical Aid in Dying" (i.e. voluntary euthanasia) is defined as medical care whose goal is to relieve "enduring physical or psychological suffering" (2014,[5] 2016, 2021[6]).

In accordance with State duties to provide medical care as a human right,[7] euthanasia is practiced in all Canadian institutions, and by all Canadian professionals (subject only to minimal conscience exceptions). In particular, euthanasia is now an integral part of palliative care,[8] long-term care, and rehabilitation.[9] In all of these areas, professionals are theoretically expected to remain officially neutral regarding a patient's will to live; to "respect" whatever suicidal ideation might arise; and are empowered even to both initiate and channel that ideation themselves.[10] [11]

Finally, all meaningful limits to eligibility --including "reasonably foreseeable death",[12] "major age",[13] [14] [15]and "mental capacity"[16] [17]-- are being (and have been) successively abandoned, since suffering itself knows no such boundaries. Euthanasia for mental illness alone is authorized to begin in March, 2027,[18] euthanasia of demented patients by advance request has already begun in the Province of Quebec.[19]

It would be impossible to imagine a system better designed to maximize the practice of euthanasia. And indeed, that maximization is to the obvious benefit of systemic budgetary interest.[20]

It thus transpires that the vast non-suicidal majority of Canadian patients are left with nowhere to go; no place where they may confidently expect care from professionals who believe that they should be allowed (and even encouraged) to persevere in living. They are forced, instead, to navigate a clinical environment which has become objectively indifferent (if not openly hostile) to their continued survival.[21]

A minimally intrusive judicial authority

As envisaged under a non-medical authority, assisted suicide is completely severed from medical practice. The proposed regulatory body would arise from the Ministry of Justice, structurally distinct from that of Health.

Most importantly, when assisted suicide is not defined as medical care, it confers none of the special obligations associated with that status. The liberty granted is one of permission only. There is no public guarantee of provision. No mandates. No funding. No entitlement of any kind.

To the greatest extent possible, other patients would be undisturbed by required formalities. Actual assisted deaths would occur in designated locations outside of National Health Service (NHS) facilities. No patients --to insist on this crucial point-- would ever be importunately engaged in death-suggestive discussions initiated by doctors, or other staff.

Delivery and Financing: NHS obscurity versus independent transparency

If offered as a medical service by the NHS, all of the work required for assisted death --from information, to evaluation, to provision of service-- would come from doctors and nurses employed by that body. In the absence of new funding, therefore, the full cost of MAID would be carved out from existing programs, effectively cannibalizing thinly-stretched professional resources.[22]

A paradoxical dynamic is thus created whereby money is reputedly saved (by substituting death for care) but where physician availability for traditional medical purposes is nonetheless reduced.

If, on the other hand, assisted death is allowed by permission only, no public costs need be assumed beyond that of the regulatory body itself (and even those might be recuperated, just as fees are charged for motor vehicle registration).

The actual work of evaluation, preparation, accompaniment, and treatment of remains would be performed by non-profit charitable entities, licensed and regulated to that end, whose billing of clients would not be a public concern.

In conclusion

On the principal question, concerning the extraordinary social perils of establishing a legal precedent for the wilful taking of life, lawmakers are hereby earnestly entreated to reject any authorization of assisted suicide whatsoever.

If, however, we are eventually reduced to choosing between what is bad and what is worse: defining assisted suicide as medical care --and providing that service through public medical administration-- creates further grievous and unnecessary harms to the natural interests of the citizen/patient/taxpayer, which might be avoided through a non-medical regulatory framework, and non-governmental service provision.

Regardless, therefore, of any separate concession to death-as-choice, we emphatically demand that the introduction of death-as-medical-care be abandoned; that legislators preserve the integrity of our healing institutions, professions, and clinical practice, “To cure sometimes, to relieve often, to comfort always”.[23]

Gordon Friesen,
President, Euthanasia Prevention Coalition
www.epcc.ca

December 2, 2024

Footnotes:

[1] Preston, Nancy; Payne, Sheila; Ost, Suzanne, Breaching the stalemate on assisted dying: it’s time to move beyond a medicalised approach BMJ 2023;382:p1968 accessed July 22, 2024

[2] Twycross, Robert Assisted dying: principles, possibilities, and practicalities. An English physician’s perspective accessed July 22, 2024

[3] Note on Canadian and Dutch cancer euthanasia as a fraction of all cancer deaths: Terminal cancer is the category in which consent to euthanasia is most frequent (70% of all euthanasia deaths). However, in Canada and the Netherlands where all cancer patients are informed of their eligibility only 10-11% consent to die in that manner.

***

Canada total deaths: 330,380 statista.com accessed Nov.30. 2024

Canada euthanasia deaths: 15280 epcc.ca accessed Nov.30. 2024

Canada total cancer deaths 86700 cdn.cancer.ca pg. 35 accessed Nov.30. 2024

Cancer fraction of all deaths (86,700/330,380) ,26

Canada euthanasia fraction of all deaths .046 (note 2) Cancer fraction of all euthanasia .63 canada.ca chart 4.1a

Canada cancer euthanasia fraction of all deaths (.046 x .63) ,029

Canada euthanasia fraction of all cancer deaths (.029/.26) .11

***

Netherlands total deaths 170,100 statista.com accessed Nov.30. 2024
Netherlands total cancer deaths (2022) 49,790 wcrf.org accessed Nov.30. 2024
Netherlands (2023) total euthanasia 9,068; cancer euthanasia 5105 english.euthanasiecommissie
Netherlands cancer fraction of total deaths: (49,790/ 170,100) .29
Netherlands euthanasia fraction of total deaths: (9,068/ 170,100) .053
Netherlands cancer fraction of total euthanasia: (5,105/ 9,068) .56
Netherlands cancer euthanasia fraction of all deaths (.56 x .053) .03
Netherlands cancer euthanasia fraction of all cancer deaths (.03/.29) .10

