Assisted dying: High Court would not need to approve cases under change to bill

Revamping Assisted Dying Laws: A Proposal for a Multi-Disciplinary Approach

Labour MP Kim Leadbeater has introduced a significant amendment to her proposed Terminally Ill Adults (End of Life) Bill, which seeks to change how assisted dying cases are approved in the UK. The initial version of the bill, which gained support from MPs in November, required a High Court judge to sign off on each request for assisted dying. However, the updated proposal removes this requirement, instead introducing a multi-disciplinary panel of experts to evaluate and approve such cases. This panel would consist of three members, including a retired High Court judge, a King’s Counsel, or someone with similar qualifications. Their decisions could still be reviewed by the High Court if necessary. Leadbeater has described this new system as a "judge plus" approach, emphasizing that it enhances safeguards by involving professionals like psychiatrists and social workers in the decision-making process.

The bill is currently under review by a committee of MPs, which began its line-by-line examination on Tuesday. The committee, handpicked by Leadbeater, has a 14-9 majority in favor of assisted dying, based on the November vote. Proponents argue that this change strengthens the system by ensuring a more comprehensive assessment of each case, while critics, including Tory minister Danny Kruger and Labour MP Diane Abbott, have expressed concerns that the safeguards are being weakened.

The Amended Proposal: A Shift Toward Expert Panels

The amended bill proposes that multi-disciplinary panels replace the requirement for a High Court judge to approve each assisted dying case. These panels would be responsible for evaluating whether individuals have the mental capacity to make the decision and ensuring that they are not subject to pressure or coercion. The panels would also have the authority to grant permission for assisted dying. In addition to the panels, the bill introduces a Voluntary Assisted Dying Commission, which would oversee all applications and be chaired by a High Court judge or a senior former judge. This commission would provide oversight and ensure consistency in the evaluation process.

Leadbeater has argued that the "judge plus" system is an improvement because it leverages the expertise of professionals beyond the legal realm. She emphasized this during an interview with Sky News, stating, "I think there’s a role for other experts to play. I think what came through in the evidence was the need for a multidisciplinary approach." She also highlighted the importance of legal oversight but suggested that the involvement of psychiatrists, social workers, and other experts could enhance the bill’s safeguards. The panels would work alongside two independent doctors who are already required to assess each case and submit reports.

A Departure from the Original Bill: What Changed?

In the original version of the bill, the approval process required two doctors to assess the individual’s mental capacity and a High Court judge to sign off on the decision. This legal oversight was intended to ensure that the process was rigorous and that vulnerable individuals were protected from coercion or exploitation. However, Leadbeater has now moved away from this requirement, arguing that the multi-disciplinary panels can provide a more holistic evaluation. While the panels would still include a legal expert, such as a retired High Court judge, the primary decision-making authority would rest with the panel as a whole.

This change has sparked debate among lawmakers and advocacy groups. Critics argue that the removal of the High Court judge’s direct approval could weaken the safeguards, making the process more vulnerable to abuse. For instance, Tory minister Danny Kruger called the amendment "a disgrace," while former Liberal Democrat leader Tim Farron accused the proposers of dropping "even the weak safeguards that existed." These concerns highlight the delicate balance between ensuring that terminally ill individuals have autonomy over their end-of-life choices and protecting vulnerable populations from potential exploitation.

The Role of Legal and Expert Oversight: Strengthening Safeguards

Leadbeater and her supporters argue that the amended bill strengthens the safeguards by involving a broader range of experts. The multi-disciplinary panels would bring together legal, medical, and social work expertise to evaluate each case comprehensively. This approach is intended to ensure that all aspects of the individual’s situation are considered, including their mental capacity, potential coercion, and social circumstances. For instance, psychiatrists could assess whether the individual is making the decision free from mental health issues that might impair their judgment, while social workers could provide insights into their living conditions and potential pressures from family or caregivers.

The Voluntary Assisted Dying Commission would further enhance accountability by overseeing the entire process and ensuring that the panels operate consistently and fairly. The commission’s chair, a High Court judge or senior former judge, would provide legal expertise and ensure that the panels adhere to the law and established guidelines. Additionally, the panels’ decisions could still be reviewed by the High Court if there are concerns about the process or outcome. This layered system of oversight is designed to provide an additional check on the panels’ decisions, addressing concerns that the removal of direct judicial approval might lead to weaker safeguards.

Broader Implications: The Ongoing Debate on Assisted Dying

The proposed changes to the assisted dying bill have reignited the broader debate on end-of-life rights and the ethical implications of assisted dying. Proponents argue that the bill respects the autonomy of terminally ill individuals who are suffering terribly and wish to end their lives with dignity. They emphasize that the safeguards in place are robust and that the multi-disciplinary panels would provide a thorough assessment of each case. On the other hand, critics warn that the amendments could make the process more vulnerable to abuse, particularly for vulnerable groups such as the elderly, disabled individuals, and those with learning disabilities.

Charities such as Mencap have raised concerns that discussions around assisted dying might inadvertently pressure individuals into choosing this option, especially if they feel that they are a burden on their families or caregivers. The charity warned in January that such discussions could push "people in a course that they don’t, they may not want to go down." These concerns highlight the need for robust safeguards to protect vulnerable individuals and ensure that their decisions are truly voluntary.

Looking Ahead: The Path Forward for the Bill

As the bill progresses through the committee stage, the debate over its provisions is likely to intensify. Proponents will need to address the concerns raised by critics and demonstrate that the multi-disciplinary panels and the Voluntary Assisted Dying Commission provide adequate safeguards. At the same time, opponents will continue to argue that the bill’s current form risks weakening the protections for vulnerable individuals.

The committee’s composition, with a 14-9 majority in favor of assisted dying, suggests that the bill may pass this stage, but it will still face significant scrutiny in the later stages of the legislative process. Ultimately, the success of the bill will depend on whether lawmakers can find a balance between respecting the autonomy of terminally ill individuals and protecting those who may be at risk of exploitation or coercion. The outcome of this debate will have profound implications for end-of-life care in the UK and could set a precedent for other countries grappling with similar ethical and legal challenges.