Catholic Medical Quarterly Volume 75(3) August 2025

Submissions

CMA Submission on the Terminally Ill Adults (End of Life) Bill

Many submissions were made to the committee scrutinising the Terminally Ill Adults Bill and we publish here some of them. Time was short in that committee and we regret that the arguments here were not heard more loudly. We print them here so that they are not forgotten.

CMA Logo The Catholic Medical Association (UK) represents Catholic doctors, nurses, pharmacists, hospital chaplains and other healthcare professionals within the UK. It celebrated its centenary in 2011.

The CMA (UK) welcomes this opportunity to respond to the consultation on the Terminally Ill Adults (End of Life) Bill which was presented by Ms Kim Leadbeater MBE on 29 November 2024.

Purpose and significance of the Bill

The purpose of the Bill is “to allow adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own life.”

The Bill concerns the deliberate and intentional killing of those considered to be within six months of natural death at their request. Those requesting assisted suicide must have mental capacity and a fixed intention to end their lives through assisted suicide.

The debate around the Bill assumes that assisted suicide would only occur out of compassion for the dying. However, compassion is not mentioned in the Bill and the intentions of those assisting the suicide of patients are not specifically considered.

Definition of assisted dying.

The term “assisted dying” has caused considerable confusion, as the main issue in the Bill is assisted suicide, or more especially the direct deliberate killing of patients. When the issues are debated many people consider palliative care as a form of assisted dying, as it is a form of assistance to those who are dying. However, although assisted dying is in the heading of clause 1, it is not defined in the Bill.

Nevertheless, even without a specific definition, under Clause 29 “Registration and investigation of deaths,” the Bill amends the Births and Deaths Registration Act 1953, by adding a new section “39B Regulations: assisted dying.” This will enable the Secretary of State to issue regulations and use the term “assisted dying” to register a death.

It is most unusual for a Bill not to specifically define new terms that are to be introduced into homicide law. In clause 24, entitled “criminal liability for providing assistance,” the Bill expressly excludes assisted dying from consideration under the Suicide Act 1961. The Bill modifies the Suicide Act by introducing a new subsection 2AA. In this amendment of the Suicide Act: “a reference to an act that is capable of encouraging or assisting suicide or attempted suicide does not include the provision of assistance to a person to end their own life in accordance with the Terminally Ill Adults (End of Life) Act 2024.”

What is of concern here is that any act capable of encouraging or assisting not only suicide, but also attempted suicide, is exempted from consideration under the Bill. However assisting a suicide remains a criminal offence under the current Suicide Act. Under section 2(1): “A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.”

The proposed Bill would allow assistance with actual and attempted suicide by healthcare professionals. The fact that the patient must be registered with a general practice, strongly suggests that assisted suicide should be provided within the NHS and not privately.

Instigation of a prosecution for assisted suicide

Whilst the definition of what constitutes a crime is a matter of statute law, the issue of bringing a prosecution in particular cases rests upon two central considerations. First, that there is sufficient evidence to bring a prosecution and second, whether it is in the public interest.

Prosecutors must apply the principles of the European Convention on Human Rights, in accordance with the Human Rights Act 1998, which include Article 2, the Right to Life.

In considering the public interest, prosecutors should consider the seriousness of the offence and the level of culpability of the suspect. Culpability is likely to include issues around the person’s involvement, premeditation, personal benefit from the conduct, the chances of repetition, the age and circumstances of the suspect, undue pressure and the vulnerability of the victim.

On the other hand, prosecution is more likely if the victim was vulnerable or where the perpetrator was in a position of trust or authority or serving the public, as in the case of a medical professional. The seriousness of the offence and its effect on the public should also be considered.

Fundamental right to life:
Article 2 incorporated into the Human Rights Act 1998.

The right to life must remain central to our understanding of human rights and international law. Medicalised killing in the form of assisted suicide and active euthanasia are logically inconsistent with the fundamental principles and philosophy of the UN Declaration and Covenants on the right to life and the Hippocratic tradition. The fundamental right to life derives from our human nature as members of the human family and must be recognised and protected through the rule of law and professional codes of medical ethics.

Changes to the law on homicide.

Changes to the law on homicide are both difficult and rare as the right to life is regarded as sacrosanct. This is particularly true when the target population are seen to be frail, elderly, vulnerable or disabled without a voice for themselves either individually or collectively. Nevertheless, the Bill seeks to decriminalise assisted suicide when performed by healthcare professionals, with the support of the judiciary.

The Hippocratic Tradition

The prohibition of both active euthanasia and assisted suicide is embodied within the Hippocratic tradition and Oath:
“I shall give no deadly drug to any, nor will I counsel such.”
Both euthanasia and assisted suicide involve the deliberate killing of patients. Doctors are responsible ethically and legally for the prescriptions they provide for patients. To allow assisted suicide is to cross the Rubicon regarding the fundamental ethics of Medicine. It would also cross the Rubicon for lawyers, as High Court Judges will be required to give their “consent” and authorise the deliberate killing of the patient.

