The York Politics Review

On 29 November 2024, the Terminally Ill Adults (End of Life) Bill, introduced by the Labour MP for Spen Valley, Kim Leadbeater, received its second reading in the House of Commons. After five hours of emotional debate, the bill passed in a historic vote, with 330 MPs in favour against 275 opposed. The bill, which follows a large number of attempts to reform the UK’s assisted dying laws stretching back to 1931, will legalise assisted dying for terminally ill adults who are expected to die within six months, given their decision was informed and free from coercion. The results of the vote were a triumph for advocates in favour of assisted dying, the majority of whom support legalisation as a means to relieve the suffering of, and provide autonomy to, the terminally ill. But whilst these groups celebrated, others expressed concern, most notably prominent members of the disabled community. 

There are many arguments that can be made against assisted dying, such as advocating for greater improvements to palliative and end-of-life care, that are explicitly centred around the terminally ill. However, disability comprises a separate sphere within the assisted dying debate, one based on genuine fear and concern for the lives of disabled people. Despite Leadbeater’s bill being designed to only include the terminally ill – indeed, it specifically excludes disability as a reason to be applicable for assisted dying – many disability rights campaigners and organisations believe that the potential for eligibility to be expanded to cover disability in the foreseeable future is strong. Part of this is based on the historical relationship between disabled people and euthanasia, such as the eugenics movement in the United States and the Nazi T4 “euthanasia” (murder) programme of the 1930s and 1940s. But Beyond this, much of the disability-based opposition to assisted dying draws from present-day attitudes towards disability, how these attitudes demonstrate a likelihood that assisted dying laws will be expanded to cover disability, and examples where such an expansion has already taken place, to the detriment of disabled persons. Whilst many advocates in favour of assisted dying brush off these concerns as a baseless, paranoid “slippery slope”, these fears are not unfounded. 

A discussion of the aforementioned historical links between euthanasia and disability is, for the most part, unnecessary, largely because the ties between the 20th-Century eugenics movement and today’s assisted suicide campaigns are incredibly minimal (although it is noteworthy that early arguments for assisted dying were the same used to justify involuntary euthanasia of the disabled.) Instead, the focus here will be on explaining how the UK’s pending assisted dying law could be expanded to cover disabled people, and why such a move would happen, in particular highlighting the hostility towards, and the lesser value placed upon, disabled peoples’ lives. This extends to advocates of assisted dying, many of whom are in favour of expanding eligibility to cover disabled people, requiring a criticism of the arguments used to justify this position. 

Before beginning, a few definitions are needed, as the terms assisted dying, assisted suicide and euthanasia are all used in this debate, often interchangeably. Assisted dying is defined as helping someone with a terminal illness, who will die no matter what, to pass away quicker and often less painfully. This is what Leadbeater’s bill aims to legalise. Assisted suicide contrasts in that it refers to helping someone whose death is not forseeable, such as someone with a long-term health condition or, relevant to this article, a disability. This is what many opponents of assisted dying fear it will turn into. Lastly, euthanasia is where another person, usually a medical professional, ends somebody’s life  In practice, the difference between assisted dying/suicide and euthanasia is solely who administers the lethal medication – the person themselves (for the former) or the medical professional (for the latter). 

First, it’s worth discussing how disabled people could become eligible for assisted dying in the UK. At this point, it’s likely that Leadbeater’s bill will pass through Parliament on its third reading, receive royal assent, and become law. Whilst the scope of the bill is outlined in its text, its regulations and applications are decided by the Secretary of State for Health and Social Care. Because of this, despite the exclusion of disabled people from the bill, a health secretary could potentially set regulations that make it easier for coercion to happen, or harder to determine whether someone will die within six months, blurring the line between terminal illness and severe disability; such changes may be unlikely, but they are not impossible. However, a more probable scenario would be for Leadbeater’s bill to be amended once it becomes law, which would take the form of a secondary act of Parliament. Should such an act have the backing of the government of the day and its MPs, it could pass very easily and without hindrance. Canada’s assisted dying law went through a similar process – it began limited to the terminally ill, but through a second act of Parliament was expanded to the “severely disabled”. Much would depend on the nature of the bill itself, such as how it defines disability, its safeguards against coercion, and its levels of support both inside and outside Parliament. 