[4] Hippocratic Oath wikipedia.org accessed July 22, 2024

[5] Quebec S-32.0001 - Act respecting end-of-life care accessed July 22, 2024

[6] Canada maid law as of 2024 (synthesis) accessed July 22, 2024

[7] Constitution of the World Health Organization accessed Jult 23, 2024

[8] Schadenberg, Alex, Euthanasia being forced on Montreal palliative care home, Euthanasia Prevention Coalition, December 2, 2023 accessed July 22, 2024

[9] Garcia-Santesmases, Andrea, El cuerpo deseado, la conversación pendiente entre feminismo y anti-capacitismo, Ed. Kaótica Libros, Madrid, 2023, pp. 210,211

[10] College of Physicians and Surgeons of Ontario HUMAN RIGHTS IN THE PROVISION OF HEALTH SERVICES September 2008 Reviewed and Updated: March 2015, September 2023 See Section 10 and 12 (not merely a permission, but a positive duty to raise MAID eligibility) accessed Nov. 30, 2024

[11] Collège des médecins du Québec, LE MÉDECIN ET LE CONSENTEMENT AUX SOINS, MIS À JOUR EN OCTOBRE 2023, see section 1.2, appropriate care-decisional process accessed Nov. 30, 2024

[12] Government of Canada Bill C-7 (2021): An Act to amend the Criminal Code (medical assistance in dying), eligibility changed to accept non-terminal patients accessed Nov. 30, 2024

[13] Canada, Special Joint Committee on Medical Assistance in Dying, Febrary 2023, Mature Minors accessed Nov. 30, 2024

[14] Coelho, Ramona Canada’s assisted dying regime should not be expanded to include children, Aljazeera, 16 Feb 2024 accessed Nov. 30, 2024

[15] Lévesque, Catherine, Quebec College of Physicians slammed for suggesting MAID for severely ill newborns, National Post Oct 11, 2022 accessed Nov.30. 2024

[16] (euthanasia of demented patients by advance request) QC Bill-11 (2023) An Act to amend the Act respecting end-of-life care and other legislative provisions , 29.1 and following: Special provisions applicable to advance requests for medical aid in dying" in force as of Oct. 30, 2024

[17] Ferrier, Catherine, Advance directives for assisted death a recipe for abuse Montreal Gazette, May 26, 2022 accessed July 23, 2024

[18] Canada to delay assisted death solely on mental illness until 2027, Reuters, February 1, 2024

[19] see note 17

[20] Schadenberg, Alex, Canada's health care savings attributed to euthanasia, Euthanasia Prevention Coalition, October 20, 2020

[21] Friesen, Gordon, Bad care brings euthanasia and euthanasia brings bad care, Euthanasia Prevention Coalition, May 30, 2024 accessed July 22, 2024

[22] Schadenberg, Alex, How the Ontario government hides the cost of MAiD (euthanasia), Euthanasia Prevention Coalition, June 30, 2023 accessed July 22, 2024

[23] Siegel, Mark David, To Comfort Always , Yale School of Medicine, June 24, 2018. accessed July 22, 2024

The British Assisted Suicide bill can be defeated.

If Britain's parliament passes the assisted suicide bill, within a few years, a bill will be introduced to expand the bill, as has happened in nearly every US state and in Canada.

Alex Schadenberg

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

The British parliament voted on Friday, November 29, 2024 (330 to 275) at second reading to support Kim Leadbeater's private members assisted suicide bill.

As I wrote on Friday, the battle is not over. The bill will be further scrutinized and committee hearings will occur before the final vote.

Some British MP's voted Yes to the assisted suicide bill but remain concerned about the implementation of a law. In other words, there are many MP's who may change their vote as they learn more about the bill.

Michael Savage, the Policy editor for the Observer wrote an article titled: Wavering supporters of assisted dying bill ' are not certain to vote it into law' that was published on November 30, 2024. Savage, who appears to support assisted suicide, states in his article:

A wavering group of MPs who backed parliament’s historic vote in favour of assisted dying may yet oppose its passage into law without further reassurances, the bill’s supporters are being warned, amid concerns that significant hurdles still remain.

There are concerns about how the bill will impact the National Health Service. Savage writes:

Health secretary Wes Streeting, who opposes the bill, has said it will have “resource implications” for the health service. Shabana Mahmood, the justice secretary, is also fiercely opposed.

Some MP's supported the bill because they felt that the "safeguards" in the current bill could protect people in vulnerable conditions from being coerced.

I have written several articles concerning the fact that nearly every US state that has legalized assisted suicide, later expanded their law.

When commenting on the bill that expanded the Colorado assisted suicide law, I explained that Oregon, California, Vermont, Washington State and Hawaii have also expanded their assisted suicide laws. Further to that, Compassion and Choices, an assisted suicide lobby group in the US has launched a lawsuit in New Jersey demanding the removal of their state assisted suicide law residency requirement.

Many of these states debated and defeated bills to legalize assisted suicide for many years, before finally approving an assisted suicide bill. Supporters of assisted suicide focus on creating a bill that sells the legalization of assisted suicide with the intention of expanding the law later.

For instance Connecticut assisted suicide supporters initiated an assisted suicide bill for eleven consecutive years, with it being defeated every time.

