Fiona Mackenzie MBE leads the Other Half. She was awarded an MBE for her work on We Can’t Consent to This campaign, which won legal change with her research on the criminal justice system’s inadequate response to ‘consent’ claims in defence of violence against women.
Safeguarding women in assisted dying
This report is a rapid review to support the debate on assisted dying in the UK. Be advised that this report contains discussion of both suicide and violent homicide.
This report in 1 minute:
Parliament will soon debate assisted suicide for the terminally ill. This report looks at ‘assisted’ deaths here and abroad, to explore the unacceptable risk that women are coerced into state death.
In a new review of more than 100 UK cases, we find that despite claims: ‘mercy killings’ are not the wanted, ‘hastened’ deaths that need assisted dying. They are overwhelmingly violent domestic homicides of women, by men: and show that our society is still poor at detecting and responding to domestic abuse. How will these men who kill behave when the state offers lawful death ?
Our society is too tolerant of the killings of disabled, elderly and infirm women, in leaving the ’clear and bright line’ that killing is wrong: ’mercy killers’ walk free from court. We fear further softening of the prohibition on femicide, as borne out in Canada.
Even if our law never widens beyond the terminally ill, safeguards fail. Elsewhere, women with anorexia, disabilities and other ‘challenging’ female conditions have been funnelled into ‘assisted’ death. Providers of assisted death can and do coerce.
We propose four principles for safeguarding women in assisted dying —these will require significant design to deliver to:
First do not kill. We must never bring death to women who have been coerced into it. Safeguards must not fail, lest the state delivers domestic homicide.
No secrecy. Assisted dying regimes favour secrecy—as privacy. But there must be no secrets in systems which end in the death of a woman.
Safeguard first: detect abuse before death. But if violent ’mercy’ killers walk free: how will we punish those who coerce, especially if they work for the state?
Do not incite suicide. Suicidality can be contagious and women seem vulnerable to seeking ‘suicide by the state’.
"Feminists know to be suspicious of secrets, especially when the result is the death of women. Abuses of power thrive on secrecy.”
Professor Janine Benedet KC on Canada’s Medical Assistance in Dying (MAID) Programme.
The UK parliaments will soon debate proposed laws on ‘assisted dying’. We explore a new risk that assisted dying brings: women coerced into being given death by the state. This is a thinly researched area, but we can learn from unlawful assisted dying here in the UK, and legal state-provided death elsewhere, to see how well our society might safeguard vulnerable women from being killed by the state.
The UK leads the world in recognising domestic abuse
Women are overwhelmingly the victims of domestic abuse: with disabled women and elderly women uniquely vulnerable. The UK is an leading outlier in taking action on domestic abuse: we have new recognition of coercive control (law in 2015), financial abuse (2014 and 2021), suicide as an outcome of domestic abuse (2024), and rejecting abuser’s claims that women consented to die (2021). But all this is very recent.
Surely we’d hear if this was an issue elsewhere? But secrecy bars us
We cannot fully predict how abuse and coercion into death might play out once assisted dying was available here. No other state, even Canada with 60,000 MAID deaths, safeguards and collects data on domestic abuse in assisted deaths. No one looks for this, and the women who might tell us about it cannot, for obvious reasons. Secrecy is common in assisted dying regimes.
‘Mercy killings’ in the UK tell us how women may be at risk
Since the 1970s, UK campaigners for assisted dying have said that ‘mercy killings’ show an urgent need for assisted death to be given by the state, and that the killers deserve leniency. These deaths are reported to be acts ‘of love’, 'accelerations’ of death.
However, in our new review of more than 100 UK mercy killings and ‘failed suicide pacts’ over 25 years, we find instead that: 88% of killers were male. Women mostly have no expressed wish to die, and overwhelmingly (78%) not terminally ill, but are disabled or elderly and infirm. Killings are triggered by increases in women’s care needs, or sometimes his. The killers say “I could not bear her suffering”. They kill with terrible violence, with overkill frequent. Despite this, these men do not face prison. A seeming desire not to make a bad job worse means our justice system has by common practice created a mercy killing “offence”—manslaughter by diminished responsibility—for men who cannot bear infirmity in women: punishable only with “the traditional penalty for euthanasia, a suspended sentence”.
Notably, abuse is private: these domestic homicides have no recorded history of domestic abuse, even with forensic hindsight review. Startlingly, the two men we found who did have a record of domestic violence are championed in the campaign for assisted dying.
