At the heart of a democracy is the idea that the public is capable of making reflective judgments on issues of concern. Yet in a parliamentary system, there are few opportunities for practising a politics of deliberation. Voters elect MPs to do that for them. With many of the recent social reforms – legalising same-sex marriages or introducing no-fault divorce – public opinion has run ahead of political action.
This situation is mirrored with assisted dying. Polls suggest 75% of the public back changing the law to let someone with a terminal condition have an assisted death. The question is whether once voters had been given a chance to learn about the issue in more depth they might take a different view. Recent evidence suggests they would not. When the Nuffield Council assembled a citizens’ jury in England to look at the issue, in an eight-week long deliberative process, 70% of participants supported a change in the law for terminally ill, mentally competent people.
Individuals sought to balance the advantages and disadvantages through civil debate. While a quarter of the jurors were against changing the current law, about two-fifths had concerns that a more permissive regime could be used for the wrong reasons if safeguarding is not in place. In a society where lives are not truly treated as of equal value, disability activists have understandably expressed concern. A third of jurors worried that it might result in less funding for palliative care. The criticism that assisted dying is a “slippery slope”– with eligibility criteria being expanded – carried less weight.
Lord Falconer, a former Labour cabinet minister, wants to allow terminally ill adults of sound mind with six months or less to live to get medical help to end their own lives. The choice would need to be approved by two doctors and the high court, safeguards to ensure the request is truly voluntary and is not the result of pressure from others, or of being made to feel a burden. These are complex ethical judgments, but they are ones many European countries and the US states have confronted and allowed their citizens to navigate.
The peer’s private member’s bill is likely to pass in the Lords, setting the stage for it to be picked up by an MP in the Commons and secure a second reading. If that is the case, the prime minister has said he will allow time for it to be properly debated at the committee stage. The law could change within 15 months.
This comes at an opportune moment for the new parliament. Scotland, Jersey and the Isle of Man are all considering changing the law to let terminally ill people end their lives. In England and Wales, it is the director of public prosecutions who decides whether a person is guilty of assisting or encouraging a suicide. In 2010, as DPP, Sir Keir Starmer introduced guidelines to clarify when helping someone to end their life would result in prosecution.
The upshot was that the criminal law “should rarely, if ever, be used against those who compassionately assist loved ones to die at their request”, as long as the request arose from the settled will of the person being helped. But professional medical assistance was denied because Sir Keir thought this was an issue for parliament, which had, on legalising suicide in 1961, banned such help. The question is whether the current law strikes the right balance. Given the clear shift in public opinion, MPs should address the issue decisively.
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