The Labour government has egregiously reconfirmed the latter with its tax hungry budget that is hammering employers, pouring manure over farmers, and hitting working people with inevitable onward cost shunting. UK PLC is delicately hanging, with the promise of a growth mission looking increasingly hollow. Yet the government has also badly over-stretched on the former and not simply on its insidious inheritance tax plans. The Assisted Dying Bill is another example.
Now this is a highly sensitive issue that deserves a serious, calm and decorous debate. There are many valid views on all sides of the argument. It is a deeply personal area of consideration, belief and viewpoint. Having seen first-hand close family members suffer horrendously in the final furlong, I do understand and indeed sympathise with the arguments many advocates propound, despite being hugely sceptical both on a matter of principle and moreover practicality.
We can agree the subject of mortality and sanctity of life is profound. Sadly, the government’s approach has been disjointed, dislocated and tone deaf to the critical importance of getting any legislation right. At the very minimum, there are major questions around how the proposed safeguarding elements would be safely and robustly enforced. Yet despite the arguments for and against, there are four fundamental reasons as to why there should be a slam dunk vote against this Bill and frankly it should be pulled all together.
First, the state of palliative care including hospice provision is vital. End-of-life care across the UK is unable to cope with rising demand and palliative services are chronically underfunded. NICE guidance has routinely been poorly implemented by the NHS. Often pain can be relieved or even prevented, but the lack of proper palliative care is not allowing it. Why is this so important? In short, we are at risk of pushing people to end their life under this Bill, purely because of an inadequate national strategy and resources. That is utterly unacceptable. This raises serious safeguarding issues compromising the sacrosanct patient-doctor relationship. The ethics of the principal (patient) to agent (doctor) dynamic risks being skewed. Gordon Brown has eloquently articulated his own opposition citing his late daughter. His brave words should be listened to and the concept of “good dying” and, in many cases, “assisted living”.
Second, the absence of a full impact assessment is truly scandalous. How much is this going to cost the NHS and social care? Where is the money coming from? Has this been budgeted? What does this mean for palliative care and hospices? What resources would need to be diverted and what is the opportunity cost? What are the implications for policing, monitoring and the judiciary? Has any future judicial and prison capacity been earmarked for potential convictions or review? I could go on. Frankly, you need an abacus for the number of questions pouring out of this Bill.
The very fact the Health Secretary has come out against the Bill and ordered a rapidly cobbled together impact assessment for the NHS is beyond unreal. If it were not so deadly serious, it would be evocative of an amusing scene out of Yes Prime Minister. Where is the coordination, collaboration and communication? It is actually not funny at all and really quite disturbing. When the person and department responsible are straight batting it with a defensiveness that even Geoff Boycott could not pull off, you really need to start the car and call it off.
Furthermore, the government cannot credibly justify inflicting pain in pursuit of its black hole (largely artificially unearthed) by hammering business with NI rises, ploughing through the P&Ls of farming and rural communities, knackering the housing market with stamp duty increases, and then whack through a tectonic piece of legislation without producing the full costs and wider array of data to inform sound decision-making. More to the point, they keep justifying all this pain to fund the NHS. Yet this Bill would cost the NHS money due to new guidance implications, resourcing needs and implementation requirements. It really is a Del-Boy approach to a literally life and death issue.
Third, the derisory amount of parliamentary time allocated is breathtakingly bad. This is one of the most emotive and exigent issues ever to be debated. Despite rightly being a free vote, the slow drip of senior Labour ministers and figures publicly declaring opposition is hardly a signal of great solidity. If so many of the government are against, how can we have confidence any such legislation would be well implemented? Leadership and buy-in when seeking to make changes are key; not resistance, public dumping and grave misgivings. It is also beyond perplexing what Simon Case’s guidance around collective responsibility means. Ironically, we rapidly need a new Cabinet Secretary as the incumbent has been moribund for some time.
More acutely, MPs cannot possibly have been able to properly canvass the opinion of their constituents and get an appropriate cross-section of views on what people think and want. This was not a clear manifesto pledge and not a big policy debate in the General Election. Democratic legitimacy is therefore beyond doubtful. We are in danger of leaving this to people’s biases, a nod and wink in the lobby, and short-circuited thinking. It is frankly invidious to ask MPs to vote on this without more time and opportunity to debate. It is horrendously unfair.
Gaffer Starmer, for all his love of football and Arsenal hospitality, has lost the public terrace in record time. He is quickly becoming the Mike Bassett of British politics. Opinion polls and all-round general dismay are analogous to a remarkably early vote of no confidence from the electorate. Labour might have been prepared to win, but is showing they weren’t prepared to govern. This Bill is just another example of the government missing the point and adopting an Ostrich syndrome that is out of tune and out of touch. The communication strategy alone has been a stinker. The Prime Minister should step in now and change tactics before it is too late. For the only thing that needs assisted dying is this hastily summoned Bill itself.
Stuart Carroll is a health and policy expert working in life sciences for a leading pharma/biotech company specialising in vaccines and prevention and is a former cabinet member for adult social care, health, and children’s services. He is also a Senior Fellow at Policy Exchange. He is writing in a totally independent capacity.
Benjamin Franklin once stated nothing was certain in the world except death and taxes.