Terminally Ill Adults (End of Life) Bill

Written evidence submitted by Dr George Gillett (TIAB04)

I am an NHS doctor and psychiatrist, wishing to contribute evidence from professional experience to the review process of the Terminally Ill Adults (End of Life) Bill.

As a psychiatrist, I spend my working life talking to people who, inspired by principles of autonomy and control, wish to end their life. I spend my working days doing all I can to stop them. Whilst I recognise the value of individual liberty, I’ve also seen first hand how one’s emotional state, anxiety for a future event and cultural context can all influence one’s decision-making.

 

These factors are difficult, and often impossible, to disaggregate. It is for this reason that I believe the so-called safeguards in the proposed legislation are entirely insufficient to protect vulnerable persons from feeling obliged to end their life prematurely. Although the bill proposes to criminalise coercive behaviour, such a provision only safeguards against one form of obligation.

 

When I sit with patients who have resorted to suicidal acts, they often explain how these acts were motivated by feeling like a burden. Rarely, if ever, do these ideas come from coercive relatives; in my experience they are much more likely to arise from cultural norms and societal precedents. Legislation sets the tone of these norms and precedents. With an ailing palliative care system, genuine social and economic inter-generational tensions, and widespread atomisation amongst the elderly population, I fear we are entirely unprepared for the consequences of re-writing this norm. In short, individual decision-making and coercion are not binary modalities, but complex, culturally-embedded phenomena. It is completely naïve to believe that in the absence of direct coercion, individuals are free of any social or cultural influence . T his is simply not how human psychology works.

 

There are plenty of other reasons to be sceptical about this bill as it currently exists. Legislation which effectively amounts to cultural avoidance of natural dying is likely to reinforce our anxiety towards death itself. Meanwhile, encouraging patients to hasten their death will likely discourage them from engaging in difficult or uncomfortable conversations, which provide the foundations for healthy grieving. Before psychiatry, I worked in general medicine. The prospect of dying understandably evoked absolute terror in patients and relatives. However, this process was rarely as difficult as it was imagined to be, and relatives were often grateful for the time it gave them, the care they could provide and the support they received. By giving terrified people the option to ‘opt-out’, we allow fear to rob their relatives of these opportunities. If anything, the option of an assisted death will only serve to entrench the fear and stigma surrounding a natural one.

 

Having spent the last decade in the NHS, I can say with absolute certainty that the service is not ready for this legislation. I have serious concerns about the quality of care the NHS provides for patients in its current state. I am equally worried about its capacity to arbitrate on matters of assisted dying. These concerns are not unique to me; I implore you to listen to other NHS doctors who will explain that a patient’s length of survival cannot be reliably predicted with any accuracy , or the majority of palliative care clinicians who oppose this legislation due to a plethora of concerns. I also implore you to read this excellent summary from a nursing colleague:  https://postliberal.substack.com/p/death-on-demand .

Finally, I am deeply concerned about the effect this legislation will have on anti-suicidal strategies pursued in public mental health. In the lead up to the parliamentary vote on this legislation, we witnessed understandable public outcry at an advert which read "My dying wish is my family won’t see me suffer… and I won’t have to" promoted on London Underground platforms. As a psychiatrist, I worry there’s a genuine duplicity in a society which endorses the fear of emotionally burdening others as a valid reason to end your life, at the same time mental health campaigns are trying to encourage us to share our emotional distress. These are diametrically oppos ite goals; and for every patient who will be freed of end-of-life pain, I worry that there exist countless other patients who will be endangered by these same shifting cultural norms. As an NHS psychiatrist, I am frequently reassured my patients – who despite being deeply depressed – tell me they could never contemplate suicide for cultural reasons. Normalisation of individual choice over ending one’s life risks removing this safeguard , sending a potentially lethal message to some of the most disaffected people in society.

 

To conclude, my views are not motivated by religion or any other conflict of interest. Rather, this letter is motivated by the many conversations I’ve had with patients who were once convinced they wanted to die and are now grateful for every single day they live; days which they were once willing to spurn away. It is not that these days are entirely free of pain or distress, but they are days which they are grateful for nonetheless. They are days they can now enjoy because the society they lived in shared a cultural norm . Their society was brave enough to contain their fear, hopelessness and despair during a difficult time, and confront it with care . I’ve listened to these patients and learnt from their stories. I hope you will too.

Yours Faithfully,

Dr George Gillett

January 2025