Josh Elliott, a three term member of the Connecticut House, and a sponsor of previous assisted suicide bills was interviewed by Paul Bass for the New Haven Independent on January 4, 2024. Bass reported:

The version he plans to resubmit this year has been narrowed to cover terminally ill people with prognoses of less than six months to live, with sign-offs from two doctors and a mental health professional, monthly check-ins, and at least a year of state residence.

“Almost no one” would qualify under that restricted version of the law, Elliott said. But passing it would open the door to evaluation and expansion.

Elliott explains that his goal is to pass a "restrictive" assisted suicide bill and then expand the law later.

J.M. Sorrell, Executive Director of Massachusetts Death with Dignity, was quoted on a similar bill as saying,

“Once you get something passed, you can always work on amendments later.”

The US assisted suicide lobby admit to their 'bait and switch' tactic, meaning, to get a tightly worded assisted suicide bill passed and then amend the law later.

Members of the British parliament need to recognize that the assisted suicide lobby realizes that it is harder to legalize assisted suicide than to expand the bill later. 

If Britain's parliament passes the Leadbeater assisted suicide bill, within a few years, a bill will be introduced to expand the bill, as has happened in nearly every US state and in Canada.

This blog rarely publishes anonymous comments and never publishes inappropriate comments

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Many people leave comments on the blog that we do not publish. This blog is moderated by myself and I will rarely publish comments that are made Anonymously. 

I made this decision after receiving attacking or rude comments from people. Often these attacks were made without the person placing their name with the comment.

I do not publish comments that contain illegal or inappropriate comments. [The death lobby often attempts to publish lethal drug ordering information on an EPC blog article.]

I have received excellent comments from readers and followers of this blog that I did not publish because the person did not post their name with the comment.

Whether the comment is instructive or destructive, I will rarely publish an anonymous comment.

British Parliament passes assisted suicide bill at second reading.

It is not the final vote. We will continue working to defeat this deadly bill.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I have sad news. Members of the UK Parliament voted 330 to 275 at second reading to support Kim Leadbeater's assisted suicide bill.

Not Dead Yet UK responded by stating that they will continue to protest this unsafe and discriminatory bill.

The battle is not over. The bill will be further scrutinised and committee hearings will occur before the final vote.

Let's be clear. If this bill passes, doctors will be given the right to assist the suicide of British residents. This is a life and death debate.

The good news is that the vote was closer than originally projected.

Prime Minister Keir Starmer, the leader of Britain's Labour Party, is a long-time promoter of assisted suicide. The July 4, 2024 election resulted in the Labour Party winning a massive majority with 411 out of 650 seats in parliament. A large number of the recently elected Labour members voted NO on the assisted suicide bill.

With further debate, MP's will have the opportunity to reflect on the deadly implications of legalizing assisted suicide.

Many MP's supported the bill because they were told that the Leadbeater assisted suicide bill was tighter than other assisted suicide laws.

We will continue to publish and circulate articles on how every jurisdiction that has legalized euthanasia and/or assisted suicide, that the laws were later expanded in scope and numbers of deaths.

The Euthanasia Prevention Coalition opposes killing people.

The UK is debating an Oregon style assisted suicide bill. The Oregon law lacks oversight.

Let's be clear. If this bill passes, doctors will be allowed to assist the suicides of British residents. This is a life and death debate.

Alex Schadenberg
Executive Director,

Euthanasia Prevention Coalition

British Members of Parliament will be voting on a private members assisted suicide bill on (November 29) that is sponsored by Kim Leadbeater.

Prime Minister Keir Starmer, the leader of Britain's Labour Party, is a long-time promoter of assisted suicide. During the election Starmer promised that an assisted suicide bill would be introduced with a free-vote in parliament. Based on MP's statements the vote will likley be closer than Leadbeater and Starmer originally projected. (Link to Article).

The British bill is similar to the Oregon assisted suicide law nonetheless, the Oregon law also lacks effective oversight.

There are unanswered questions, related to abuse and under reporting concerning the Oregon assisted suicide law.

Let's look at the data.

The 2023 Oregon assisted suicide report indicates that there were 367 reported assisted suicide deaths up by 21% from 304 in 2022.

The number of lethal poison prescriptions written under the Oregon assisted suicide law increased to 566 in 2023 up by 29% from 433 in 2022.

There were more than 367 assisted suicide deaths in 2023. Every year the Oregon assisted suicide report updates the number of assisted suicide deaths in the previous year. 

The 2022 Oregon assisted suicide report stated that there were 278 assisted suicide deaths while the 2023 Oregon assisted suicide report stated that there were 304 assisted suicide deaths in 2022. The same has been true in every report. The increased number of assisted suicide deaths is based on late reporting. Based on this reality, I suggest that there were likely 400 assisted suicide deaths in 2023.

Since Britain has more than 16 times the number of citizens as the State of Oregon, there would likely be at least 6400 assisted suicide deaths and 9000 lethal poison prescriptions written yearly, if Britain legalizes assisted suicide.

Let's be clear. If this bill passes, doctors will be allowed to assist the suicides of British residents. This is a life and death debate.

Lack of oversight of the law.

The 2023 Oregon assisted suicide report states that the "ingestion status" was unknown in 141 of the 566 lethal poison prescriptions. This means that the Oregon Health Authority does not know how 141 people who were approved and received the lethal drugs died. Some of them are assisted suicide deaths that will be reported in the 2024 report. Some of these people died a natural death and some of these people died by assisted suicide but the death was not reported.

Considering that the Oregon assisted suicide law employs a self-reporting system, meaning the doctor who carried out the death is also the one who is responsible for reporting the death, therefore it is not surprising that unreported assisted suicide deaths would be happen in Oregon.