As to why such a change would occur, it is undeniable that disabled peoples’ lives are considered to have less value than non-disabled lives. In public policy, it is often disabled people who bear the brunt of bad decisions, whether that be the effect of economic austerity since the early 2010s, or the decisions made during the Covid-19 Pandemic. One noteworthy example was the “Do Not Resuscitate” orders given out during the pandemic to patients with learning disabilities, meaning if they stopped breathing, doctors would not attempt to help them, allowing them to focus on patients whose lives are supposedly worth more. In general, disability is still regarded as something tragic and terrible, robbing those it affects of all autonomy and dignity. Being disabled myself, I have encountered these attitudes numerous times in my life, as has almost every disabled person, regardless of the differences between our disabilities. One of the most common examples of this that almost every disabled person is familiar with is being told by non-disabled strangers that if they were in our position, they would rather die. In our society, disabled people are the “other” – we don’t function in the way we are expected to, therefore our lives are valued less. 

An extension of this attitude is the hostility shown towards disabled people in everyday life, both in public and in private. Due to the impact of economic austerity, disabled people have been attacked for relying on benefits and for not working enough, thereby leeching off the state and the taxpayer. During the last Conservative government in particular, disabled people were ordered to find work or face the prospect of cuts to their Personal Independence Payments (PIP) – money that, for many, is the only thing protecting them from poverty. Such decisions ignore the systematic discrimination disabled people face in the workplace, particularly in application processes that employ subtle ways of weeding out disabled applicants- after all, why would any business want to hire someone who costs more to accommodate? Furthermore, disabled people are often seen as burdens on their families and carers, a big reason why disabled people are significantly more likely to be victims of domestic abuse than non-disabled people. Being valued less is one thing, but it makes it easier for outright hostility of this kind to occur and go unchallenged. 

In summary, it is clear that within our society, the value placed on disabled people’s lives is inherently less than that placed on those of the non-disabled. In this country in particular, disabled lives have already been lost due to hostile public policy decisions and higher rates of abuse from family members and carers. Given this hostility, it’s not hard to imagine a scenario where assisted suicide is touted by politicians and the media as a less costly way of reducing the burdens of disabled people on the state and the taxpayer. I encountered this attitude even amongst fellow students at my university – whilst discussing assisted dying with others in my accommodation block, one student indicated their support for disabled people being eligible because they don’t like paying for disability benefits through taxes. Essentially, this implied (intentionally or not) that disabled people should die because they cost too much to look after. Because of this, when the “right to death” becomes enshrined in the public policy that is already hostile to disabled lives, it inherently puts us in a more hazardous position – why is our right to death considered more important than our right to life? 

Disabled individuals should never, under any circumstances, be eligible for assisted dying solely because of our disability. The reason for this is that disabled people are not suffering as a result of our disability, but because of societal barriers and problems that mean we are unable to live a properly fulfilling life- a perspective known as the social model of disability. If disability were to be a reason for assisted dying, it would make death a solution to problems that could be resolved through societal action – action that is not taken as it would require a radical overhaul of our economic and social systems unacceptable to many in our society. Disabled people are not a problem to be fixed or cured, but an inherent part of our society that should be respected and accommodated. 

Many assisted dying advocates would agree with this statement, including a large number of pro-assisted dying organisations. However, this is not a universal opinion. Researching for this article was a strange experience – I would move on from articles claiming that assisted dying is not a threat to disabled people as they wouldn’t be eligible, to others arguing enthusiastically that expanding assisted dying to cover disability is the strongest way of protecting disabled people’s rights. Some articles, bizarrely, even argued for both at the same time. Many avoided comparisons to countries such as Canada, whose euthanasia programme has been condemned by the United Nations for its abelism and discrimination against disabled people, whilst others embraced it as an example of a comprehensive system of assisted suicide. Clearly, the assisted dying movement is not as united as it may like to be. 

In a somewhat cynical move, some proponents of expanding assisted dying to cover disabled people often hijack the rhetoric of disability rights to justify their views – they argue that if we really want to respect the dignity and autonomy of disabled people, we should give them the right to choose when and how to die. They go so far to suggest that the risk of coercion is minimal because every disabled person is intelligent, independent and knows what’s best for themselves – a sentiment not extended to non-disabled people.  The rhetoric and language these supporters use is telling – their use of autonomy as an argument suggests that they believe the only way disabled people can truly be autonomous is in death. Furthermore, they describe disabilities as “incurable”, and refer to the disabled as “persons with disabilities” rather than “disabled persons”. This terminology flies in the face of the social model of disability, which regards disability as something to be accepted, not cured, and indicates that these advocates don’t have disabled persons’ best interests at heart. Disabled people don’t need to be fixed, we need to be accommodated. 

