‘1,400 victims’

The Other Half’s written evidence for the Terminally Ill Adults (End of Life) Bill at Westminster.

In order to set out the scale and seriousness of the issue of detecting domestic abuse in those being offered assisted dying, we look at the Australian model for assisted dying. We estimate that Government should plan for 1,400 domestic abuse victims to be given assisted deaths each year in England and Wales, within the first few years of the operation of the scheme - 15 times as many die through known homicides or suicides. This is clearly a staggering problem for all of society to face.

Fiona Mackenzie MBE - 4th March 2025

Link to version accepted by Bill Committee on 3rd February 2025

1.       The Other Half is a non partisan think tank developing policy in women’s interests.

2.       As set out in our paper on Safeguarding of Women in Assisted Dying, our concern is that without assisted death safeguards which are designed to never fail, the state would find itself delivering femicide. That paper highlights that women are uniquely vulnerable to assisted dying when it goes ‘wrong’, and refutes the claim that so called ‘mercy killings’ show a need for assisted dying, instead posing a new risk that homicidal perpetrators would seek to exploit this system of lawful death.

3.       This written evidence submission for the Committee sets out a new analysis of adoption of the Australian model for assisted death, in order to highlight the scale and seriousness of the issue of detecting domestic abuse in those being offered assisted dying. We focus on Western Australia (WA) Voluntary Assisted Dying (VAD), which as in this bill, allows doctors to suggest assisted death to patients[i]. The VAD Review Board of the Australian state of Victoria suggest[ii] that ‘doctor initiation’ may be the reason for takeup of VAD in WA (now 1.65% of deaths by year 3[iii]) quickly becoming around double that in Victoria.

4.       If England and Wales follow the WA takeup of assisted dying, we should plan to expect deaths of domestic abuse victims by state assisted death may number between 500-1,400 each year within the first few years of operation. This obviously presents incredibly complex practical and moral challenges for our society, our criminal justice system, state agencies, charities – all of us. Committee needs to hear from experts who can explore the potential for harm.

5.       The UK is a leading outlier in recognising domestic abuse in law. Even so, our understanding is new[iv] and our data is poor[v], particularly on disabled people, older adult victims[vi] and understanding of male and female experiences. The ONS only recently started to collect data on the over 75s[vii]. Resulting caution on these estimates is wise[viii] but we know older people are uniquely vulnerable to domestic abuse: the over 60s make up 25% of domestic homicide victims[ix], despite being only 18% of the population. A global elder abuse meta analysis[x] found 15.6% of over 60s had experienced abuse  in the last year: 1 in 6.

6.       England and Wales would be the largest roll out of state permitted assisted dying in the world by population. That scale matters. If we follow the Western Australian model, we might see 1.65% of adult deaths each year through assisted death within 3 years: i.e. 9,500 deaths per year by 2030[xi]. We may also expect 90% of those deaths to be in people aged over 60 – making domestic abuse in older adults a key concern.

7.       Because of this scale, we estimate that Government should plan on the basis that the number of domestic abuse victims given death via proposals in this bill would be 500 - 1,400 per year[xii]. This is considerably more than die through killings in domestic homicides (111 in year to March 2023[xiii]) and suspected suicides after domestic abuse (93 to March 2023).

8.       Initial requests to be assessed for assisted dying eligibility are likely to be even higher, perhaps almost double this number each year (800-2,500 domestic abuse victims among 17,000 initial requests per year by 2030) if we follow WA’s outcomes. This presents huge challenge in how we reliably assess that terminally ill people are acting voluntarily and without coercion.

9.       It is already well understood that domestic abuse victims are more likely to be suicidal, due to suicidality triggered by the abuse, or through direct coercion into suicide by their abuser. This risk is likely to be further elevated by an escalation in abuse when receiving a diagnosis. Standing Together say a cancer diagnosis is a trigger for escalation in domestic abuse and abusers “coercing them into, or away from, certain treatment choices”[xiv], choices which would now include death.

10.    Domestic abuse training for physicians, as proposed in amendments 20, 21 and 22 to the bill, does not seem to screen out potential victims, at least where used in Australia. Domestic abuse training for Australian VAD providers makes up a part of a single module of c.40 – 60 minutes of self guided e-learning[xv]. This is obviously not enough: and in WA, the ‘acting voluntarily and without coercion’ test which requires doctors to screen for domestic abuse has recorded no one as being screened out, in 1,851 people’s eligibility assessments so far.  New South Wales’s assisted dying safeguards on first assessment found 3 people out of 992 who may have been pressured or coerced: 0.3%, compared to 15% of Australian older people who may suffer elder abuse. Other assisted dying jurisdictions avoid this question by not screening for domestic abuse at all.

11.    Nevertheless we support amendment 20, 21 and 22. Domestic abuse training for assisted death providers should still be done, as identifying even 10% of domestic abuse victims in the early assessment for assisted dying might be 80-250 people per year, more than the number who are killed by perpetrators.

12.    We highlight that this bill removes the coroners’ duty to investigate suicides. This should be reinstated. Other measures Committee could consider to protect domestic abuse victims from coercion could include a statutory duty to provide safe accommodation for victims who are facing a terminal diagnosis (to avoid people finding it easier to die than access a refuge), a route for commissioning of Death after Domestic Abuse multiagency Reports given removal of the coroners’ role – where these could be commissioned by any party (state or member of the public), and very robust data collection and monitoring[xvi].

13.    Committee has already rejected an amendment to the witness list proposing experts on domestic abuse in cancer care, in the elderly and a leading KC who has spoken to the removal of the Coroner’s duties to investigate suicides in this bill. Given the truly staggering scale of potential for deaths of domestic abuse victims by assisted dying in England and Wales, we would urge the committee to think again and engage fully in the truly extraordinary safeguards needed to support this change.  We support the new amendment by Diane Abbott to invite experts on elder abuse and domestic abuse in cancer to appear.

 Notes on methodology, data sources and further references

[i]We can look to Australia to understand how uptake of assisted dying may play out here

There is little quality research which sets out the assisted dying design factors that drive public take up of assisted dying. The Australian states may give clues in time, as they are broadly based on a similar model for access but have some key differences, summarised well here https://end-of-life.qut.edu.au/assisteddying . Accelerant factors for assisted dying takeup might be:

·        Physicians being able to initiate discussions on assisted death, (permitted in this bill, and in WA, NSW, QL, banned in Victoria, SA)

·        Practitioner administration (final act' not permitted in this bill, restricted in Victoria, SA, WA, permitted by choice in NSW, QL)