Assisted Suicide: A Letter to my MP

Why this bill is bad law and the the hasty campaigning process around it is conducive only to making bad law.

Dear Mr Pennycook MP,

1. I write to you this open letter regarding the Terminally Ill Adults (End of Life) Bill to ask you to consider a number of constituent concerns with the text of the bill and the campaign around it. I do so in the context of recognising you voted in favour of this bill at second reading and I have no doubt you had perfectly reasonable grounds that decision. It is on any view a difficult issue that arouses understandably strong feelings both for and against. As I will go on to detail, I take the view that even those who support the principle of this legislation should be concerned as to three matters: (1) the fundamental weaknesses in the safeguards in the bill, (2) the fairness of the parliamentary process thus far and (3) likely changes to this bill which significantly alter what was put before the House on second reading.

Weaknesses in the safeguards

2. Safeguards present on the face of the bill were naturally emphasised by supporters at second reading and were most likely a crucial factor in many MPs voting in favour of this legislation. Specifically, MPs were told the bill had the most robust safeguards in the world in respect of (i) detecting coercion, (ii) establishing capacity, (iii) requiring the approval of a High Court Judge and (iv) closely restricting the scope of eligible parties. On closer analysis, I fear these purported safeguards are entirely illusory and ask that you beware taking them at face value.

3. The Bill requires that two medical practitioners (who could be GPs) certify that coercion and pressure are absent in a patient’s decision to seek assistance with their suicide. While this sounds reassuring, it remains entirely unclear how a GP might safely come to that conclusion because the bill gives the medical practitioner none of the basic tools the police or courts might use to establish that fact. In civil law, undue influence claims (where a party unjustly exploits a power relationship for gain) are often document heavy and require expert witnesses. Criminal law is sadly replete with voluminous examples of perfectly plausible fraudsters preying on the elderly and the abuse of persons in controlling and coercive relationships. The victims in these cases are often vulnerable and do not contemporaneously realise that they are being exploited; this is why fraudsters target them in the first place. I remark that a GP would not have the power to call for a recently changed will, consider or require witness statements as to a person’s social arrangements or establish who, as a matter of fact, was to benefit from a will. That seems a serious oversight. As matters stand, the bill gives all of the responsibility of ruling out coercion or pressure to a GP, but none of the powers we would ordinarily deploy to investigate that fact. For this reason, this purported safeguard is ineffective.

4. MPs at second reading were told that the bill’s reliance on the Mental Capacity Act 2005 (“MCA 2005”) was a sufficient safeguard to deal with the nature of the choice involved. This assurance misunderstands the purpose and role of this act. In his evidence to the committee Professor of psychiatry, Allan House pointed out that the MCA 2005 has never been used in the case of suicidal ideation to establish that this a person’s desire. His evidence was that where a person expresses such ideation, a clinician would commission any number of reports beyond capacity to get to the bottom of why a person felt as they did. In this way, he pointed out, the requirement that a person simply has capacity under the MCA 2005 is actually a lower standard than would be required in normal clinical practice where a patient presents with suicidal ideation. Professor House is supported in his view regarding the purpose of the act by MCA 2005 specialist King’s Counsel, Alex Ruck Keen, who questioned the wisdom of linking an act designed to deal with those without capacity to an assisted suicide bill based on a person having capacity. References to the MCA 2005 no doubt assuaged concerns many MPs had at second reading, but a closer examination of the act and its purpose mitigate away from regarding this as a safeguard of any substance.

5. Proponents of the bill have placed great weight on the fact the bill requires the permission of a High Court Judge before any suicide is assisted. It has been said this is the most robust safeguard globally and, again, was no doubt a significant matter in the mind of MPs persuaded to vote in favour at second reading. Despite these assurances, it has become clear that in committee that this safeguard is unworkable, unclear and likely to be abandoned. Retired High Court (Family Division) Judge, Sir Nicholas Mostyn, (who is a supporter of assisted suicide legislation in principle) gave evidence that that the bill as written is unworkable; the High Court simply does not have the sitting days or general capacity to deal with the likely number of applications. This concern was also raised by a former President of the Family Division, Sir James Munby, (an opponent of this legislation), who was unfortunately not invited to give evidence.

