Just when you think the ‘assisted dying’ bill couldn’t possibly get any more dystopian, The Times reports that, if the Terminally Ill Adults (End of Life) Bill passes, the NHS in England and Wales could end up outsourcing assisted suicides to private companies. The committee currently scrutinising the bill is apparently considering a model whereby deaths would be free at the point of use, but then contracted out to be performed by the private sector.
It’s not hard to see why ‘assisted dying’ advocates might be keen on this model. Such an arrangement would remove some of the obstacles currently facing the bill. Namely, the fact that offering assisted deaths would draw important resources away from the NHS, something that UK health secretary Wes Streeting has previously expressed concern about. Outsourcing resolves the problem of treatments being withheld or NHS waiting lists being lengthened because staff or operating rooms have been diverted to helping people commit suicide.
It could also be used to get around resistance from doctors. Andrew Green, the chairman of the British Medical Association’s ethics committee, said: ‘We believe that a separate service outside of existing pathways – though not necessarily delivered outside of the NHS – would provide reassurance both to doctors and patients, as only those healthcare staff who have opted in to provide the service, and have completed specialised training, would be able to take part.’ This would be vital for the functioning of any assisted-suicide programme, given that many doctors oppose the practice and would likely refuse to facilitate it.
Introducing profit into the already thorny issue of ‘assisted dying’ throws up a number of important and uncomfortable questions. Will private healthcare providers like Serco, Capita or Virgin Care be involved? Will providers be paid per body? How much will they be paid?
At the moment, it appears that an assisted suicide would be free on the NHS, but there’s nothing in the bill to suggest a patient couldn’t pay to be ‘fast-tracked’ in a fully private clinic. What might a ‘no frills’ death look like, as opposed to a ‘premium’ one? If someone goes private, would they pay up-front, or might relatives – who, as the legislation stands, don’t need to be informed of the assisted suicide – be greeted with a bill after the event?
The fact that such questions can still be raised at this stage is testament to the minimal scrutiny this bill has faced as it’s been rushed through parliament. After all, this bill has already passed its second reading in the Commons and has nearly completed the committee stage. Yet members of the committee, who were selected to scrutinise it, still don’t seem to know what the ‘assisted dying’ process they’re about to legalise would even look like.
An example of this confusion occurred this week, when Kim Leadbeater, the Labour MP who introduced the bill, denied that assisted suicide would be privately provided. However, pro-assisted suicide Tory MP Kit Malthouse then insisted, in a bizarre intervention, that it will be both public and private, like having a baby at the private Portland Hospital or undergoing cosmetic surgery. Leadbeater then recanted and admitted that plans for private-sector involvement were indeed on the table.
As others have pointed out, the legal ramifications of this plan are incredibly worrying. Clause 29 of the bill protects anyone involved in facilitating an assisted suicide from civil lawsuits. Will this apply to private companies, too? They could well be insulated from claims over misdiagnoses, incorrect life expectancy, wrong dosages and other medical errors.
The fact that no one seems to have any answers to these questions is beyond concerning. It is shocking that the bill has managed to get this far, without addressing an issue as basic as how assisted suicides will actually be delivered. Will it be a private or public service? Will approval of judges, or of a ‘panel of experts’, be necessary for those who want to have assisted suicide? Will this judge or panel have to meet the patient beforehand? For the moment, no one knows.
As the bill stumbles through parliament, we are none the wiser as to what the new ‘assisted dying’ regime is actually going to look like. But one thing is certain: opening the door to profiteering from suicide is a nightmare waiting to happen.
Kevin Yuill is emeritus professor of history at the University of Sunderland and CEO of Humanists Against Assisted Suicide.
