Terminally Ill Adults (End of Life) Bill

Written evidence submitted by the Catholic Bishops’ Conference of England and Wales (TIAB25)

Executive Su mmary

· W hil st we are opposed to this B ill in principle, we also believe that the provisions under the B ill are unworkable.

· The Bill raises practical concerns which puts vulnerable people, the system of hospice care and medical practitioners at risk. In addition , t he proposals in the B ill, if enacted, would undermine the G overnment’s own strategies in improving NHS provision, addressing inadequacies in palliative care and suicide prevention.

· The Catholic Church provides many care homes and hospices which operate according to Catholic principles and are open to all. They employ a wide diversity of staff. The lack of protection for the freedom o f such institutions would put their modus operandi at risk . E xperience in other jurisdictions suggests that there is no effective protection against this.

· There are many Catholics working in the healthcare sector. T he B ill raise s serious questions of conscience and expose s healthcare professionals to moral injury . It will also change the fundamental nature of the relationship between doctor and patient.

· We believe strongly that palliative care should be improved in this country. Experience from other jurisdictions highlights that t he legalisation of assisted suicide has had a negative impact on palliative care and suicide prevention.

The Catholic Church’s work in healthcare and end -of-life care

1. The Catholic Bishops’ Conference of England and Wales is the permanent assembly of Catholic bishops across the two member nations and also acts as a national representative body of the Catholic Church.

2. The Catholic community has a long history of working in partnership with Government across a range of public services. We provide chaplains in hospitals as well as hospices and palliative and end-of-life care. There are approximately 6.2 million Catholics in England and Wales, making it the largest religious minority group. 1.75 million Catholics attend Mass across England and Wales on a regular basis. [1]

3. Catholics form a significant proportion of staff working in medicine and social care, with many staff coming from recent cohorts of migrants to Britain from the Philippines, Ireland and Eastern Europe. There are Catholic chaplains in all hospital trusts and many hospices and care homes are part of the Catholic community. The Catholic Medical Association, representing Catholics in the healthcare sector, opposes the legalisation of assisted suicide as proposed in the Bill. [2] Priests, religious and lay people also have a wealth of experience in caring for sick, frail and vulnerable persons. This includes organisations such as the Society of Saint Vincent de Paul who last year made 475,064 visits to people in need. [3]

Opposition to the Bill

4. We oppose this bill in principle and believe it to be unworkable. Care for human life should protect and promote human life until natural death. Elected officials have a responsibility to ensure the right to good healthcare is upheld and should not allow the passing of laws that put citizens at risk and endanger the provision of good care at the end of life.

Assisted d ying : eligibility ( Clause 1 )

5. The B ill uses the euphemism ‘assisted dying’ to describe the practice of prescribing lethal drugs to terminally ill patients so that they can take their own life . The correct term ‘assisted suicide’ should be used, instead , to av oid confusion and not to mislead patients, their families and practitioners. In this context, it is noteworthy that the B ill necessitates an amendment of Section 2 of the 1961 Suicide Act , that prohibits assisting someone else in committing suicide (see S. 24(3)) .

6. The re is evidence that the leg alisation of assisted suicide has had a detrimental effect on suicide prevention and is linked to a n increase in the number of non-assisted suicides, especially among the elderly and among women. [4] [5] The provision to al low assist ed suicide therefore stands against the government ’s suicide prevention strategy. [6]

Terminal Illness ( Clause 2 )

7. The definition of terminal illness is not sufficiently narrow , making it open to interpretation , abuse and expansion both legally and practically . Evidence shows that in the jurisdictions where assisted suicide has been legalised, there has been an incremental expansion of the criteria used . In Oregon , USA, despite the law itself not changing, the understanding of what constitutes a terminal illness has widened to include non-terminal conditions , such as anorexia or diabetes. [7] Cases of assisted suicides for people with eating disorders have also been found in other jurisdictions. [8] Canada is another example of rapid and significant expansion s of such laws . Within five years of the introduction of its medical assistance in dying (MAID) law , eligibility was extended to non-terminally - ill individuals . I n 2027 , the Canadian law is scheduled to widen further to include those with mental illness. It is abundantly clear from the international evidence that there can be no safe or limited assisted suicide law. 

8. We are particularly concerned that vulnerable people will be pressured to end their lives or that a decision to do so will be taken by those who feel a burden on others. Th is concern is informed by the huge amount of experience the Church and its associated charities has working with people who are vulnerable . In the US state of Oregon, l oss of autonomy, bodily functions or feeling a burden are among the top five reasons for choosing assisted suicide, with inadequate pain control much less frequently cited [9] ; 48.3% of those who underwent an assisted suicide between 1998 and 2021 cited fear of being a burden on their family, friends, or caregivers as a concern motivating their request . [10] T he latest available evidence from Canada reveals that in 2023, 45.1% of those whose death was ‘reasonably foreseeable’ and 49.2% of those whose death was not ‘reasonably foreseeable’ requested euthanasia in part due to feeling a ‘perceived burden on family, friends, or caregivers’. [11] In Washington in 2022 fear of being a burden was cited in 59% of cases. [12] The fear of being a burden on family and society would only be amplified by current gaps in social and palliative care. [13] Concerningly, Age UK recently reported that 2 m illion older people across the UK are now living with some unmet need for social care . [14]

