The Civil Service has done an ‘impact assessment’ for what the NHS and hospice sector will look like if Kim Leadbeater’s assisted dying (AD) Bill becomes law.
It’s chosen a sample of a few ‘comparator’ US jurisdictions and New Zealand to show how many cases of AD there are (expressed as percentage of total deaths). The population of the sample is equivalent to England and Wales.
The projection estimates a few hundred AD cases here a year initially, rising annually. However, New Zealand, in its first year of AD, recorded an AD rate six times the rate that was recorded in the first year in California – equivalent to 4,000 England/Wales deaths if we scale up for population size. The maximum Civil Service estimate for the first year in England and Wales is 1,600 deaths. So what has gone wrong ?
Let’s look how Kim Leadbeater described the civil servants’ actions ( Report stage debate , May 16th):
‘They certainly have not expressed any opinions on the content of the Bill. They have merely provided the technical advice and expertise, and they have done so brilliantly’
[Terminally Ill Adults (End of Life) Bill – Hansard – UK Parliament]
I‘m sorry but I thought the civil service was supposed to ‘speak truth to power’
They haven’t. They’ve ignored the New Zealand data.
There is another serious miscalculation.
In the USA, AD is a massive overdose of morphine, valium , digoxin and amitryptiline. As a combination. – Not intravenous (IV) injection because IV of lethal drug doses in the US is reserved for criminals.
IV will be permitted here.
The Bill does not allow the doctor to give you an injection like vets do. It allows use of a ‘device’ – a pump – so long as you yourself physically press the ‘start’ button. I presume there will be a software safeguard which asks ‘are you really sure? ‘ – A bit like if you try to cancel an unwanted direct debit.
What will the doctor do, apart from being a token presence? Before the chosen day the NHS will provide the doctor with some 6 hours time to assess your eligibility, your mental capacity and your understanding. That’s like 36 normal appointments in the surgery – you may not get this many in the whole of your illness. There may have to be more than one syringe in a pump – but that’s pharmacy’s role to mix. Some clever software will deliver the right doses in sequence so you don’t wake up. The doctor connects an IV to the pump, and confirms you are aware enough to make a decision (this could entail clearing your body of sedative pain killers for several hours). The doctor has to stay (but not necessarily in the same room), maybe having a coffee , doing emails or phone calls – to patients whose appointments have just been cancelled – until the end. Delivering a coup de grace is prohibited . When unconscious you may cough , choke on your final meal or asphyxiate in the sight of your family.
In Canada , a jurisdiction not in our Civil Service’s selection , the ‘self checkout’ method has been abandoned in favour of the doctor or nurse’s reassuring hand.
So it’s hard to forecast the ‘service’ we may end up with , especially now so many regulations will be adjusted on the hoof by what are referred to as ‘Henry VIII’ powers. The old monarch would envy the Minister’s power.
There is a forgotten principle in planning medical services. Services develop , not primarily because of public demands, but because professionals offer them. Whether that’s ear dewaxing , prostate screening, or developments in pain relief in palliative care, it’s the vision – and reward – of the practitioner that maintains the service . Disincentivise palliative care specialists, by taking away the freedom for their workplaces to express collective conscience, and they might disappear.
An enthusiastic maternity doctor ‘delivered’ AD on the summer day the Canadian Bill received Royal Assent. With colleagues, she delivered about 80 to a population of 850,000 before the following spring – a rate of AD some 10 times than south of the border.
That scales up to 15,000 AD cases a year here. – Over half the number of heart bypass operations. Is this our vision for the NHS?
* The author is a retired pain specialist doctor who worked with palliative care specialists, a former hospice trustee and non executive member of a clinical commissioning group until it was dissolved. They have stood as a county council candidate for the LibDems.
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13 Comments
I have been a member of the Campaign for Dignity in Dying for about 20 years. While I think it is unlikely that I would use the option personally, I believe that all citizens should have a free choice.
I can understand people who oppose assisted dying either because of their religious beliefs, or because they have deep philosophical (non-religious) objections to allowing it. However I consider it wrong to impose one’s beliefs on others.
Since the current Bill was introduced in Parliament, I have seen many opponents basically misrepresenting the experience of those countries and US states that already have assisted dying.
I have never seen anything in information sources that I respect (such as “The Economist” or “The Financial Times”) which indicate anything other than that assisted dying has worked perfectly well in such jurisdictions, and is accepted there as just another part of life.
Instead we see fear mongering which seeks to paint such jurisdictions as having failed systems. My view is that this article is another such example.
@Mohammed Amin
Could not agree more. And as I expressed in my own article that I wrote and was released earlier today – we are liberals and us liberals should champion people who are of sound mind to might their own choices of a dignified exit and it is more illiberal in my view for the State to oppose agency. Because if we believe in dignity, we must believe in the right to choose a dignified death. Because if we believe in compassion, we must extend it even to those who are leaving us.
And because if we believe, truly believe, in freedom — then we must also believe in the freedom to say: enough.
