That is a low blow, health secretary. On a matter of life, death and personal freedom, the debate should be elevated above this. Wes Streeting cheapens discussion on the right to die by suggesting there is no money to pay for a doctor to hand a dying patient the lethal dose they request. Disingenuously, he suggests that finding the funding would mean cuts to other services. It would have “resource implications” that would “come at the expense of other choices”. He made this unevidenced assertion before asking his department to look at any possible costs that implementing the legislation could incur. If he really wants to bring in the crude question of cash, I assume his department will assess savings in bed-days and staff time from those who choose to depart intensive end-of-life care a little sooner.
In two weeks’ time, parliament will vote on Kim Leadbeater’s assisted dying bill. The process would require two doctors to sign witnessed statements from a mentally competent patient who has been diagnosed as likely to die within six months. Then the application must be heard by a high court judge, who can question doctor or patient. Then there must be a 14-day pause before the patient self-administers life-ending medication. It is such a long process that many may die waiting in agony.
A House of Commons full of new young Labour MPs, progressive by nature and more in touch with the huge majority of the public that has long backed the right to die, will surely pass this law, won’t it? The largest poll on assisted dying showed 75% of respondents supported a change in the law, with a majority in every constituency in Great Britain: surely Labour MPs will back it too?
Probably, but not certainly. The word in Westminster is that Streeting’s abrupt retreat into opposition has set many of them wavering. His outright campaigning contradicts the instruction sent to all ministers by the cabinet secretary on how to conduct themselves on a free-vote issue. “Though ministers need not resile from previously stated views when directly asked about them, they should exercise discretion and should not take part in the public debate.” For the health secretary to threaten that passing this law might mean treatments being denied to others is up there in the dishonesty levels with that “£350m a week for the NHS” Brexit campaign promise.
Every Labour government brings breakthroughs in personal freedoms: abortion, gay rights, civil partnerships, abolishing the death penalty, censorship and more. Only Labour governments dare implement “nanny” public health laws that save untold numbers of lives – compulsory seat belts for drivers, the 70mph speed limit and a ban on indoor smoking, all facing vociferous rightwing opposition, but all popular.
The right to escape the last stages of dying if suffering is unbearable is the freedom this Labour government is being asked to bring to England and Wales. If it wobbles, it will be another decade at least before any bill would try again, and it’s highly unlikely that any future Tory majority would do this. It’s now or never. Ducking out would be an act of cowardice. Keir Starmer promised Esther Rantzen, who is dying of lung cancer, that he would ensure a free vote on the issue. As director of public prosecutions, his guidelines made the prosecution of anyone assisting a suicide less likely. But now he seems to be stepping back, claiming he hasn’t yet made up his mind on assisted dying. Or maybe he’s just obeying the cabinet instructions that Streeting flouts.
The mostly (though not solely) religious lobbies campaigning against the bill include church leaders, though not their congregations – 69% of Christians are in favour of assisted dying. The Care Not Killing alliance is the main umbrella group for the opposition, and is composed largely of the religious. Not Dead Yet speaks for some disabled people, but according to one poll, 78% of people with disabilities support assisted dying. Opponents argue that the Leadbeater bill’s five-hour debate in the Commons will be too short – as if the whole country hadn’t been debating this for years, as bill after bill failed in the Tory era.
Opponents manage to make it sound as if they have far more support than they do from those who work in palliative care and hospice services. But Mark Jarman-Howe, the chief executive of St Helena hospice in Colchester and a strong advocate for the Leadbeater bill, told me that while most in the sector stay neutral in public, a “silent majority” agreed with him. “Those opposed are a very vocal minority,” he said. “Everyone sees horrible deaths, such as terminal bleeding or fungating tumours caused by cancer.”
He perceives the double-effect principle in operation at present in palliative care – where doctors may hasten a patient’s death by sedating them, so long as death is not the purpose of the sedation. “It’s ethically dodgy,” he said of this practice. “It’s not monitored, [there is] no scrutiny. Nor is it [monitored] when people choose to refuse food or liquids, but that can lead to days of pain and torment for them and their family.”
He is indignant at Streeting using the shortage of palliative care in some places as an excuse for refusing the right to die. “Yes, it is underfunded,” he said, claiming that it receives far less money per patient than the rest of the NHS. The service was “teetering as numbers of deaths are rising”, he said. But even the best care, he added, could not prevent some horrific deaths.
The bill’s conditions are stricter than any law in other countries with a right to die. Personally, I think it’s been drawn far too tightly, excluding many in intolerable suffering with degenerative diseases, but if there is wobbling even on this bill, there is probably no chance of a better one. After studying the phenomenal 40 pages of safeguards and conditions accompanying the bill, I believe there is no excuse for Labour MPs to dither. Let each of them speak up now. This is not just for the few dying horribly: everyone will die, and everyone who ever thinks about what kind of death they could face deserves to know they can go when they choose at the end.
Polly Toynbee is a Guardian columnist
This article was amended on 15 November 2024 to expand on an observation by Mark Jarman-Howe about paradoxes within some current medical practice in palliative care.
