Our political class is incapable of joining dots, a criticism made by the Home Secretary in Parliament on Monday about several public sector institutions. She really should look in the mirror. However, this week and last provide other examples of a failure to use information painfully learnt in one context to prevent the problem happening again elsewhere.

It is a story about two Private Members Bills. The first is the Assisted Dying (“AD”) Bill. The other is the Powers of Attorney Bill. It seeks to increase the powers of the Office of the Public Guardian to investigate misbehaviour by those given powers of attorney. The need for this is the many instances of misuse of these powers, starting from coercion of vulnerable people into granting them to professionals or family members to those granted such powers misusing them for their personal benefit. (They could even, under the proxy powers in the AD Bill, then ensure their victims are dead and buried without anyone knowing.) An account of examples of coercion and misuse can be heard in this BBC radio documentary Vulnerable people are vulnerable to coercion. Does this really need saying? Hence the need to give regulators greater powers to scrutinise and prevent abuse.

Meanwhile the AD Bill comes up for its Third Reading this Friday. There are MPs opposed to AD under any circumstances. There are many others not opposed in principle or even in favour but whose concern is whether the Bill contains sufficient safeguards, especially for the vulnerable and those at risk of coercion or whether its risks outweigh the benefits. It is these MPs who will decide its fate. It is notable how many external bodies, many of which are neutral on the principle, have said that they cannot support this Bill as drafted precisely because all amendments designed to safeguard the vulnerable and ensure effective scrutiny have been voted against and those safeguards in the original draft (described by Ms Leadbetter – incorrectly – as the strongest in the world) have been removed or watered down (A list of these is here, here and here.) Some are those professionals with a key role under the Bill – specifically psychiatrists. But the list of opponents include every organisation for the disabled, the National Downs Syndrome Policy Group, the Royal Colleges of Physicians and Pathologists, the Association of Palliative Medicine, the British Geriatrics Society, the Coalition for Frontline Care, Liberty,  the former President of the Family Division of the High Court, the EHRC, experts in anorexia, palliative care, domestic coercion, coroners, medical examiners, the government’s own advisor on suicide prevention and expert criminologist, J Monckton-Smith who described the Bill as “the worst thing potentially we have ever done to domestic abuse victims”.  A look at their expressed reasons for their concerns is worth making, especially for those claiming that safeguards are unnecessary inconveniences.

The key point about the Bill is how it is designed to satisfy the demands of articulate, high agency individuals, well able to make decisions without being pressured or coerced, used to having their choices fulfilled without question and impatient at having any restrictions placed on them. Why should they worry about others? What they want, they should get: AD is no different to any other service or good. It is the ultimate triumph of a a consumerist approach to our choices in life, fundamentally selfish in its disregard for the effect of those choices on others. Or, if you want to put it poetically: “Every man is an island. Entire of itself.“

When Mrs Thatcher was asked in 2002 what her greatest achievement was, she replied: “Tony Blair and New Labour. We forced our opponents to change their minds.”

We see the extent of that change of mind now: a proposal to alter the NHS’s founding principles (Labour’s proudest achievement as it never ceases to remind us and only safe with Labour, apparently), to include the provision of death (delegated to Ministers under a Henry VIII clause with no further Parliamentary scrutiny), a person’s choice to kill themselves to be provided by the state for free (in reality at the expense of other health budgets), to be outsourced to private providers who can make uncapped profits, will have a financial interest in approving every application, regardless what the law says, and who will face no oversight of either their conduct or profits. It is a surer bet for the Macquaries of this world than even our water companies.

There is much talk about choice but note that there is no choice for hospices to opt out, regardless of their charitable objectives or reservations nor any choice for those needing palliative care and wanting a hospice not offering this. Nor any choice for those wanting palliative care. (Every country which has implemented assisted dying has seen a reduction in the palliative care sector.) And if it were really based on a person’s freely arrived at choice, why the provision allowing doctors to suggest AD to patients? While there will be a legal right to AD, there will be no legal right to palliative care. The Palliative Care Minister, Stephen Kinnock (a man who has clearly forgotten his father’s speech before the 1983 election and with no understanding of the conflict of interest his role on the AD Bill Committee creates) said that there could be no such amendment as it would cost too much. That’s the (Thatcherite) spirit! And, of course, AD will, as the government and its sponsor have admitted, save money – for the NHS – and for families spared the financial burden of paying for care for relatives. What’s a coerced, wrongful death when an inheritance or the NHS budget are at stake, eh!

It is a view best expressed by neurosurgeon Henry Marsh, when he said: “They argue that grannies will be made to commit suicide. Even if a few grannies get bullied into it, isn’t that a price worth paying for all the people who could die with dignity?” No it isn’t. Wrongful deaths in pursuit of a greater good are rejected when it comes to capital punishment and crime prevention. Why should AD be different?

What is also notable is how it is Labour MPs who, as well as ignoring the risks of individual coercion, are indifferent to the the structural inequalities – social, economic, sexual, racial and health – affecting so many and which make talk of choice and autonomy so much hot air far removed from the reality of people’s lives. (Odd this since these issues and their intersectionality have defined the careers of so many Labour MPs.) It has been old Labour MPs (Diane Abbott, for instance) to remind us that structural inequalities – deprivation – matter. Anecdotes – Ellie Chown claiming that coercion doesn’t happen because her mum told her so – are a pathetically frivolous answer to such concerns. Have Labour MPs forgotten what their party is for? Has it forgotten that it should listen to the ordinary people – not just celebrities and the well-connected with access to the media? Has it forgotten that this country’s structures determine to a very great extent how much “choice” and “autonomy” people really have and that the reality for most is not very much at all? Have they forgotten that they should be on the side of the bullied, whether grannies or not, not those who see them as an obstacle to be ignored and brushed aside? Have they never even heard an anecdote about a person used to being in control suddenly finding themselves vulnerable, dependant on the goodwill and care of others and worried about being made to feel an unwanted burden and so pushed into doing they something they really do not want?

“The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which.” Truly Labour has been remade in Mrs T’s image.

As for scrutiny, remember this: when MPs come to debate and vote on Friday they will only be able to vote on 12 of 133 amendments, only 5 of which are by MPs other than the sponsor. What the Bill will therefore include is the following provisions: any doctor can raise ending a patient’s life, no matter how vulnerable the patient, including those with learning disabilities, even if the doctor is not expert in the patient’s condition and does not know them. There is no obligation to involve other professionals. Nor to ensure drug safety standards, protect against distressing or prolonged death or tell the patient about possible complications; the panel need only be 51% sure there’s been no coercion and can assess all this over the phone without making any inquiries at all. All independent oversight for this “medical treatment” is removed. More details here.

The complete Bill in its form as it is now after the Committee’s amendments and last week’s debate is currently unavailable and will still not have been published by Friday. MPs will have had no chance to read and consider the whole Bill before they vote on it. This is no way for Parliament to behave on something as legally, morally, and socially consequential as this.

Cyclefree