Contribution
My Lords, I, by contrast, speak as an atheist and humanist, mainly to address my Amendment 45, which would add the word “encouraged” after “coerced”. I support the general theme of the other amendments in this group, which largely tackle the need to strengthen safeguards against patients being indirectly influenced into opting for assisted death—often coerced, in all but name. All these loopholes undermine any certainty that the “choice”, in inverted commas, is made autonomously.
My amendment, supported by the noble Lord, Lord Goodman of Wycombe, may appear to be a small change, as it would add just one word. But before anyone concludes that I am tabling trivial amendments to waste time, I note that, when dealing with a fundamental change in the state’s relationship with its citizens and the NHS’s relationship with patients, and life and death decisions, the specificity and appropriateness of the words in the changed law matter.
At present, the Bill requires doctors to ascertain only coercion or pressure. They are the only two words given in Clause 1; there is no duty even to probe or ask broader questions about more subtle, insidious influences that could affect a person’s decisions. I note that the concept of encouragement is not arbitrary; the encouragement of assistance in suicide is illegal under the Suicide Act but would not be in this Bill. Indeed, CPS policy guidance on prosecuting those who have assisted suicide acknowledges “encouraging”—it uses that word—the victim as a factor in favour of prosecution. It is also criminal to encourage a person to commit an offence under the Serious Crime Act. Therefore, the question is less about why I am bothering to table an amendment to add just one word; the question is why the sponsors of the Bill left out that word “encouragement”.
Adding the word “encouragement” would allow a shift in perception about what undue influence could look like. Even though there are real problems in spotting coercion or pressure—we have heard many examples of that—the concepts at least have a hard edge or overt sense, at least in everyday parlance, that you are talking about people doing something that they really did not want to do. You do not say, “I had a really lovely day today; my husband coerced and pressurised me into doing” something. There is a grey area of much more subtle intervention; an individual could motivate, lead on or nudge someone into opting for an assisted death, rather than making that person aware of all the ways that they might live out their limited time as comfortably as possible. This amendment is trying to get at that sort of encouragement.
As I explained at Second Reading, one of my big dreads is that, once assisted dying is normalised as a positive treatment option, that vibe shift will not be confined to medical scenarios. It can and will mean that it is popularised as a go-to option in broader society. Consider this scenario: you have just received the news that you have a terminal diagnosis and have about six months to live. You are frightened, shocked and seeking reassurance. It is a bleak time and you are depressed because you do not want to die.
But then a third party—a family, carer or friend to whom I ascribe no motivation—says, “Have you thought about asking your GP for an assisted death? I’ve been reading about it all over the place and you can do that now. At least that way you’d have dignity in dying. You know how much you hate hospitals and all those doctors fussing about you, and we all know that you are not good with pain. How would the kids cope with running around having to visit you when you’re in and out of hospital? Wouldn’t it be so lovely to choose when you go, then we could all be with you at the end?” All of this is said in soothing, kind tones. Therefore, you think, “Well, I really don’t want to die. My instincts are to
‘Rage, rage against the dying of the light’,
but I don’t want to be a nuisance either, and they know me so well. They know what I’m like and that I won’t cope. They have my best interests at heart, so I suppose so”. It does not sound exploitative or coercive, but it is an iron fist in a velvet glove.
We have some cultural reference points here. In discussions about how the Online Safety Act will tackle suicide sites, there is consensus about the problems of online influencers encouraging vulnerable people into believing that suicide is a positive way out of their suffering. There is widespread revulsion at those cajoling siren voices encouraging death as an attractive option. In that context, none of us concludes that this encouragement is not problematic because it is not explicitly coercive.