Consent.

Attempted suicide is familiar to psychiatrists, general physicians and emergency care doctors since attempted suicide is a common reason for hospital admission. What is new, is that healthcare professionals will be asked to be involved in the actual suicide.

The decision to commit suicide is complex, is often prolonged and usually involves patients with mental health problems, including severe depression. It is difficult to understand that the law will simply assume that the patient will have made a “voluntary, clear, settled and informed wish” to commit assisted suicide. Those who survive a suicide or para-suicide attempt are currently referred for a psychiatric assessment and support.

A particular concern for physicians, who would normally refer those who have attempted suicide to a psychiatrist, is that the patient would then receive proper counselling and support to prevent a further suicide. It would be a matter of considerable concern if the referral then led to the assisted suicide of the patient.

Diagnosis of terminal illness.

It is not clear as to whether the prognosis of six months treatment is with or without treatment, even if the condition cannot be reversed. Hence, insulin dependent diabetes is a progressive condition which is likely to lead to death within a short period if insulin is withdrawn. The term “reversed by treatment” is ambiguous. Insulin will alleviate symptoms and prevent death from an underlying condition which cannot be reversed, although the rate of progression can be significantly reduced by adequate insulin treatment. Similar considerations would apply to heart failure and other conditions which are not normally regarded as imminently life threatening unless treatment is withdrawn. Non curative cancer treatment is another example.

Management of those who are dying

We must all face death. There are as many experiences of dying as there are individuals. Of all the areas of medical practice, the care of the dying is one which even experienced clinicians and nurses do not find easy. Doctors and nurses find dealing with patients who are facing death difficult and there is no easy and universal answer. Empathy and understanding of the individual patient in their particular circumstances is essential. All patients are different and experience death in unique and individual ways.

Roles of the coordinating and independent doctors.

The Bill puts forward a radically different approach to the management of those thought to have six months to live. It would introduce into law the possibility of deliberately causing the death of those who are terminally ill. The only requirement of the proposed approach is that two doctors agree with the procedure. This is irrespective of any doctors who may know the patient and their condition and would not consider assisted suicide as the appropriate option. Family and friends need not be involved. Witnesses to the declarations would normally exclude family members who might be seen to benefit from the death e.g. as beneficiaries of the Will.

It is clear that the assessments of the “coordinating” and “independent” doctors is to be judged subjectively. Hence, the only legal requirement is that the doctor has made an assessment which is correct in the opinion of the “coordinating” or “independent” doctor. The pupils are allowed to mark their own homework

The patient can only be assessed by an “independent doctor” after the “first period for reflection” of 7 days from the first statement of the coordinating doctor. This could therefore be only a short time after the initial diagnosis for some patients who will still be coming to terms with the diagnosis of a terminal illness. This could be a time when the patient is still in denial or suffering anger or frustration at the diagnosis.

Court approval

When it comes to judicial approval of the declaration for assisted suicide, it is not clear if the process will remain largely secret, or will be held in Court at an open hearing when additional practitioners, witnesses and interested parties may be called.

It appears that the judge would only be confirming that the conditions of the Bill were satisfied and the decision of the patient was deemed to be voluntary, uncoerced and fixed. This is to cross the judicial Rubicon. It would lead to the death of countless patients whose lives were considered as no longer worth living by virtue of terminal illness and its sequelae. The remedy would be suicide authorised by the Court.

Assisted suicide, if approved by Parliament, will authorise both the judiciary and the medical and nursing professions to deliberately cause the death of innocent patients.

Sir James Munby, Former President of the Family Division, recently summarised the situation

“It is fundamental that the court cannot authorise the administration of treatment intended to kill. Specifically, a judge cannot authorise the administration to a patient of a drug intended to bring about the patient’s death. The Falconer Bill, and it would seem also the Leadbeater Bill, stand this fundamental and unchallenged principle on its head. What is proposed is that a judge by court order should facilitate the administration to a patient of a drug intended to bring about the patient’s death.”

Conclusion

Health professionals who are involved in assisted suicide, will be directly involved in deliberately killing patients. This will have a profound effect on the trust and confidence of the public in the medical and nursing professions. The memories of relatives and friends of the deceased will remain with them. Their trust in the individual clinicians involved will be deeply affected in the long-term. The standard of our palliative care must remain a gold standard to determine the quality of our care. Cicely Saunders pioneered palliative care in this country. It is now difficult to comprehend the impression that would be left if this Bill regarding the deliberate killing of our patients were to pass into law.

Catholic Medical Quarterly