6. Legal scholar Professor Laura Hoyano said in evidence to the committee that the very nature of the inquiry expected by a High Court Judge is unclear on the face of the bill. On one view, it could simply be a “tick list” check of documents prepared by doctors (which seems no safeguard at all). On another view, it could be a complete hearing of the claim which she described as “wholly inappropriate to an appellate jurisdiction”. Proponents of the bill on the committee seemed to tacitly accepts some of these points by engaging in a discussion of Spanish style “panels” and a co-sponsor of the bill Jake Richards MP write recently that “the need for a holistic assessment to eligibility and to safeguard against the risk, means the High Court may not be the most appropriate forum for this¹”. This seems a very clear signal that the assurance of High Court oversight MPs voted for at second reading will not survive the committee/reports stage of this bill. Any MP who based their vote on judicial oversight may wish to take that into account on third reading.

7. MPs were told that the bill would be tightly restricted to a terminal condition with a 6 months to live prognosis that could not be a product “only” of a disability or mental health condition. The strength of this safeguard is dubious for a number of reasons. Many mental health conditions have physical manifestation, anorexia being perhaps the most obvious example, as Chelsea Roff, director of eating disorder recovery organisation “Eat Breathe Thrive” said in evidence to the committee. It is also unclear in the case of progressively degenerative disabilities where a line between a disability and a terminal illness can reasonably be draw, a point Dr Milo Griffiths made in his evidence.

8. There are also reasonable grounds to suspect the definition of a terminal illness MPs voted for at second reading will progressively widen through amendments and legal challenges. Human Rights challenges are all but inevitable in this field, and while the European Court has been reluctant to intrude into this area with other member states, the widening approach the Court takes to Article 8 (the right to a private and family life) by no means guarantees this will always remain the case. Tom Gordon MP has proposed an amendment that would widen the criteria to those with a 12 month to live prognosis in the case of a neurodegenerative illness, disease, or medical condition². There is therefore every reason to question the definition of a terminal illness in the bill on safeguarding grounds and every reason to suspect that the UK will follow the legislative direction of travel by countries across the globe in “widening access” to assisted suicide once the principle is enshrined in legislation. This is a paradigm example of a slippery slope.

The fairness of the campaign around this issue

9. As an MP, you will appreciate that the Private Members Bill procedure places a great deal of power in the hands of the sponsoring MP and supporters. It is not clear that this power has been exercised fairly in producing the open, balanced and fair examination of this issue you were promised at second reading. This committee begun proceedings by voting to sit in secret to agree the list of witnesses. That vote produced 24 witnesses in favour of the bill compared to 6 against. This does not seem balanced or fair.

10. You are no doubt aware that the in built majority on this committee then voted against hearing from; The Royal College of Psychiatrists, Disability Rights UK and an amendment moved by Diane Abbot MP that it should hear from the CEO of Hourglass (a charity that campaigns against the abuse and exploitation of the elderly). In each of these three cases public reaction persuaded the Committee to think again and hear from these witnesses. Writing in House Magazine, Dianne Abbot said of the process, “It has also been blatantly mishandled, with some of its leading supporters making statements that are clearly false, blocking opponents of the bill from giving evidence in committee, and generally treating them with contempt. ³“

11. Witnesses opposed to this bill also report a less than a courteous of fair hearing from campaigners for this legislation sitting on the committee. Following her evidence, palliative Care specialist Dr Rachel Clarke posted on X (emphasis added) “My thanks to Kim Leadbeater for the chance to give oral evidence yesterday on matters of profound, life & death importance. Gratifying to see how engaged & serious the committee was, apart from one MP who yawned & openly scrolled on his phone whenever the evidence bored him”⁴. Professor of psychiatry Allan House wrote of the committee (emphasis added) “Frustrating format and sense of minds made up. But interesting to be told by Kim Leadbeater that I don’t understand suicide in life limiting illness.⁵” You may also have noted Baroness Falkner of the Equality and Human Rights Commission interrupted by the sponsor with an unjustified point of order for simply pointing out that government bills have consultations while private member’s bills do not.