Only 3 of the 566 people who were prescribed lethal poison in 2023, were referred for a psychiatric assessment.

In Oregon, complications are only reported when a health care provider is present at the death. In 2023, there were 10 known complications based on 102 reported deaths representing almost a 10% complication rate. Based on the 367 reported assisted suicide deaths, there would be approximately 36 complications in 2023.

It is important to note that the longest time to die, in 2023, was 137 hours (more than 5.5 days).

Nearly every US state that has legalized assisted suicide has expanded their laws.

The assisted suicide law is well aware that it is harder to legalize assisted suicide than to expand the law once legal. Therefore assisted suicide bills are designed to sell the legalization of assisted suicide with the intention of expanding the law later.

It is important to note that no new US state has legalized assisted suicide in the last three years.

In 2019 Oregon expanded their assisted suicide law by giving doctors the ability to waive the waiting period when a person was deemed "near" to death.

In 2021 California expanded their assisted suicide law by: reducing the waiting period, forcing doctors who oppose assisted suicide to be complicit in the process (later struck down by the court) and it forced all medical institutions to post their policy on assisted suicide.

In 2022 Vermont expanded their assisted suicide law by removing the waiting period, (allowing a same day death), removing the requirement that an examination be done in person, (allowing approvals by telehealth), and it extended legal immunity to anyone who participates in the act.

In 2023 Oregon removed the assisted suicide law residency requirement which allows anyone to die by assisted suicide in Oregon.

In 2023 Vermont also removed the assisted suicide law residency requirement to also allow anyone to die by assisted suicide.

In 2023 Washington State expanded their assisted suicide law by: allowing advanced practice registered nurses to approve and prescribe lethal poison, reducing the waiting period, and to force healthcare institutions and hospices to post their assisted suicide policies.

In 2023 Hawaii expanded their assisted suicide law by: reducing the waiting period, allowing the waiting period to be waived if the person is "near" to death and allowing advanced practice registered nurses to approve and prescribe lethal poison.

In 2024 Colorado expanded their assisted suicide law by: reducing the waiting period, allowing the waiting period to be waived if the person is "near" to death and allowing advanced practise registered nurses to approve and prescribe the lethal poison.

The assisted suicide lobby launched a lawsuit challenging the New Jersey state assisted suicide residency requirement.

The goal of the assisted suicide lobby is to legalize assisted suicide by devising a bill that will sell the legalization to politicians. The assisted suicide lobby will then expand the scope of the assisted suicide laws after legalization either through legislation or by launching court cases. Once legal the assisted suicide lobby will argue that the safeguards stand in the way of equality.

UK assisted death bill: a disability perspective

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Madeleine Kearns has written an excellent article examining the issues related to the UK assisted death bill from a disability perspective, published in The Free Press on November 27, 2024. 

Jamie Hale

Kim Leadbeater's assisted dying bill will have it's second reading vote on November 29. Kearns writes:

Jamie Hale has been in and out of the hospital for more than half his life. The 33-year-old Brit needs a wheelchair and relies on partial ventilation and round-the-clock care. Several years ago, he was critically ill and hospitalized for six months “as a direct result of not having had that care,” he told me from the back of a car on his way to a weekly visit at a National Health Service clinic in London. “I’d be dead without the NHS,” he concludes. 

Even so, Hale—who has a master’s degree in philosophy, politics, and the economics of health—often thinks about how much his life costs the state. “I’m very aware I’m not cost-effective,” he added. “It’s very hard not to be aware you are the kind of financial burden the system is creaking under.” 

Hale is deeply opposed to the assisted suicide bill that the United Kingdom’s Parliament is voting on this week.

Hale, who is not terminally ill, is concerned about assisted dying. Kearns explains:

At first glance, the law appears to have little to do with people like Hale. His condition, which he prefers not to specify, is chronic and progressive, but it isn’t terminal. Still, he’s among many disabled people, end-of-life doctors, and concerned citizens who fear the law could put vulnerable people under pressure to end their lives, and start a slippery slope toward future laws allowing euthanasia for the disabled, the poor, and the depressed.

Opposition to assisted dying comes from many perspectives:

If the law passes, Hale worries it will “change the way we think” about end-of-life care. “It’s going to make it look perhaps increasingly selfish to stay alive in an expensive way.”

Kearns interviewed Claire MacDonald, Director of development for the assisted death lobby group, My Death, My Decision. MacDonald argues that people want to avoid a bad death and many people in Britain are dying a bad death.

Matthew Doré

Matthew Doré, honorary Secretary of the Association of Palliative Medicine of Great Britain and Ireland, opposes assisted dying and says that legalizing assisted dying is not necessary:

... it’s common for people coming into a hospice to say, “I want to die, kill me now,” but once they have the holistic support they need, that feeling “just melts away, disappears pretty much completely in almost everyone.”

Not all assisted deaths are peaceful:

What’s more, assisted suicide does not always lead to a more peaceful death, Doré said. Studies show that complications from the lethal drugs include burning, nausea, vomiting, and regurgitation, severe dehydration, seizures, and regaining consciousness. In Oregon, the annual complication rate is nearly 15 percent, although it’s likely higher given that “patients often ingest the lethal drugs without a healthcare professional present to record complications,” one study reported.

Kearns states that legalizing assisted death will save healthcare money:

Once the jewel of the UK, the National Health Service has recently been dogged by staff shortages and strikes. A 2024 report found the UK lagging behind 10 other developed countries on hospital wait times. Only Canada had comparably long wait times, while the U.S. was one of the best-performing countries for timely access to care. ...Earlier this month, a Telegraph columnist wrote that “assisted dying will leave society financially better off” as well as help “people protect their family wealth.” Earlier this year, a Times of London writer suggested it would be “a healthy development” if assisted suicide for the infirm is “considered socially responsible—and even, finally, urged upon people.”

