Dr Jennifer Dvorak argues that if assisted dying is leagalised in Britain, it must follow a thorough and objective analysis of the evidence, and not rely on an emotive vote.

Following the announcement that the government will have a free vote on assisted dying the quick rush to legislate is of concern to many who would prefer to slow things down and gain a better grasp of the evidence before diving in.  A cautiously optimistic approach would be advisable given that some inconvenient truths have been omitted from wider public discussion and require some careful thought and consideration.

Although it is true that opinion polls show a large percentage of the population support law reform concerning assisted dying, there isn’t good evidence to suggest that the public understand exactly what assisted dying under MP Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill likely entails.

Does the public truly comprehend the distinction between assisted dying and euthanasia, for example, and the evidence of the safety and efficacy of either approach?

The Bill proposes assisted suicide (where a person must end their life themselves) not euthanasia (where a doctor can end a life for them). In other jurisdictions evidence concerning drug efficacy and risks of complicated -not quick and peaceful- deaths suggests that there is no magic bullet as is sometimes conjured up in the public imagination surrounding assisted dying.

A second inconvenient truth is that medical regulation is not a perfect system. The British Medical Association and Royal College of Physician surveys on assisted dying are often cited as evidence of physician support, but the reporting on these surveys is heavily biased: aspects of the data that do not conform to the public script are often negated e.g. the fact that only half of those doctors in support of assisted dying would be willing to be involved/prescribe for it (24%). This is an important omission from a regulatory point of view because embedding assisted dying provision in medicine has caused challenges in other countries, where the actual uptake of physicians in assisted dying provision is low (e.g. only 1.5% doctors in Canada and 2.3% Oregon). Evidence from the Netherlands suggests that doctors procrastinate to avoid difficult decisions over assisted death.

A third inconvenient truth is that, where evidence is conflicting, sometimes only one side emerges in the public eye. Many palliative care doctors are concerned about cuts to palliative care services. The recent Health and Social Care Inquiry pointed to evidence cited in the Australia’s legal decision-making, which suggested palliative care spending increased in regimes where assisted dying was legalised. However, this data is far from conclusive. More recent data was omitted from the Inquiry report which, conversely, suggests that palliative care service growth has stalled in some Benelux countries.

Finally, those opposing assisted dying who cite concerns over structural vulnerabilities and ‘slippery slopes’ are often dismissed as succumbing to scaremongering, conservativism, religious zealotry or logical fallacy. In global debates Downar et al’s research is frequently cited as evidence that structural vulnerability factors do not influence assisted dying requests. However, conflicting data (and even Canada’s Human Rights Commissioner) reveals evidence of a correlation between social inequality, structural vulnerability and assisted death.

If we are to legalise assisted dying in Britain this cannot be through an emotive vote but must follow a thorough and objective analysis of the evidence. It is important that people’s autonomy can be respected whilst also ensuring effective safeguards are in place.

Dr Jennifer Dvorak Senior Lecturer in Law & Sociology, in the School of Law, Policing & Social Sciences.

In 2023 she had a BMJ Rapid Response published: Demedicalising assisted dying & safeguarding through a civil law model  (Rapid Response to Preston et al Breaching the stalemate on assisted dying: it’s time to move beyond a medicalised approach, BMJ, 2023 382: p. 1968)