Britain’s 'assisted dying' bill debate risks turning care into coercion

Hospice leaders warn that the push for legalized 'assisted dying' in the UK may lead to a significant number of staff resignations, undermining the very health institutions established to minister to the sick, elderly, and dying.

The former head of the NHS (the British public healthcare system) has also indicated that some patients could opt for assisted suicide to ease pressure on the NHS.

Key Takeaways:

• Many have voiced concerns that if 'assisted dying' is legalized in the UK, conscience-based staff resignations and divisions may occur in an already strained workforce attempting to provide palliative and hospice care.

• Other concerns include possible coercion of patients, workers, and faith-based institutions, as well as erosion of trust toward clinicians.

The Details:

Stressed workforce and conscience rights

Hospice UK chief executive Toby Porter warned that in an “already under-resourced workforce,” some staff and volunteers who cannot, in good conscience, be involved in assisted dying may simply leave the industry. In remarks cited by The Independent, Porter stated: 

“It is unquestionable that there is a major risk of an already under-resourced workforce saying, ‘I can't hack this, this is too controversial, I'm gonna go off and work somewhere else.’”

Porter also conceded that some staff might oppose participating in assisted dying, but explained that employees and volunteers would wait for more details on how the proposed legislation could impact hospices before making any final decisions to exit the sector. 

Porter also believes that if the law were approved, charities would need to earmark significant time and resources in discussions with their staff, patients, and volunteers, since such a change would entail matters of well-being, religion, ethics, and politics.

“Different team members will feel very differently, there could be divisions within teams that have never experienced that before. Some people might feel demoralised, some people might feel rather pleased at a change in the law,” Porter elaborated, adding:

“Hospices benefit from really uncontroversial status within communities… In this one instance, we may find ourselves on the front line of the new and very potentially polarising legal right. Whatever the position and the outcome that a hospice board eventually takes, there will be people who will be disappointed and who will publicly criticise the hospice.”

He also fears that despite claims that the legalization of assisted dying "wouldn't impact... existing palliative care services," this is highly unlikely, as staff and management only have so much time and attention to devote to the services that already exist. Adding assisted dying would take that time from palliative care.

Threats to faith-based institutions

Echoing fears from pro-life advocates and faith-based groups that the assisted suicide bill could force Catholic and other religious hospices to offer, host, or promote assisted suicide in defiance of their religious convictions, Professor David Albert Jones, Director of the Anscombe Bioethics Centre, declared: 

In the Leadbeater Bill, providing assistance in suicide is now termed “Voluntary Assisted Dying”, but this vote means that the practice might not be ‘voluntary’ for Catholic organisations. Hospices could be compelled to provide assistance in suicide or forced to close. This Bill not only threatens the right to life of vulnerable patients, it threatens freedom of conscience and freedom of religion.

Likewise, James Sanderson, chief executive of the palliative care and bereavement charity Sue Ryder, mentioned the uneasiness people are feeling:

"There is a very real fear, both among people with terminal illness and the wider public, that if people can’t access all the care they need, which is the current reality for one in four people at the end-of-life, they may view an assisted death as a better option for them.

In a polarised debate on assisted dying, I am willing to bet that all people, all parties and all sides of the debate would agree that this is wrong."

Coercion and undermining trust

Professor Jones' and Sanderson’s fears are not unfounded; Lord Stevens of Birmingham, a former senior NHS leader, suggested how assisted dying could reduce pressure on the health service, The Telegraph reported. 

In a speech in the House of Lords, Lord Stevens stated: 

“Part of the reason why I think it would be dangerous to include assisted dying in the National Health Service is because it risks undermining the very trust that people have in their clinicians. It increases the risk of what you might call self-coercion in the name of altruism.

We saw that, frankly, during Covid, when the slogan ‘Protect the NHS’ was used. A number of us were opposed to that, fearing that it would put people off coming forward for needed care. That is precisely what happened.

The idea that an NHS-branded assisted dying service might therefore, in people’s minds, at least, come to be associated with helping protect the NHS by virtue of choosing an earlier death, seems to me a blurring of the lines that we should be careful to avoid.”

Adding that it is “unnecessary in practice” to incorporate assisted dying into Britain’s NHS, Lord Stevens said: 

“Just because doctors, like lawyers or social workers, are proposed to be involved in this doesn’t mean it is inherently part of the National Health Service. Doctors do DWP assessments; that doesn’t mean the National Health Service runs the benefits system.”

Lord Stevens’ statements came amid questions raised by members of the House of Lords as to the source of funding for assisted dying, how it would be overseen, and whether it could influence other aspects of NHS operations.

These questions have emerged alongside concerns that proposed safeguards to assisted suicide may fall short of protecting the vulnerable from being coerced into assisted dying or from choosing it due to financial stresses.

The Bottom Line:

Present debates surrounding Britain’s assisted dying bill showcase an alarming direction for British public life: turning care institutions into potential slaughterhouses, and possibly leveraging patients’ sense of guilt and pushing them to end their lives.

Rather than administering lethal drugs to people who are frightened, in pain, or beleaguered by financial constraints, the UK should invest in better hospice and palliative care, guard the conscience rights of staff, and oppose laws that devalue human dignity under a false sense of compassion.