Cost savings studies from Canada:

In 2017, one year after Canada legalized assisted suicide, a report estimated the procedure could save the country between $34.7 million and $138.8 million annually. In 2020, ahead of the expansion of Canada’s Medical Assistance in Dying program (MAID) to include those with disabilities and chronic illness, the government projected it would save an additional $62 million a year. At the same time, the number of assisted suicides in the country keeps rising. In 2019, MAID accounted for 5,665 deaths; by 2022, that figure was 13,241. Today, MAID is at least the fifth leading cause of death in Canada.

Wes Streeting, the UK's Secretary of Health, opposes assisted dying:

Wes Streeting, the UK’s Health secretary, worries that assisted dying will come at the expense of NHS funding in other areas. Palliative care in the NHS currently receives only 37 percent of funding from the state, the rest coming from charity. Assisted suicide would be entirely state funded.

Paula Peters, who had a DNR placed on her medical chart without her consent:

And some say the NHS might already be encouraging people toward an untimely death. During the pandemic, Paula Peters, 53, was one of hundreds of people who discovered her doctor put a “do not resuscitate”—or DNR—notice on her medical records without her knowledge. After Peters discovered the DNR on her records, she had to fight for nine months to get it removed, she told The Free Press.  

“My doctor thought I was disposable and expendable because I was clinically extremely vulnerable, and that had a profound impact on me,” said Peters, who has rheumatoid arthritis and other disabilities. “I’m not a piece of rubbish you can just toss aside.” 

Kearns concludes:

If it becomes law, Hale worries that a society uncomfortable with disability will suddenly have more justification to remove people like him from it. “If you live long enough, you will probably become disabled,” he said. “People don’t necessarily want to engage with that. We are the future that they’re terrified of.”

Previous articles about the UK assisted suicide bill: (Link to articles).

Proposed UK Assisted Dying Bill Fails Public Safety Test

This letter was published in the British Medical Journal.

Dear Editor,

As the UK Parliament prepares to debate assisted dying, its impact on those with mental health conditions, particularly eating disorders, must be urgently considered. If legalised, the proposed bill may enable patients with treatable eating disorders who have life-threatening malnutrition and/or feel suicidal to qualify for assisted death. Looi (1) highlights global expansion in assisted dying laws, yet gaps in safeguarding vulnerable groups remain.

Research suggests assisted dying laws have already led to preventable deaths of young people with eating disorders in multiple countries (2). At least 60 individuals with eating disorders have died through physician-assisted death, including in jurisdictions limiting the practice to terminal conditions. Of these, one-third involved women under 30. These deaths raise profound ethical concerns, as many patients were severely depressed or suicidal when deemed eligible.

These patients did not have concurrent terminal illnesses. Rather, clinicians asserted their eating disorders were “untreatable,” offering limited substantiating evidence. Some practitioners suggested patients had “terminal anorexia,” a term not recognised by any medical authority (3). Downs et al. (4) described it as a “nosological free-for-all,” highlighting the danger of inventing new illness classifications to justify ending vulnerable lives under the guise of medical treatment. Empirical efforts to validate terminal anorexia have raised significant questions about its validity (5). Anorexia nervosa is not a terminal condition; almost all the medical complications of eating disorders are reversible with nutrition and weight restoration (6).

The proposed bill aims to restrict eligibility to terminal illness — in practice, this safeguard is porous. In Oregon US, officials interpret “terminal illness” as any condition expected to cause death within six months if untreated (7). Patients with non-terminal conditions can become terminal by choosing to forego life-extending treatments, such as dialysis. This has led to deaths in patients with non-terminal conditions; including anorexia, arthritis, and hernias (8). The wording of the proposed U.K. bill similarly allows for this broad interpretation, offering minimal protection to vulnerable patients (9).

Assessing capacity to make a life-ending decision is particularly fraught in patients with malnutrition or mental distress (10, 11) who may appear lucid and articulate, yet struggle to process information fully. Evidence suggests that clinicians’ judgments of capacity in these patients are often inconsistent (11). In Oregon, only three individuals who received lethal prescriptions (1%) were referred for psychiatric evaluation in 2023, down from 33% in previous years (12), raising concerns that evaluators have become less cautious about capacity and psychiatric comorbidities.

Moreover, evidence from jurisdictions where assisted dying is legal reveals weak oversight and opaque reporting mechanisms (13). For example, U.S. oversight agencies confirmed anorexia nervosa has been documented as a terminal illness in cases of assisted death; however, these cases are hidden in public reports under the broad category “Other Illnesses” (2). Officials declined to disclose the exact number of cases, and agencies have limited authority to investigate potential misapplications of the law.

In the UK, the Court of Protection has already allowed treatment withdrawal and palliative care for eating disorders deemed ‘untreatable’ (14). However, researchers have raised concerns that many patients are labeled 'untreatable' without having received adequate treatment (4). If the proposed bill passes, “palliative care for eating disorders” may expand to assisted dying, undermining protections for those with complex, often stigmatised mental health conditions.

Evidence from other jurisdictions should serve as a stark warning to UK policymakers. The question before Parliament is not only whether individuals have the right to die, but whether assisted dying can be safely implemented within the NHS. Evidence from other countries shows that safeguards intended to protect vulnerable patients from medically-assisted suicide have failed. We urge MPs to weigh these findings carefully and vote against the bill—it fails the public safety test.

Chelsea Roff
Executive Director, Eat Breathe Thrive

James Downs
Peer Researcher and Expert by Experience

Agnes Ayton
Consultant Psychiatrist in Eating Disorders
Oxford Health NHS Foundation Trust

Ashish Kumar
Chair, Faculty of Eating Disorders, RCPsych
Clinical Director at Mersey Care Foundation Trust

Angela Guarda
Professor of Psychiatry and Behavioral Sciences Director
Eating Disorders Program Johns Hopkins School of Medicine

Patricia Westmoreland
Medical Director, ACUTE Center for Eating Disorders & Severe Malnutrition Department of Psychiatry, University of Colorado

Philip Mehler
Founder, ACUTE Center for Eating Disorders & Severe Malnutrition
Professor of Medicine, University of Colorado

Mark S. Komrad
Faculty of Psychiatry
Johns Hopkins School of Medicine, Tulane, and University of Maryland

Paul Appelbaum
Dollard Professor of Psychiatry, Medicine & Law
Columbia University

Ronald W. Pies
Professor Emeritus of Psychiatry
SUNY Upstate Medical University

Annette Hanson
Assistant Professor
University of Maryland

Catherine Cook-Cotton
Licensed Psychologist, Professor and Researcher
University at Buffalo (SUNY)

Anita Federici
Clinical Psychologist
Center for Psychology and Emotion Regulation

Hope Virgo
Founder of #DumptheScales, Author,
Mental Health Campaigner

Ali Ibrahim
Consultant Psychiatrist, Eating Disorders

Suzanne Baker
Family & Carer Representative, FEAST UK

Marissa Adams
Peer Research & Expert by Experience

References
1. Looi, M. K. (2024). Assisted dying laws around the world. bmj, 387.
2. Roff, C., & Cook-Cottone, C. (2024). Assisted death in eating disorders: a systematic review of cases and clinical rationales. Frontiers in Psychiatry, 15, 1431771.
3. Gaudiani, J. L., Bogetz, A., & Yager, J. (2022). Terminal anorexia nervosa: three cases and proposed clinical characteristics. Journal of eating disorders, 10(1), 23.
4. Downs, J., Ayton, A., Collins, L., Baker, S., Missen, H., & Ibrahim, A. (2023). Untreatable or unable to treat? Creating more effective and accessible treatment for long-standing and severe eating disorders. The Lancet Psychiatry, 10(2), 146-154.
5. Robison M, Udupa NS, Abber SR, Duffy A, Riddle M, Manwaring J, Rienecke RD, Westmoreland P, Blalock DV, Le Grange D, Mehler PS, Joiner TE. "Terminal anorexia nervosa" may not be terminal: An empirical evaluation. J Psychopathol Clin Sci. 2024 Apr;133(3):285-296. doi: 10.1037/abn0000912. PMID: 38619462; PMCID: PMC11062513.
6. Westmoreland P, Krantz MJ, Mehler PS. Medical Complications of Anorexia Nervosa and Bulimia. Am J Med. 2016 Jan;129(1):30-7. doi: 10.1016/j.amjmed.2015.06.031. Epub 2015 Jul 10. PMID: 26169883.
7. Stahle F. Notarized Questions to Oregon Health Authority. January 2018. Available online: https://drive.google.com/file/d/1XopTDjBA2SAVBGBxpDazNN899eTHixSe/view
8. Oregon Health Authority. Oregon Death with Dignity Act: 2021 Data Summary (2022). Available online at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARC...
9. Leadbeater K. Terminally Ill Adults (End of Life) Bill. Nov 11, 2024. https://bills.parliament.uk/bills/3774 [Accessed 14th November 2024].
10. Van Elburg, A., Danner, U. N., Sternheim, L. C., Lammers, M., & Elzakkers, I. (2021). Mental capacity, decision-making and emotion dysregulation in severe enduring anorexia nervosa. Frontiers in Psychiatry, 12, 545317.
11. Elzakkers, I. F. F. M., Danner, U. N., Grisso, T., Hoek, H. W., & van Elburg, A. A. (2018). Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice. International journal of law and psychiatry, 58, 27–35. https://doi.org/10.1016/j.ijlp.2018.02.001
12. Oregon Health Authority. Oregon Death with Dignity Act: 2023 Data Summary (2024). Available online at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARC...
13. Raikin, A. (2024). A pattern of non-compliance. The New Atlantis. 11 November 2024.
14. Cave, E., & Tan, J. (2017). Severe and enduring anorexia nervosa in the England and Wales Court of Protection. International Journal of Mental Health and Capacity Law, 23(17).

Nitschke will bring Sarco suicide pod to Britain if assisted death legalized

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Philip Nitschke, who invented the Sarco Suicide pod, stated that he is ready to launch his suicide pod in Britain if the assisted death bill passes in parliament.

Janet Eastham reported for the Telegraph on November 25, 2024 that:

The doctor behind the so-called Sarco “death pod” has said he will bring his invention to Britain if assisted dying is made legal.

Dr Philip Nitschke, 77, has said he is ready to launch in Britain a 3D-printed portable machine that floods with nitrogen gas at the press of a button, should Labour MP Kim Leadbeater’s assisted dying Bill become law.

Kate Connelly reported for the Guardian on September 24 that Swiss police made several arrests related to the first Sarco suicide death. A 64-year old American woman had died inside the suicide pod in the town of Merishausen Switzerland.

Euthanasia Prevention Coalition reported on September 29, 2024 how the Sarco suicide pod works. The Sarco Suicide Pod is promoted as an easy and pain free death (nitrogen gas is released into the pod causing the person to die of asphyxiation).

