Mary Creagh MP: ‘Andy Burnham is right – fixing care must come before assisted dying’

Andy Burnham has left the forthcoming “assisted dying” vote to the conscience of individual MPs, but only after clearly setting out his own view. Ahead of parliament once again considering whether people should be given a legal route to end their lives prematurely on the NHS, the prime minister recently told journalists that we should first tackle the current crisis of care inadequacy, which risks leaving vulnerable patients feeling without hope at the end of their lives.

The prime minister’s instincts are right. In the furious rush to legalise assisted dying in parliament, the question of what alternatives might be available to a frightened, frail or terminally ill person has too often been treated as an afterthought. We should follow Burnham’s lead in reversing that order of priorities: fixing palliative and social care first, and only then asking whether it would be wise to introduce assisted suicide.

The government’s own revised assessment of the new bill makes the wisdom of the prime minister’s position painfully clear. It warns that poverty, poor access to healthcare, low-quality care and domestic abuse could create structural pressures leading to disproportionate numbers of people from ethnic minority backgrounds choosing an assisted death. It has also newly identified neglect, poverty and difficult living conditions as potential pressures on disabled people considering assisted suicide.

Surely Labour, of all parties, cannot possibly back legislation that would so directly disadvantage those who suffer under the burden of structural inequality?

We are often told that assisted dying is about personal autonomy, as though decisions take place in a vacuum between an entirely free individual and an entirely neutral state; but circumstances shape choices. A mother who is terminally ill and worried about becoming a financial burden on her children; a wife who is under pressure from a domestic abuser to stop “dragging things out”; a wheelchair user suffering from advanced cancer unable to access adequate support, struggling with poor housing or conscious that their caregivers are exhausted may reach a very different conclusion from someone who has the means and privilege to know that first-class palliative and social care will be there for them for as long as they need it.

The government’s warning about poverty and poor care is an acknowledgement that coercion does not always look like somebody standing over a vulnerable person and demanding that they die. Sometimes it can take the form of a social environment in which death appears easier, cheaper or less burdensome than continuing to live.

The new impact assessment has also revealed that the scale of the proposed change is considerably greater than the public debate has sometimes acknowledged. The government has increased its central estimate of the number of assisted deaths in England and Wales ten years after legalisation by 60%, from 2,183 to 3,502 a year – almost ten deaths every day. Its high-end scenario has risen from 4,559 to 6,257 a year – more than 17 every day – and the government explicitly says that even this scenario should not be treated as a definitive upper bound.

One new sensitivity analysis produces a figure of 9,810 assisted deaths in England and Wales in Year 10 if New Zealand’s actual and projected assisted-death rates were followed here.

The concerns Andy Burnham rightly highlights with the care system will not be resolved by an increase in premature deaths. The government’s central estimate of the cost of health and social care staff time required to deliver assisted dying has risen by around 69%, from £5.49 million to £9.27 million in Year 10. We are told that there is not enough money or capacity to provide everyone with the palliative and social care they need, yet simultaneously are considering constructing a new state-funded system requiring doctors, nurses, social workers, psychiatrists, lawyers and other professionals to use their professional time to administer assisted deaths.

Against this backdrop, it is perhaps no surprise that the public is not clamouring for parliament to make assisted dying its priority. In a recent poll of more than 10,000 people, just 7% of the public and 7% of Labour voters selected legalising assisted dying as one of the three priorities they would most like their MP to focus on if they had the opportunity to make a law change over the next year. And in every constituency in Great Britain, a majority of voters agreed that parliament should prioritise fixing the NHS and improving palliative, social and end-of-life care before considering whether to introduce assisted dying.

The prime minister has therefore articulated what the evidence, the government’s own assessment, and the public are all telling us should be our focus instead: fix the NHS. Fix social care. Properly fund hospices. Strengthen palliative care. Make sure disabled people and the terminally ill have the support they need to live with dignity.

Only then should parliament ask whether assisted dying is really the answer. If we cannot yet guarantee that vulnerable people will receive the care they need, we have no business guaranteeing them that we can help them die.

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