The risk of coercion cannot be understated, for both the terminally ill and the disabled. To focus on Leadbeater’s bill in particular, two doctors and a high court judge are grossly insufficient to identify coercion – neither of these professions require the training needed to be certain that coercion has occurred, and it ignores the coercion that may come from doctors themselves, given the significant amounts of ableism within the medical professions. It also fails to give a proper definition of coercion, meaning it’s not even clear what the two doctors and the judge are supposed to be looking for. At large, it is a simple fact that disabled people are more likely to be victims of coercion and abuse than non-disabled people – no amount of pseudo-inspirational talk about independence and autonomy will change that. Disabled people can be hugely reliant upon their carers and family members, putting them at risk of continued abuse from these groups – abuse that, on many occasions, has led to disabled people being murdered by those around them, a clear demonstration of how disabled lives are valued less even amongst family and friends. Should assisted dying be extended to disabled people, it would provide an easy means for such family members to lawfully get rid of their disabled relatives – all that is needed is the appearance of consent.

Furthermore, coercion can also be as a result of societal pressures and difficulties. A clear example of this happening can be seen with Amir Farsoud, a disabled man living in Ontario who, after facing the prospect of homelessness due to the costs incurred by his disability, applied for MAiD, Canada’s euthanasia programme. Farsoud had no desire to die, and his death was not imminent or forseeable, yet he still sought out death as an alternative to the social costs of being disabled. Only after local news covered his situation did an online fundraiser raise enough money to provide him with a place to stay. Farsoud’s example demonstrates that the coercion and pressure of being disabled in society are enough to cause disabled people to consider death – a problem exacerbated by the higher levels of depression and mental illness amongst disabled people, themselves caused by that same societal pressure. This is wrong – we have the ability to resolve these pressures by radically reforming public policy towards disabled people, but our refusal to do so is driving many disabled people to view death as the only option to relieve their suffering.

These two arguments do much to undermine the concept of autonomy that supporters of assisted dying rely on – if a disabled person is being coerced, they cannot act in a truly autonomous manner. But beyond this, it’s worth noting that the main reason terminally ill individuals in places such as Oregon request an assisted death is not because of the suffering they are in, but because of the loss of dignity and autonomy incurred by their illness. In a similar manner, advocates of expanding assisted dying to cover disability believe that disabled people lack autonomy and dignity, and that only by providing us with the ability to choose when  and how to die will we gain that autonomy. But this demonstrates a fundamental misunderstanding of disability – disabled people do not lack dignity and autonomy because of our disabilities, but because of how we are treated within society. Death is not a liberator, and there is no dignified sacrifice in choosing it over a disabled life. Each and every disabled life is valuable – regardless of how reliant disabled people are on carers, family members, and welfare benefits, we retain our dignity and autonomy, and our lives are never worth less than anyone else around us. We do not need the choice of death to provide us with that dignity, that autonomy, and that value; what we need are stronger rights, improved accommodations, and better care than that we already have.  

It is for these reasons that this article opposes the passage of the Terminally Ill Adults (End of Life) Bill and the legalisation of assisted dying in England and Wales. This article has demonstrated that, should it pass, the bill could easily be amended to cover disabled people within its scope. It has outlined the lesser value placed on disabled lives in our society, and how disabled people have been hurt by hostile public policy. It has evinced how many advocates of assisted dying are in favour of expanding it to cover disabled people, following a misguided notion that doing so will somehow strengthen disabled peoples’ autonomy. It has criticised this perspective, and has demonstrated that disability is not an inherent robber of autonomy and dignity. 

Before establishing the right to die, we must strengthen and protect the right to live, even if this process will require a radical restructuring of our economic and social systems. This article’s opposition to assisted dying does not detract from my immense sympathy for the terminally ill and their families; I hope that, with the passage of this bill, they will find the dignity and autonomy they deserve. But advocates for disability rights cannot be silent in the face of this threat to the disabled community – with this article, I hope to have demonstrated the nature of this threat, and to have changed the perspective on assisted dying and disability.