Veterinarians have rejected death by nitrogen gas for animals. The ACLU defines death by nitrogen gas as torture, with reference to capital punishment.

Eastham reported:

Dr Nitschke said the machine could prove popular with people undergoing assisted dying who do not want to die by lethal injection or medicine cocktails designed to end their life.

He told The Telegraph he is “absolutely” keen to bring the Sarco pod to the UK.

Richard Ekins KC, professor of law and constitutional government at St John’s College, Oxford, said: “If Kim Leadbeater’s Bill passes, and if the Secretary of State approves liquid nitrogen as an approved substance, then the Sarco death pod would be a lawful means to assist suicide in Britain.”

If Wes Streeting, who intends to vote against the Bill this Friday, rejects the Sarco device, those with swallowing difficulties or needle phobias are “likely” to bring a discrimination challenge under the European Convention on Human Rights (ECHR).

Once killing becomes a legal option why wouldn't Nitschke's Sarco suicide pod be an option? The ACLU and veterinarians consider death by nitrogen gas to be torture. The assisted suicide drugs that are currently in use can be descriibed the same way.

Legislators need to reject euthanasia and assisted suicide and commit to caring options.

Do you have a story? Order our poster today.

Do you have a story?

There have been approximately 75,000 (MAiD) euthanasia deaths in Canada since its legalization. 

Many people have contacted EPC seeking advice to prevent a euthanasia death or who are grieving the death of a loved one or friend.

When people tell their story, it leads to more people becoming open to sharing their story --- and this helps everyone.

The Euthanasia Prevention Coalition has produced 8.5 x 11 posters  to encourage people to contact EPC to tell us their story. EPC will send you posters upon request. These can be given to local churches, nursing homes, etc. Please have the poster displayed in a prominent place.

You can order the posters by contacting EPC at: info@epcc.ca or 1-877-439-3348.

Please consider making a donation to the Euthanasia Prevention Coalition for the cost of this campaign. (Donation link).

Order Your Life Is Worth Living! Euthanasia is NOT the answer. (Link).

Care NOT Killing: Who opposes UK assisted dying bill?

Care NOT Killing update.

Former UK PM Gordon Brown joins the Health and Justice Secretaries, Liberal Democrats leader, disability rights groups, and medical bodies in urging the rejection of the UK assisted dying bill slated to be voted on 29 November 2024.

As the real-world implications shine through, and the "safeguards" in the late-released text of Kim Leadbeater's Terminally Ill Adults (End of Life) Bill start to unravel, an increasingly broad chorus of opposition and concern has emerged.

Politics

Former Labour Prime Minister Gordon Brown:

"With the NHS still at its lowest ebb, this is not the right time to make such a profound decision. Instead, we need to show we can do better at assisted living before deciding whether to legislate on ways to die." (Guardian, 23 October 2024)

Health Secretary Wes Streeting MP (Labour):

"I am not sure as a country we have the right end-of-life care available to enable a real choice on assisted dying." (Telegraph, 7 September 2024)

He's subsequently made clear that he will vote against the Leadbeater Bill, having voted for the Marris Bill in 2015.

Justice Secretary Shabana Mahmood MP (Labour):

"It cannot be overstated what a profound shift in our culture assisted suicide will herald. In my view, the greatest risk of all is the pressure the elderly, vulnerable, sick or disabled may place upon themselves… The right to die, for some, will - inexorably and inevitably - become the duty to die for others. And that is why I will be voting against this bill." (Observer, 23 November 2024)

Disabled People's Minister Sir Stephen Timms MP (Labour):

"As the party of the vulnerable, the voiceless and the victim, the stories that have emerged from these countries ought to give us significant pause for thought." (Labour List, January 2024)

Deputy Prime Minister Angela Rayner MP (Labour):

Report, Daily Mail 16 November 2024 

Jon Ashworth, Labour's Shadow Health Secretary 2016-2021:

"I worry about the pressure that this would put on people who are in the most desperate of circumstances... I just don't want people feeling that they are a burden or that their time is up." (GB News, 25 November 2024)

The Commons' longest-serving MPs, Sir Edward Leigh and Diane Abbott (Conservative & Labour):

"Our politics could not be more different - but we're united against this dangerous assisted dying bill." (Guardian, 20 November 2024)

Shadow Justice Secretary Robert Jenrick MP (Conservative):

"Having consulted with members of the judiciary and senior practitioners, there is significant concern that the assisting dying procedure outlined in the Private Member's Bill is unworkable." (Telegraph, 18 November 2024)

Liberal Democrat leader Sir Ed Davey MP:

"I had to look after my mother when she was terminally ill as a young teenager … she had a very, very painful disease." It was in being there at the end of her life that "I came to the conclusion we should not have this (assisted dying)... we should focus on better palliative care."(Independent, 12 November 2024)

Reform UK leader Nigel Farage MP:

"I look at the way assisted dying is taking place in Canada and frankly, it gives me the shivers." (GB News, 8 November 2024)

Welsh Parliament:

Rejected a motion in support of a change in the law 26-19 in September 2024. 

