‘Sinister’ government analysis of assisted dying bill adds weight to fears of financial incentives for deaths

A “sinister” government analysis of the impact of a bill to legalise assisted suicide suggests it could eventually save public bodies more than £100 million a year in health and social care costs, benefits and pensions.

The figures – which the government warned were “uncertain”, and could be even higher – were published just two weeks before MPs are set to vote on the terminally ill adults (end of life) bill at its crucial report stage.

They will add weight to fears that some cash-strapped public bodies might be tempted to suggest the option of an assisted suicide to a terminally-ill patient or service-user as a cheaper option than continuing to provide them with expensive health and social care services.

The impact assessment makes it clear that the “monetised impact” of legalisation in England and Wales is “for the most part uncertain” and the “upper bound of these ranges should not be interpreted as maximum values”.

A separate equality impact assessment (EIA) warns of the “scarcity of evidence” on the impact of assisted suicide legislation in the 25 states and countries that have introduced some form of legalisation and regulation of the process.

But the impact assessment says the potential savings could reach £59.6 million a year in “unutilised healthcare” by the 10th year of the law’s introduction, in addition to £18.3 million in unpaid pensions, £6.2 million in unpaid attendance allowance, and £3.17 million in unpaid personal independence payment, as well as £10.5 million in unpaid care homes fees and £8.69 million in unpaid domiciliary care fees*.

The assessment points out that there would also be significant costs of legalising assisted suicide, including staff costs in delivering the assisted suicide service at up to £11.5 million a year by the 10th year, and the costs of running an assisted suicide commissioner’s office at £10 million a year and another £3.6 million to run a panel to approve each suicide.

The assessment estimates that nearly 5,000 people a year in England and Wales could opt for an assisted suicide by year 10.

Baroness [Jane] Campbell, who for years has led the fight against legalisation as co-founder of Not Dead Yet UK (NDY UK), told Disability News Service (DNS) this week that she found the “narrative surrounding a cost benefit analysis of assisted suicide quite sinister”.

She said: “Having surveyed assisted suicide legislation in other jurisdictions across the globe, I believe it will subtly incentivise doctors, inheritance beneficiaries or other public health and social care services to see an assistive early death as a positive treatment option for all concerned.”

She remembers telling fellow peers in July 2009, when they were debating a bid by Labour peer Lord Falconer to legalise assisted suicide, that such a move would “place a new and invidious pressure on disabled and terminally ill people who think that they are close to the end of their lives. 

“Some will consider death as preferable to fighting for support to live with dignity. It will be the cheapest, quickest and simplest option.”

She told DNS that, 16 years later, nothing had changed, and that those diagnosed with a terminal or progressive illness or long-term medical condition were even in a “more precarious position due to deterioration in our NHS and social care public services”.

Her fellow disabled activist Liz Carr, whose award-winning BBC documentary about assisted suicide, Better off Dead? – still available to watch – explains the dangers of legalisation to a mainstream audience, said she was shocked by how the government’s equality impact assessment “was so focussed on ensuring equal access to assisted suicide for all rather than equal protection for all under the law”.

She said: “There’s no recognition, for example, of the inherent discrimination in a bill that offers ill, older and disabled people suicide support rather than offering them suicide prevention like everyone else. 

“That is not equality, that is discrimination – deadly discrimination. 

“But no, instead, the equality impact assessment’s focus is on ensuring reasonable adjustments are made so information about assisted suicide is in accessible formats.”

Mike Smith, an NDY UK spokesperson, said the two assessments had only heightened concerns about the bill.

He said: “We already know that disabled people ‘cost money’ when it comes to decent social care.

“It’s chilling that the impact assessment talks about potential cash savings. 

“So in a world where resources are already constrained, another way of saving money could be to encourage disabled people to opt for assisted suicide.

“Whether that was explicit, or just implied, it still puts disabled people’s lives at risk.”

He said the EIA “spends more time explaining how disabled people might be excluded from accessing assisted suicide because of their impairments, with only a passing reference to coercion and pressure. 

“It is focused entirely on the provisions of the bill alone, missing out the wider issues in society into which the bill will be introduced.”

Smith said NDY UK was equally concerned** about the assisted dying for terminally ill adults (Scotland) bill, which will be debated in the Scottish parliament on 13 May, and is “in many ways… an even more dangerous piece of legislation”, as it has a broader definition of terminal illness.

The impact assessment for the England and Wales legislation points out that one of “the main reported disbenefits” of legalisation for people who are terminally-ill is that they “may feel pressured into have an assisted death”.

In the US state of Oregon, which has similar laws to those that could be introduced in England and Wales, research last year found that 42 per cent of terminally-ill adults reported feeling a “burden on family, friends/caregivers” before their assisted suicide, with nine per cent reporting concerns about the “financial implications of treatment”. 

The equality impact assessment says evidence suggests disabled people “may be more susceptible to feeling as though they are a burden on those around them” and “may feel subtle pressure due to attitudinal barriers or a lack of alternative appropriate services and support”.

It also points out that disabled people are twice as likely as non-disabled people to be victims of domestic abuse, which includes coercive behaviour, while evidence suggests healthcare professionals lack training and education on domestic abuse and may be “unwilling to engage in conversations about domestic abuse”.

And it says the Equality and Human Rights Commission has highlighted how older people “may feel subtly pressured to end their lives prematurely”, and that regional variations in the provision of palliative care could be another reason for some patients to consider an assisted death.

*The assessment suggests that local authorities will not gain financially because if they are no longer funding the care of someone who has had an assisted suicide “they would instead pay for someone else”

**NDY UK has organised email and postcard campaigns for people in England, Wales and Scotland to highlight their concerns with their MPs and MSPs

Credit for this article goes to John Pring with the Disability News Service