Not for the first time, I completely agree with Amin. The choice to end your life should be entirely your own and not impeded because someone else doesn’t like the concept, has different religious views, believes it may set a “bad precedent” or feels that other people may be bullied into it.
This is quite a peculiar article, I’m not really sure what point it’s trying to make. But for those who say “there will be more people availing themselves of assisted dying than you think”, my response would be that’s fine – if that’s what people want, they should be entitled to exercise their free will. And if there are more than expected, that only goes to show what a scandal it is that so many people are currently being denied that free choice.
If the basis of the argument for assisted dying is that ‘people of sound mind should have the right to die at a time and place of their choosing’, surely the logical conclusion of this belief is that we should support the right of people of sound mind to end their lives whether or not they suffer from a terminal illness?
That is not my vision of a progressive, liberal society.
@Mike Peters – I agree that we should indeed support the right of people of sound mind to end their lives whether or not they suffer from a terminal illness.
Where we differ is that is *precisely* part of my vision of a progressive, liberal society. Indeed what could be more liberal than permitting people to make those choices that affect their own lives (so much more than they affect anyone else’s life)
If any MPs are reading this, I would like to ask you this : Are you prepared to accept the fact that inevitably some vulnerable people will be coerced into ending their lives? Are you also prepared to accept the fact that some people may opt for assisted dying because that are afraid of being a burden, and have convinced themselves that it is somehow their duty, even if they have not been coerced by others?
Kim Leadbeater has herself admitted that even if someone’s only reason for requesting asssisted dying is the wish not to be a burden, they would still qualify, under the terms of this bill. Anyone with a prognosis of six months or less will qualify, whatever their reason. Kim Leadbeater did seem to recognise that it was not ideal if someone made this choice solely to avoid being a burden, but seemed to accept it, saying something about “autonomy”.
So to MPs who may be reading this, I would like to ask : How many deaths as a result of coercion do you consider acceptable? How many deaths of people who would like to live longer but are afraid of being a burden, do you consider acceptable?
I would like you think your answer is “none”. If so, ple
ase vote against this bill.
Liberals do believe in personal autonomy, but not when such autonomy risks terrible harm to others.
@Catherine Crosland – surely another valid question is how many people should be forced to endure pain, suffering and distress for up to an additional 6 months when they have no hope of recovery?
The “death” bit is the only part of the process that is inevitable. The suffering bit could be shorter.
Nick Baird, There are no easy answers, but surely it is better to focus on improving palliative care, and also research towards finding preventions and cures for cancer and other terrible illnesses, rather than rushing to legalise killing as the answer. You haven’t answered my question : How many deaths of vulnerable people who have been coerced do you consider acceptable? How many deaths of people who opted for assisted dying because they were afraid of being a burden do you consider acceptable? If the answer if none, then this bill is unacceptable
Catherine – I don’t accept that it is inevitable that people will be coerced into this. Nor do I accept that the distress that a terminally ill person may feel at the thought of being a burden is invalid.
But regardless, how many lives will be saved if this bill is blocked? Sadly, the answer is none. It’s incorrect to frame this as a choice between living and dying.
Nor should it be framed as a choice between improved palliative care and assisted dying. This is about dignity and freedom for individuals to make their own choices when death is inevitable and imminent.
A question for you – how many terminally ill people should be forced to endure 6 months more suffering when they would prefer to chose the manner and timing of their own death?
Nick Baird, lives would clearly be saved if this bill is defeated – the lives of people who would be coerced into assisted dying, or opt for assisted dying because they are afraid of being a burden. We need to remember that a prognosis of six months to live is not precise, as supporters of the bill accept. Some people with this prognosis may live for years, even if they do have a terminal illness of which they will eventually die. People living with cancer or another terminal illness may have a good quality of life
@Catherine Crosland
“lives would clearly be saved if this bill is defeated – the lives of people who would be coerced into assisted dying, or opt for assisted dying because they are afraid of being a burden.”
What evidence do you have that people would be coerced into assisted dying?
Nick Baird 19th Jun ’25 – 5:03pm.. Having watched a loved one go from a vibrant human being to a ‘barely living’ skeleton longing for release, I agree with you.
Catherine Crosland 19th Jun ’25 – 3:56pm….”.improving palliative care, and also research towards finding preventions and cures for cancer and other terrible illnesses”…
Why do you suggest that it is ‘either or’.. Such research will not end..
@Catherine: The problem we have is that whatever we do leads to results that would seem unacceptable. Of course, it’s unacceptable for anyone – even a single person – to be coerced into assisted dying. But equally, to my mind, it’s unacceptable for anyone – even a single person – to be forced to live for an additional few months, perhaps in unbearable pain, when they truly have reached the point where they wish to die and end their own suffering.
So what do you do? Change the law and there’s a plausible risk of the former happening in some cases. Refuse to change the law and there’s a certainty of the latter happening, perhaps to many people. Either option leads to situations that no-one would wish, so we ultimately – as with so many political decisions – have to decide which of two imperfect options will do the most good/least harm.