Partner and Head of Private Client, Deena Iqbal, argues that the current safeguards in the assisted dying bill leave room for coercion and manipulation of the elderly and vulnerable, and must be tightened significantly.
Deena’s article was published in The Times, 27 March 2025.
The proposed assisted dying legislation is steadily shedding the safeguards that were initially hailed as the most protective in the world. High Court Judge approval looks to be replaced by a panel (senior lawyer, psychiatrist and social worker) to review applications. So saying, it will be hard to source willing experts, with not enough psychiatrists available to fill 25% of consultant roles. The Royal College of Psychiatrists (RCP) states that 58% of psychiatrists would be unwilling to participate in assisted dying assessments.
The proposed legislation oversimplifies the issue of consent. Even for experts, it is difficult to assess mental capacity to consent, and to identify undue influence and coercion, as one cannot know what takes place behind the patient’s closed doors. Witness evidence from family members – usually an important consideration – will not be considered. It is proposed that the assessment can be by video or audio, without meeting the patient in person. This increases the risk of coercion by someone out of sight or not heard, pressuring a terminally ill person towards assisted suicide for example due to concern about cost of care fees reducing an inheritance. Phone assessments carry the risk of someone answering the questions in place of the patient without the panel knowing. Surprisingly, it is now likely that the application can be signed by a proxy for any reason. This is of concern given the increasing pattern of predatory marriages of the elderly by fraudsters.
Doctors may suggest assisted suicide, without discussing the implications of the drugs to be used. Full understanding of implications would ordinarily be necessary to achieve informed consent. These amendments open the door to the risk of fraud or coercion of the vulnerable which in turn leads to unreliable consents. According to RCP, almost two thirds of psychiatrists were not confident that the consent criteria can protect against people making unfree choices.
Diagnosis of a terminal condition can render someone temporarily incapacious just as grief can. When passing through the seven stages of grief, the patient’s desire to bring forward their death may fluctuate. They often change their mind about wishing to shorten their life, hoping to spend more time with loved ones. However, if after a written consent, their capacity declines, it might be too late to revoke their consent. In the Netherlands, a patient was euthanised against her will because she could no longer legally revoke her consent, giving rise to the country’s first euthanasia malpractice case. This is a very dark concept which could apply here under the proposed legislation.
The watering down of safeguards is deeply concerning for a bill that operates to bring about the end of a human life. Legislation must prioritise the vulnerable and disabled if we are to proceed with state sanctioned assisted suicide.
