Assisted dying debates full of talk about compassion – but no mention of this in the bill

What is meant by ‘compassion’? Tea by Shutterstock

In the week that parliament resumes debate on Lord Falconer’s assisted dying bill, we can expect further claims about whether the proposed legislation is compassionate. Greater clarity is needed in use of this concept.

The bill, which returns to committee stage on January 16, allows the terminally ill assistance in their suicide. “Compassion”, which comprises the intention to alleviate the suffering of another, is not referred to in the bill, nor is “suffering”. Yet, the debates on the bill are filled with references to compassion.

Lord Falconer, in introducing his private member’s bill, was quick to explain that nobody wants people to assist who are motivated by compassion to be prosecuted. It will, he said, lead to “less suffering”. But both supporters and opponents of the bill use compassion differently to argue their cases. And each side reflects diverse understandings of the concept.

Purpose and values

It is important for legislators to be clear about the purpose and values underpinning legislation to properly carry out their legislative responsibilities. Debates in parliament may inform interpretation and implementation of any legislation. Compassion is increasingly being referred to in law, policy, and guidelines.

The thrust of arguments in parliament in support of the bill are that it is compassionate to relieve the suffering of the terminally ill. Some arguments suggest compassion towards the carers. Reference is made anecdotally to relatives who die after long, painful chronic illnesses.

Yet, the bill allows only assisted suicide in the “last six months of life” and for “terminal illness”. Some see this as inconsistent with claims about compassion. But these limitations may reflect a need to introduce careful protections in order to get the bill passed. Critics fear that once passed, this precedent will allow extension of the law beyond its original scope.

Opponents of the bill argue that compassion requires “suffering with”; that experiencing suffering is part of the process of living and dying and that ending life simply to cease suffering is neither compassionate nor otherwise morally acceptable. Others query whether the bill’s stringent requirements are compassionate in imposing too strenuous decision-making on the terminally ill.

Baroness Helena Kennedy has referred to the broader socio-economic context for a law that allows such suicide. “Compassion”, she said, was “in short supply”. Kennedy questioned “whether we are creating a climate of greater compassion or stimulating a climate of chillier decision-making”.

Understanding the social context in which purportedly “free” decisions are made is essential. Codes of practice would not be likely to help address such a broader context. Though that need not prevent achieving what might initially be possible to alleviate suffering, it reminds us that suffering takes many forms and requires social and economic intervention as well as clinical aid.

It is argued that allowing assisted suicide will lead to pressure on vulnerable people to commit suicide. Lords crossbencher, Indarjit Singh argued that this may create suffering among others and is not compassionate.

The bill seeks to address some of these concerns. It provides that someone must have a clear and settled intention to end their life. Doctors must confirm that the person has capacity to decide. The intention must be reached voluntarily, on an informed basis, and without coercion or duress. An amendment made by Lord Pannick at an earlier stage of the bill requires that a high court judge must approve any cases of assisted dying.

Compassion can be for more than one

Compassion need not be a simple concept that applies only to one person in only one type of situation. It is legitimate to recognise that such compassion might be in conflict with compassion to another person or others. Compassion must also be understood alongside and if necessary balanced against other values, some of which are referred to in the debates. These include sanctity of life, protection of the vulnerable, and respect for dignity and autonomy.

But as the bill proceeds through parliament – there are two further stages, report and third reading, in the House of Lords before it would move to the Commons and consideration of any more amendments – it is clear that further consideration needs also to be given to what precisely is understood by compassion. What kind and level of suffering requires a moral response? Whose suffering counts? Whose judgement matters: the dying person and/or someone else?

Answers to these questions may not be easy. They have exercised thinkers such as Aristotle, Arendt and Nussbaum throughout history. But the increasing reliance on compassion in law-making, law, and policy requires such analysis.