'My life, my death, my choice'. Supporters of the Assisted Dying Bill maintain that assisted death is a progressive legislative change - one which empowers those who are by the circumstance of their terminal condition, already vulnerable and disadvantaged. As such, choice offers control and comfort. But if that choice cannot be exercised on free and equal terms, empowerment for a few risks being bought at the price of disadvantage for others - those who are most vulnerable and at risk.
The patient well used to the free exercise of their own autonomy is inevitably in a different category from the patient without, or who perhaps through long ill health has a different attitude towards dependency, autonomy and self-worth. In this way the provision of choice of an assisted death risks itself being a coercive act.
The law as currently framed, set out in the Director of Public Prosecution's (DPP) guidelines, already admits flexibility in whether a prosecution would be in the public interest, when the motives are compassionate and acts as a necessary backstop against abuse. Sir Keir Starmer at least recognises that the law which he upheld as DPP is there to protect the vulnerable. Speaking to The Times about his support for the bill, the Labour MP said "do we keep something there to protect the vulnerable and ignore the plight of those actively committing suicide or being assisted to attempt suicide, or move to a different position where there are strong safeguards?"
But the Assisted Dying Bill does not define its safeguards, leaving them instead to codes of practice that 'may' be issued at a later date. It fails to take into account the inherent unpredictability in diagnosing life expectancy beyond six months. Doctors who may not have any specialism in detecting mental illness would be given powers to decide whether the applicant requires specialist assessment of their capacity, meaning depression or other mental illnesses could pass undiagnosed. There are no requirements on the High Court to investigate any of the applications brought to it via doctors. The onus is to endorse, not scrutinise.
Perhaps most alarmingly the bill doesn't require a doctor or the High Court to have any more than a cursory awareness of the patient's home circumstances. As only one in seven GPs are willing to participate, the problem of doctors not being equipped to judge a patient's reason for requesting assisted death will be compounded.
Oregon has its own problems. In the Wall Street Journal on 17 August, William Toffler, a doctor from that state described how the law there had adverse consequences for the doctor-patient relationship and had created a climate of 'secrecy' and 'fear': "no one outside of the Oregon Health Division knows precisely how many assisted suicides have taken place, because accurately tracking them has been made impossible." The US Disability Rights Education and Defence Fund has also documented cases of complication and abuse arising from the law in Oregon and Washington states.
Little wonder that in the UK, alongside medical professionals, those who have been most vocal in their opposition to the Assisted Dying Bill are grassroots groups of disabled people. Activists see the bill as a step towards a society that develops social and cost-related judgements about a person's quality and value of life, which then become inevitable factors in the conversation around eligibility for assisted dying. In Oregon, where health insurance covers treatment, but the state covers the cost of assisted death, as Toffler puts it "what sort of a choice is it when life is expensive but death is free?" It would be naïve to assume that cost factors would play no future part at all should the NHS be required to make provision for assisted dying.
The Assisted Dying Bill would put in place a framework that would not be progressive for those most in need of care and protection. Pitched as offering empowerment for the many, instead it risks the creation of a more hostile environment for the most vulnerable as the price of comfort for the few. All those who suffer through terminal illness deserve not only our emotional care and attention, but our commitment to the highest level of publicly-funded medical support available. That is why investing in palliative care, not offering legal assistance with suicide, is the truly progressive response.
Richard Chapman is the head of Parliamentary affairs at the Church of England