Former Labour Humanists Chair and Humanists UK Patron Joan Smith:

"There is a woeful lack of knowledge about coercive control, which many women suffer in abusive relationships. Doctors & judges, the latter making decisions about someone they don't know, are unlikely to recognise coercion that's been going on for years." (Post on X, 24 November 2024)

Ann Furedi, former chief executive of the British Pregnancy Advisory Service:

"I haven't changed my views on autonomy & individual choice, but I have changed my view on 'assisted dying' and this Bill." (Post on X, 16 November 2024)

Healthcare

Association for Palliative Medicine:

"The APM opposes any change in the law that could lead to the supply or administration of lethal medications to deliberately end a person's life." (Position statement, October 2024)

British Geriatrics Society:

"The BGS commissioned a working group of its members to review the evidence, gather the views of BGS members… and formulate an updated position on Assisted Dying. Following this review, the BGS… is opposed to the legalisation of Assisted Dying and is urging the government to be cautious in proceeding with any change in the law." (Position statement, 8 November 2024)

Royal College of General Practitioners:

Position statement, adopted by Council following a membership consultation.

Eating disorder charity Eat, Breathe, Thrive:

"In the U.S., assisted suicide is only legal for patients with a terminal illness and less than six months to live. Yet, a groundbreaking study shows that some doctors have misrepresented eating disorders as terminal in order to prescribe patients lethal drugs — denying patients and families the chance for life-saving treatment." (Report, 2024)

British Islamic Medical Association:

"Traumatic care experiences, particularly in marginalised communities and those with high socioeconomic deprivation, will contribute to the fear of suffering at the end of life. The solution is not to legislate state-endorsed assisted suicide and euthanasia that is delivered by a healthcare system in crisis." (Position statement, October 2024)

Our Duty of Care:

ODOC's open letter to the Prime Minister has been signed by thousands of healthcare professionals and is still open.

Human rights

Liberty:

"The Assisted Dying Bill has been drafted with the best intentions, but there are serious concerns over how it places disabled people, people of colour and other marginalised communities at risk… Every single part of this Bill has to be the 'gold standard' - silver is simply not good enough. Liberty is calling on MPs to keep this in mind when they vote." (Issue FAQs, 21 November 2024)

Disability Rights UK:

"Giving us dignified and equitable lives should come before putting in place ways of assisting us to die." - Kamran Mallick, Disability Rights UK Chief Executive, The Times 20 November, reinforcing DRUK's new position statement (12 November)

Inclusion London:

"We know many in our society think our lives are not worth living and we see the consequences of this deeply entrenched view in the experience of other countries, such as Canada, where the conditions and criteria for assisted dying quickly become wider than only the terminally ill and now include many different groups of disabled people." (Statement, 8 November 2024)

Not Dead Yet UK (website)

Disabled People Against Cuts:

"There is no straightforward way to legalise AS... There are no clear lines, only blurred boundaries. This is why no [deaf and disabled people's organisation] in the UK is in favour of legalisation. Additionally, all medical bodies remain opposed or neutral on the subjects. Doctors working in specialities such as oncology, geriatrics and palliative care, those where they are most likely to work with dying people, are the most opposed." (November 2024)

Legal experts

Former President of the Family Division of the High Court, Sir James Munby:

"In relation to the involvement of the judges in the process, the Leadbeater Bill falls lamentably short of providing adequate safeguards… Only those who believe implicitly in judicial omniscience and infallibility - and I do not - can possibly have any confidence in the efficacy of what is proposed." (Transparency Project, 14 November 2024)

Former Chief Coroner of England and Wales, Thomas Teague KC:

"Many of the promised safeguards amount to "nothing more than arbitrary restrictions" which would be subject to a "logically inexorable" erosion over time." (Telegraph, 17 November 2024)

Alex Ruck Keene KC, who worked on Noel Conway's legal challenges:

"The thing which increasingly troubled me, and has increasingly troubled me since, is it's not about an individual… That's the thing I think is very difficult in this space to think about. Because you have individual stories which are very, very powerful, and we've got lots of other individual stories out there in the public domain at the moment. But the law can't operate for individuals. The law has to operate for everybody." (The House, 11 November 2024)

Philip Murray, Assistant Professor in Law at Cambridge:

"Once a blanket ban is lifted and assisted suicide is permitted for certain groups and not others, the force of any argument that exclusions from the law are necessary for the protection of vulnerable people becomes inherently weakened." (UK Constitutional Law, 30 October 2024) 

More than 50 teachers and practitioners of law, including 15 KCs:

"The law reports are littered with cases of undue influence and duress, and legalisation would inevitably expose the most vulnerable to that risk." (Observer, 27 October 2024)

Journalism

The Times:

"Even apart from the dangers inherent in the bill, the lack of scrutiny and thought invested in it is cause for concern. It is a bad bill with potentially corrosive consequences." (Leading article, 18 November 2024)

The Telegraph:

"Small wonder… that many MPs appear to lack confidence that this legislation is fit for purpose… When the time comes to debate the Bill, MPs should be wary of rushing into a decision they may regret." (Telegraph View, 17 November 2024)

Sonia Sodha, The Guardian:

"A decade ago, I would have supported assisted dying out of a respect for personal autonomy and a desire to alleviate suffering. Today, I understand these objectives are not standalone but need to be weighed against the impact on those for whom an abstract liberal notion like autonomy is highly simplistic, and the state-sanctioned wrongful deaths that seem to me impossible to avoid." (April 2024, prior to further persuasive articles)

The Morning Star:

"Socialists need to stand in solidarity with the most vulnerable. That means opposing Leadbeater's Bill." (Editorial, 11 October 2024)

And the public? 

• 70% want to see a Royal Commission review palliative care provision before further debate on "assisted dying".
• 61% are concerned that some people would be pressured into having an assisted death if the law changes, including a majority (53%) of those who support a change in the law.
• And 56% of those who expressed an opinion in a June 2024 poll said they supported a change in the law in principle but thought there were too many complicating factors for it to be safely implemented.
  

And you? Ahead of the second reading debate and vote on 29 November, email your MP using our quick and easy online tool.