9. We believe th is B ill would lead to danger s for those living with disabling conditions with unreliable prognosis , especially given the reservations we have expressed about the apparent safeguards . The United Kingdom enjoys a proud history of addressing discrimination against people living with disabilities and it would be a grave mistake and contradiction to legalise a practice that would especially endanger those with disabilities. M ajor disability rights groups in the United Kingdom have opposed any change in the law on assisted suicide/euthanasia, including Disability Rights UK, Scope and Not Dead Yet UK. [15]

10. The ability to access assisted suicide , even i f there is treatment available that alleviates symptoms , leads to the danger that assisted suicide will partially replac e palliative care. As recognised by the recent Health and Social Care Select Committee there is a need to improve palliative care in the UK. [16] There is evidence from other jurisdictions that the legalisation of assisted suicide has led to a reduction in effective palliative care provision or that improvements in provision are slower than in jurisdictions that do not have assisted suicide. [17] The lack of effective palliative care will lead to pressure for the extension of the criteria under which assisted suicide is allowed. The provisions under this B ill therefore undermine the priority of this government to improve palliative care services – in practice, assisted suicide provision and palliative care are not complements .

Initial discussions with registered medical practitioners ( Clause 4 )

11. The possibility of doctors suggesting assisted suicide to patients will fundamentally change the relationship between doctors and patients as well as the culture in which medical care is provided . Assisted suicide is not a medical treatment. For a doctor to suggest to a patient that they could end their life is a major – and potentially alarming – step , and not one that the law should allow a medical professional to take. This provision makes the safeguards in this B ill weaker than those in other jurisdictions , such as Victoria in Australia, where medical professionals are prohibited from suggest ing assisted suicide to patients.

12. The duty of referral in this clause violates the consciences of medical professionals by requiring them to collaborate with assisted suicide. A ssisted suicide is contrary to the conscience of a large proportion of doctors. Freedom of conscience is protected in the UN Declaration of Human Rights, the European Convention on Human Rights, the UK Human Rights Act and the Equality Act. For the avoidance of doubt, requiring a doctor who does not wish to be involved with assisted suicide to refer to another doctor who does , would mean that the referring doctor would be co-operating directly with the act of assisted suicide in violation of his or her rights of conscience. A legal duty to refer for assisted suicide is unacceptable and is contrary to the policies of the World Medical Association . [18] It has been opposed by the British Medical Association in their parliamentary brief on the B ill. [19] [20]

13. The duty of medical professionals to refer for assisted suicide has the potential of furthering the negative impact of this B ill on medical professionals, and their ability to work for the benefit of their patients. A d uty of referral against a doctor’s conscience , and the feeling of an inability to give adequate care that comes with it, can create moral injury and moral distress, which creates profound discomfort and therefore can constrain the work of the professional. [21] [22] These are phenomena which are increasingly being understood as very real problems.

No obligation to provide assistance etc ( Clause 23 )

14. There is a widespread objection among doctors toward s providing assisted suicide in the British Isles with only 36% of doctors willing to be involved if the law changed (according to a survey of almost 29,000 doctors) [23] . A survey from 2023 showed that 34% of medical professionals would consider leaving the Isle of Man, if assisted suicide were to be introduced on the island [24] . A ssisted suicide is an issue that will concern practitioners across all areas of healthcare and it may further undermine staff moral and exacerbate recruitment and retention problems within the NHS and care services.

15. Clause 23 does not protect institutions, such as hospitals, hospices and care homes from being required to facilitate assisted suicide. There are a number of Catholic and other faith-based hospices and care homes around England and Wales, many of which are r u n by religio us orders and which are seriously concerned about the impact of this B ill on their future . Experience of other jurisdictions strongly suggests that they w ould be required to provide assisted suicide either a s a result of regulations from the Secretary of State (under Clause 32 or otherwise ) or as a result of court challenges under human rights or equalities legislation . This often happens under the pretext of such institutions receiving government funding. Such moves would be an attack on institutional freedom and what might be termed "institutional conscience". We have been told by hospices that, if they are required to facilitate assisted suicide (as seems likely, even if not immediately), the provision of their services would be put in jeopardy . Hospices, such as St Joseph’s in London, have already made their opposition to assisted suicide known , and showed how it is inconsistent with the ethos of palliative care. [25] W e expect other institutions to submit evidence to the Committee on how this would significantly limit, or even halt , their ability to operate. Toby Porter, CEO of Hospices UK has commented : "The implications for hospices must not be underestimated or sidelined. There are huge unanswered questions." [26]

Dishonesty, coercion or pressure ( Clause 26 )

16. The concept of coercive control is only beginning to be underst ood , and reflect ed in law, legal procedures and social work practices . It can be exercised in subtle ways over very long periods of time. "Coercive control creates invisible chains and a sense of fear that pervades all elements of a survivor’s life. It works to limit their human rights by depriving them of their liberty and reducing their ability for action." [27] The safeguards in this B ill referenced in c lause s 5-22 in conjunction with clause 26 are wholly inadequate for dealing with this phenomenon given that there is no guarantee that anybody with the appropriate expertise will be involved with the process and given the short timescales in which decisions will be taken.

21 st January 2025