Lords debate guarding against coercion, encouragement and pressure

Friday November 21st'  Lords sitting focused on a group of amendments concerned with guarding against coercion, encouragement and pressure.

Baroness Berridge noted that the Leadbeater Bill does not actually define “pressure” (economic? emotional? financial? spiritual? reputational? internal? external? circumstantial?) and constructively proposed learning the lesson of the Serious Crime Act (under which the Home Office had to supplement with 91 pages of guidance on the meaning of “coercion”).

Baroness Finlay, noting that suicide is now the commonest cause of domestic abuse-related deaths, cited research which found many women would be unlikely to disclose domestic abuse during assisted dying assessments. Conversely, she recalled a patient whose pain was uncontrolled until she entered hospice; once her pain was under control, she felt strong enough to disclose years of domestic abuse and was finally able to access support.

“Total distress from hidden abuse had given her total pain.”

Lord Hunt of Kings Heath and Lord Farmer tabled amendments guarding against financial abuse, and barrister Lord Carlile noted that there are many examples of calculation masquerading as kindness.

Baronesses Coffey and Ritchie proposed amendments recognising the dangers of internal pressure, supported by the former Chief Nursing Officer Bishop Sarah Mullally who said:

“I believe that the supporters of this bill have decided that the policy intent of the Bill is that even if somebody chooses an assisted death to save their family care costs, that is OK so long as it is their decision, free from coercion.”

Lord Deben added:

“This bill will change how we view old age and infirmity. I desperately want people to know they are valuable, that they have something to give even at the end of life… If we’re going to have it, let’s make sure people are protected not just from coercion but also encouragement [e.g. freeing up capital for younger relations].”

“Every amendment that I have tabled is designed to make the Bill better.”

More than 1,000 amendments have now been tabled, and it is telling that backers of the Leadbeater Bill (like Lords Watts in today’s debate) focus their attacks on the number, rather than the substance — all the more stark during a debate considering how to guard against financial and domestic abuse, and internalised pressure. Baroness Hayter provoked indignation when she accused Peers unlikely to vote for an amended Bill of “trying to stop discussion and proper scrutiny” — quite the reverse, obviously – and “wasting the time of those of us who want the Bill to go through.”

Lord Carlile said many Peers would make a judgement based on the Bill’s final form (“it is unworthy of the noble lady to allege that all of us here are wasting time”) and former High Court judge Baroness Butler-Sloss said given the possibility of the Bill becoming law, “we want it better than it is at the moment.”

Baroness Finlay cemented the case for pursuing the improvements under discussion when she quoted Lord Falconer’s own “Commission on Assisted Dying”, which acknowledged:

"A real risk that some individuals might come under pressure to request an assisted death if this option should become available, including direct pressures from family members or medical professionals, indirect pressures caused by societal discrimination or lack of availability of resources for care and support, and self-imposed pressures that could result from the individuals having low self-worth or feeling themselves to be a burden on others.

“The [Falconer] Commission does not accept that any of these forms of pressure could be a legitimate motivation for a terminally ill individual to seek an assisted death. Therefore, it is essential that any future system should contain safeguards.”

Personal perspectives

Lord Blencathra described the life-changing effect of a drug he takes to help him walk in the face of MS. He could easily imagine external pressures like the withdrawal or denial of expensive drugs leading someone to seek assisted suicide.

Considering how subtle and accumulative pressure can be — fuelled by “anonymized vitriol” on social media — disabled Peer Lord Shinkwin told the House that:

“I was laughed at in the street as recently as last weekend because of how I look as a result of my disability… How can being subject to such prejudice not affect… a person in a vulnerable situation who is considering assisted dying? …How many non-disabled people factor that in?”

Baroness Hollins described how her late husband, when he was “dying with Motor Neurone Disease last year… felt under immense pressure from this debate”, from the push for assisted suicide. Was his continued use of overstretched resources justifiable, he asked?

“Pressure to not be a burden is just huge”.

Still to come

There are clearly significant concerns in the Lords, and just as members are rightly taking the time needed to properly address these, influential figures have been laying down markers for necessary debates in the weeks to come. Just this week, the Telegraph has covered:

•The risks to people with eating disorders, as highlighted by a joint letter from, among others, actresses Sophie Turner and Stephanie Waring, TV personality Gail Porter and mental health charity Mind (Telegraph, Eat Breathe Thrive)

•The particular needs of under-25s, as highlighted by Children’s Commissioner Dame Rachel de Souza and Baroness Berger (Telegraph)

This Bill’s flaws must continue to be unpicked, and as the Government Chief Whip implicitly reminded Peers this morning: this is a Private Member’s Bill, not a Government bill, and certainly not a manifesto pledge — they can throw it out if they see fit.

Report from Our Duty of Care https://ourdutyofcare.org.uk/