Terminally Ill Adults (End of Life) Bill

Written evidence submitted by Christine Kelly (TIAB1 76)  

Summary.

The provision of legal assisted suicide within the Terminally Ill Adults End of Life Bill (The Bill) is in direct opposition to the updated Suicide Prevention Strategy. In late 2023, an updated version of the first Suicide Prevention Strategy (SPS) was published with the aim of reducing the suicide rate in England, especially for those suffering serious physical conditions. The Bill and the SPS initiatives appear to be in direct opposition to each other.

1) Acknowledging the need to do more to prevent suicide, the government published a Suicide Prevention Strategy (SPS) policy document which set out aims to reduce the rate of suicide in England. The updated version acknowledges the progress made to reduce the suicide rate in England since the introduction of the original strategy; it is aiming to build on this as follows:

· To reduce the suicide rate over the next five years with initial reductions observed within half this time or sooner

· Continue to support people who self-harm

· Continue to improve support for people bereaved by suicide

2.1) The SPS report lists risk factors for suicide which research has identified. The factor at the top of the list is physical illness. As the diagnosis of a serious physical condition is often a major contributory factor when a person asks for assistance to die, this section is relevant to the discussions around the Assisted Dying Bill. The strategy within the SPS document designed to address the risk of suicide associated with physical illness is: to ensure that there is a "strong coherent policy agenda that sets out to shift to integrated whole-person care", thereby hoping to address any mental health issues associated with serious physical illness. It also notes that "it is important that those working in primary care recognise the risk of suicide associated with physical ill health and that they have the knowledge and skills to effectively intervene and signpost to support".

2.2) When Cicely Saunders set up the first modern hospice in 1967, her aim was to provide total care for each patient, addressing physical, mental, spiritual and social needs. (James 1994, 109) Whilst not every diagnosis of a physical condition is terminal, the approach taken within the hospice movement, i.e. total care, is identical to that identified within the 2023 SPS document described above as a means to address suicide in those who are vulnerable. This total care approach, together with the wealth of experience of the hospice movement, should be applied to address the concerns raised in the Strategy for Suicide Prevention. Extending and supporting the availability of the hospice approach to care would benefit a number of patients with difficult physical conditions.

2.3) For those whose diagnosis is terminal, the palliative care consultant, Kathryn Mannix in her book ‘With the end in mind, (2017) draws on her experience to show how skilful, sensitive and compassionate end-of-life care in the vast majority of circumstances can ensure that as the end approaches, the experience of the patient and their loved ones is a fitting end to the patient’s life. [1]

3) A further point identified in the SPS document is that of staff training. There is a likelihood for a situation to arise where on the one hand we provide training for medical professionals to be more aware of potential suicide in patients in order to prevent suicide, whereas on the other, legalising Assisted Suicide will require medical professionals to be involved at some point in the assisted suicide process. In Switzerland, the patient is assessed and a prescription issued by doctors. However, the rest of the procedure is delegated to non-medical personnel. It has been suggested by some doctors that this approach could be used in the UK. However, this paves the way for commercial interests to be involved.

4) The third aim identified for the Suicide Prevention Strategy is to improve support for those bereaved by suicide. The question arises whether a planned and medically assisted suicide would require the same level of bereavement support as a suicide which did not occur under these circumstances.

5) Finally, if the aim is to reduce the suicide rate, how might cause of death by assisted suicide be identified in the death statistics if it is legalised in England and Wales? This is a dilemma; a reduction in the total suicide rate is desired, whilst simultaneously assisted suicide would be available. I suggest that only by classifying an assisted suicide as something other than suicide could this prevent an undesirable increase in suicide statistics. If an assisted suicide is classified as something other than suicide, then this is simply sweeping the inconvenient category under the carpet.

6) If the Assisted Dying Bill is passed then there is the potential for government strategies to be in opposition to each other. On the one hand suicide reduction and prevention and on the other allowing terminally ill patients to resort to state-supported suicide. The SPS strategy recognises that serious physical conditions are a major factor when a patient asks for assistance to die and looks to ways to support patients through integrated whole person care. However, the experts providing this care, namely hospices are inadequately funded and rely on charity and fund-raising efforts of the local community to keep them afloat. The money which will follow this Bill if it is made into law would be better spent if applied to support the SPS strategy.

Details of the sender.My name is Christine Kelly. In 1998, I obtained an MA in Science Education from York University. In 2013, I also obtained an MA in Bioethics and Medical Law from St Mary’s University, Twickenham. I have since embarked on a doctoral programme at QMC, University of London where my topic was the portrayal of assisted suicide in film.

February 2025