12. International critics of this legislation were not called to give evidence at all. This seems surprising given several Canadian experts submitted written evidence (which has not been published) and were not called to counter balance the American and Australian witnesses in favour of the bill. There are reasonable grounds to question the objectivity and impartiality of the international witnesses that were called. One said that family members trying to stop a loved one seeking assisted suicide should face prosecution⁶. Another witness claimed that a person feeling like a burden was an unremarkable expression of their autonomy (and therefore of no consequence in questions of coercion⁷). Finally, an Australian politician called to give evidence appears to have incorrectly claimed that funding in his state for palliative care went up after passing similar legislation, when the opposite appears to be the case⁸. The same witness went on to claim that assisted suicide legislation is a form of suicide prevention⁹, a contention that appears to owe more to the language of concerted campaigning than it does to speaking plainly about reality.

13. In view of the above, there are reasonable grounds to question whether the approach taken procedurally is the fair and balance investigation you and fellow MPs were promised at second reading. Certainly the concerns across the house have been so marked that a group of labour MPs felt compelled to write to their colleagues on this matter¹⁰. If I may, I would urge you to listen to the analysis of on of the signatories to that letter, Jess Asato MP, who on Times Radio described the process as rushed and respectfully pointed out that there there is a fundamental difference between campaigning and legislating¹¹. I would add that the haste she identifies is in fact built into the bill, with the unnecessary requirement that it come into operation 2 years after passing irrespective of whether the NHS is ready, a point that Sir Chris Witty questioned in his evidence.

    Conclusion

14. I start by thanking you and your staff in advance for considering what I know is a long letter by normal standards and I hope you would agree with me that it is all too easy in an age of online politics to construe disagreement as a “toxic debate” (as has been complained of by proponents of this bill). That is an unwelcome response to the discussion that was promised because in reality, what is happening here is simply “debate”. It hardly needs saying that change this profound requires the most conscientious and anxious consideration. Literal life and death questions should not form the backdrop for energetic campaigns, unfair witness lists or closed minds on the issue. As matters stand, not despite the efforts of the committee, but precisely because of the conduct of this committee, I and many of your constituents view with process with more rather than less scepticism that this is a fair or proper process.

15. In view of my observations, if I may, I invite you to consider carefully the efficacy of the promised safeguards, the fairness of the process in general, the undue haste which seems to accompany this legislation and whether a mind set more suited to campaigning rather than legislating wisely is being adopted. Even those most ardently in favour of the principle underlying this legislation want good law with adequate safeguards. This is not such a law. For those reasons, I respectfully ask that you take into account these concerns when considering how to vote on third reading.

    Yours Sincerely,

    Dennis Noel Kavanagh
    8th February 2025

1. https://www.politicshome.com/thehouse/article/legislating-assisted-dying-monumental-task-its-beyond-capabilities-parliament

2. https://www.mydeath-mydecision.org.uk/2025/02/06/amendment-to-allow-assisted-dying-at-12-months-left-to-live-for-those-with-neurodegenerative-illnesses/

3. https://www.politicshome.com/thehouse/article/disability-activists-dont-support-assisted-dying-know-last-queue-human-decency

4. https://x.com/doctor_oxford/status/1884500322955010072

5. https://x.com/AllanOHouse/status/1884666537656672724

6. https://x.com/danny__kruger/status/1884330756862009445

7. https://x.com/nmdacosta/status/1885227087839027266

8. https://x.com/danny__kruger/status/1885044934249426956

9. https://x.com/danny__kruger/status/1885044937315541252

10. https://x.com/antoniabance/status/1887583052362031463

11. https://x.com/TimesRadio/status/1887789314320302233