Thread by @ddhitchens

Major unresolved problems with the Leadbeater bill: an A-Z guide.

A is for Anorexia.

Eating disorder charities and experts have warned that the bill leaves the door open for sufferers to qualify and receive an assisted death:

B is for Burden.

Under the bill, if someone meets the criteria and their sole motive is feeling like a burden, they qualify for an assisted death.

If unamended this could open the way for large numbers of people to receive lethal drugs out of mere guilt.

C is for Care.

The crisis in the care system creates some terrible incentives.

The Coalition for Frontline Care, representing leading health and social care organisations with a combined workforce of 3 million, calls the bill “unworkable...and naïve”.

D is for Dame Caroline Swift.

The former leading counsel to the Shipman Inquiry predicts that “independent” doctor approval will become box-ticking.

(In Victoria in 2023, 10 doctors were involved with the approvals process for 55% of assisted suicides.)

E is for Encouragement.

The bill allows it (“Mum, have you considered…”). Doctors can raise AS unprompted even if you have learning disabilities. Some advertising is allowed.

Bill supporter Alexandra Mullock told the committee the bill was weak on this:

F is for False Prognosis.

The bill’s proponents say AS is only for people who are dying. But the 6-month test is so unreliable that clinicians compare it to a “coin toss”; a fifth of those who are given six months to live are still around 3 years later.

G is for G4S.

Not that we know if they would deliver it (they haven’t commented. I understand Serco have ruled out being involved).

But there’s a decent chance one or other big outsourcing firm will be involved. And the bill has no profit cap and no transparency requirements.

H is for Henry VIII Powers.

These are areas where ministers can amend primary legislation by fiat.

There are five of them in the bill, and 38 ministerial powers in all: as Paul Kohler MP complains here, “in large part the safeguards are left to be decided by regulations.”

I is for Institutional Opt-Out.

While individuals can opt out, hospices and care homes cannot. Leadbeater says there are “considerable harms that can come with the ability of institutions to opt out”.

Palliative care leaders say this could be disastrous:

J is for Jane Monckton Smith OBE.

The criminologist says: “Unless we do take this incredibly seriously, this bill is going to be the worst thing potentially that we have ever done to domestic abuse victims.”

@STagainstDA_ have given similar warnings.

K is for Kin, Next Of.

The bill has no requirement to inform family at any point; nothing in the bill gives family a right to contribute to the decision-making process.

The first you could learn of your 18-year-old’s AS is when you’re asked to make arrangements for the body.

L is for Lethal Drugs.

Internationally, AS/death penalty drugs are highly controversial; but we do not know which ones will be used, and a host of safeguards—including a requirement for the MHRA to licence them—were rejected in committee.

M is for Mental Capacity Act.

The bill relies on it; but the Royal Colleges of Physicians and Psychiatrists say the MCA is the wrong tool to use. Amendments to tighten the capacity criterion were rejected.

@george_gillett writes powerfully about this:

N is for NHS.

1) Could our universal health system mean we accidentally create an AS conveyor belt?
2) What about Lord Bethell’s concerns here?
3) Could the powers in Clause 41, as Dame Siobhain McDonagh warns, be “the Trojan Horse that breaks the NHS”?

O is for Options.

Gordon Brown argues (see below) that there is no real choice “if the alternative option, the freedom to draw on high-quality end-of-life care, is not available.”

The BMA’s ARM meeting voted this week to back an amendment to tackle this:

P is for Psychiatrists.

Of all the bill’s critics—Disability Rights UK, Association for Palliative Medicine, @GeriSoc, @RCPhysicians, Liberty, STADA, Beat—@rcpsych’s objections are especially telling, as the panels rely on psychiatrists to be involved:

Q is for Questions.

The bill doesn’t require doctors to ask the applicant why they want lethal drugs. (An amendment on this was rejected.)

The panel isn’t obliged to ask anyone a single question.

If you meet the broad criteria, you can receive AS for *any* reason including:

R is for Royal College of Physicians.

Inter alia, they’re concerned that doctors can judge prognosis/treatment/coercion etc on their own. (The panel checking criteria isn’t a real MDT.)

This is “not in line with good clinical and professional practice”:

S is for Strasbourg—and Slippery Slope.

According to some legal scholars—including Alex Ruck Keene KC, who’s neutral on the bill—the ECtHR might well require us to expand the law to other forms of “intolerable suffering”, eg disability or mental illness.

T is for Terminal Illness.

Baroness Finlay, palliative care professor and ex-BMA president, says the bill’s definition of this term is “incredibly broad”.

Clinicians warn it could mean diabetes, anorexia etc. Disability rights activists have said it could apply to disability:

U is for Under-Resourcing.

Palliative care already faces an unprecedented funding crisis. There’s good reason to think the bill will make it worse:

V is for Verification.

Under the bill, the doctors’ and panel’s decisions—Is it terminal illness? Is there coercion and capacity?—are only subject to a “balance of probabilities” test: are they 51% likely?

The panel also has no power to summon witnesses:

W is for Wills.

Ruth Hughes KC, a leading barrister in this area (and neutral on the bill), says in written evidence that, without more safeguards, the bill would be “profoundly disturbing and wrong” because of how it enables financial abuse.

X is for (cut me some slack here) ex-High Court judge Sir James Munby.

He says the panel has a “wholly inadequate procedure” regarding evidence-gathering, evidence-testing, secrecy, and appeals; and that “the Bill still falls lamentably short of providing adequate safeguards.”

Y is for Year-On-Year Analysis.

If AS becomes a national scandal needing a public inquiry (as a few observers have predicted), what will be the early warning signs?

The bill lacks detailed reporting requirements, though Sarah Olney MP has proposed some:

Z is for Zero Hour.

The bill must commence—in full—4 years after it passes. Will the NHS be ready? Will palliative care provision, hospitals, prisons, mental health services...?

Many MPs objected to this; one was so concerned he switched from Aye to No: