It is deeply disappointing to see the British Medical Association (BMA) change its position on assisted dying. Previously opposed to physician involvement in any active assisted dying measures, the BMA at its 2021 conference instead adopted a ‘neutral’ stance. This regressive move was achieved on the narrowest of margins – with 49% in favour of the motion to change the position but 48% opposed and 3% abstaining.
The vote took place alongside persistent attempts by pro-euthanasia (or ‘right to die’) organisations to change law on this matter via parliamentary bills. So far none of these have met success but the lobby is relentless and a further bill was launched in the House of Lords in May 2021.
Although media coverage often portrays opponents of changing the law as solely those with particular religious motivations, in fact many people oppose assisted suicide becoming lawful. In particular, such a move has been opposed by disabled people’s organisations and many individual disabled people. Their argument is that so strong is the prejudice about and failure to understand the lives of disabled people that right to die legislation represents a strong and specific threat to disabled people in their interactions with health professionals and other authorities.
So-called voluntary euthanasia has a coercive potential, both consciously and unconsciously. Research shows that unconscious and unrecognised feelings between patient and physician can have powerful effects in influencing discussions and decisions on assisted suicide. One comprehensive review of the literature showed that ‘Transference and countertransference influenced 19% of cases in which the request for PAS or euthanasia was granted, despite the advice of the consultant’. One might wonder how ‘voluntary’ are decisions on euthanasia when they are informed by difficult, unconscious feelings about impairment, disability, fear of death, loss, inability to ‘cure’, beliefs about vulnerability and weakness, or much else? It is instructive that palliative care doctors, who spend much time close to those in the final stages of life and to understanding care, health and support needs, remain opposed to assisted dying laws.
Disabled people’s fears about how their lives are misunderstood and undervalued have been borne out by the pandemic and by ongoing underfunding of health, social care and measures to support independent living and inclusion. Disabled people argued vigorously before the BMA vote that particularly after 18 months of a pandemic where disabled people’s lives were shown to count for less in the eyes of government and many professionals now is certainly not the time to be moving closer towards assisted dying.
Examples of how disabled people’s lives are devalued are replete. Daily government media broadcasts on deaths from Covid-19 differentiated between deaths of those with ‘underlying conditions’ and other deaths, implying the former were less important. Disabled people found themselves subject to Do Not Resuscitate orders without consultation or consent. Disabled people who use personal assistants at home found themselves unable to get protective equipment (PPE) for many months. Disabled people died at hugely greater numbers. Current government policy to ‘live with covid’ means that many disabled people are condemned to permanent shielding, going into dangerous and potentially life-threatening workplaces or risk losing their jobs, and social exclusion and isolation.
Making it easier to take active measures to hasten death will not affect us all equally. Such a provision is more dangerous depending on who you are, your social position, what discriminatory attitudes you are exposed to and on the whole social and psychosocial context: it is not an abstract question.
Assisted suicide is also something which evidence shows individuals themselves may change their mind on over time – something that seems unliveable with in the abstract may become bearable in the actuality or if the concerns or fears involved are addressed.
As many disabled people have pointed out: while the right to and active support for living equal lives is not attained and, in fact, has been so weakened through the pandemic, now is not the time to make assisted dying more of an option. A weakening NHS and welfare state, deeply negative attitudes towards disability – including the wish not to think about our own vulnerabilities – and the ongoing impact of the pandemic and how it has been handled in Britain, mean this is a terrible time to move towards normalising killing as part of medical ‘care’.