This all should tell us that our society is still poor at detecting domestic, abuse and facing up to male violence against women. Mercy killings should have had us call for care, not death, to be given by the state. We must ask what these homicidal men would do if they could access lawful death for the women whose suffering they find so intolerable. And even if we did detect the subtle coercion of an unwilling woman into assisted dying, how will we punish if a violent ‘mercy’ killer walks free?
Safeguards must never fail, but they do
This paper assumes the UK law never expands beyond terminal illness, but even so, safeguards are missed, definitions are stretched, and dying ‘providers’ may aggressively coerce- all real examples from here and abroad. One UK group unlawfully gave euthanasia to disabled women, despite high profile leadership and good intentions. In the US, anorexic women are deemed ‘terminal’ and can seek death. We know that suicidality can be contagious and we find women especially vulnerable when the state offers lawful death.
Why do mercy killings tell us about how society would cope with lawful assisted dying?
Many people would understand mercy killings to be killings of someone who is near death, in great suffering and who asks to die.
In fact, campaigners for assisted dying have long sought leniency for mercy killers: and say that assisted dying law will end the need for mercy killings and ‘failed suicide pacts’.
As we will see though, the killings we know of are mostly something quite different.
They are very frequently the violent domestic homicide of elderly, infirm or disabled women by men. Our society has much too high a tolerance for these killings.
Mercy killings and failed suicide pacts in the UK showed an urgent need for care, not death.
They tell us that our society has yet to face up to the reality of men’s abuse of women.
Assisted dying campaigners view mercy killings as a siren call for assisted dying here, but we should beware simplicity in human stories.
“This proposed new guidance recognises that mercy killing and suicide pacts are different from murder and manslaughter, and that they should be treated differently by our criminal justice system. Differentiating acts of compassion from serious crimes is an important milestone on the road to law change, as well as a clear indication that the blanket ban on assisted dying does not work. Parliamentarians should take note. But this does not legalise assisted dying – only Parliament can do that.”
Dignity in Dying 1 on their campaign for the CPS to relax its prosecution guidelines on mercy killing and failed suicide pacts
“there are many broad similarities between assisted dying, mercy killings, and suicide pacts. All three typically include the subject seeking an end to physical suffering, all include them wanting the autonomy to choose the manner, timing, and method of their own death, and all will include at some point close friends or family members.”
Humanists UK 2 on the CPS’ relaxing of mercy killing prosecutions in 2023
“This terribly sad case demonstrates why both the law relating to ‘mercy killing’, and the law on assisted dying must change, and we are pleased that the Court of Appeal has acted with compassion in reducing Mr Webb’s sentence today”
Dignity in Dying on the freeing of George Webb. The Court also found that Webb – who had killed his mentally ill wife – had been violent to her in their early relationship. 3
“What jury is going to convict someone in a case like this? The police aren’t catching bad guys. They are causing an incredible amount of distress, It’s a waste of public money and often in cases like this the police are embarrassed to be part of it”.
Dignity in Dying 4 on the 2023 police investigation of Conservative Councillor Douglas Laing, who had ended his first wife’s life as she suffered with ovarian cancer in the 1990s. Laing had been jailed 5 in 2017 for bludgeoning his second wife with a mallet.
“Without a compassionate right-to-die law, it is hard to see how tragedies like this can be avoided. With an appropriate law, Mrs Beddows would be able to formally request medical assistance to die.”
My Death, My Decision 6 on the bludgeoning of Olive Beddows: she had been worried about going into a care home, and had become more dependent on her husband. He had repeatedly refused to allow social services to help them, before attempting to kill her. 7
“What makes this case so very difficult is that it is not clear what Cherith Van Der Ploeg wanted. It’s vital that dying people can have honest, open conversations with their loved ones and their doctors about what they want for the end of their lives. Under the change in the law proposed by Dignity in Dying, a terminally ill person would have to meet a range of robust safeguards before they could have an assisted death, ensuring they were fully mentally competent and making an informed decision. Relatives would no longer have to contemplate breaking the law to end a loved one’s suffering, as terminally ill people who wanted the choice of an assisted death would be able to access it, safely and openly, with proper medical support.”
Andrew Mitchell MP, Co-Chair of the All Party Parliamentary Group on Choice at the End of Life 8 comment on the murder of Cherith Van Der Ploeg, whose ex husband decided to smother her as she lay dying of cancer, to the devastation of her children.
Our initial findings on mercy killings and failed suicide pacts in the UK, 1999-2024
88% of killers were male, overwhelmingly husbands or sons of female victims. Three men killed their teenage daughters whom (may have) suffered from mental health issues.
These are overwhelmingly very severe crimes of male violence against women: men cutting women’s throats, bludgeoning them, shooting them, or using stabbing, suffocation and strangulation. Overkill is frequent.
Women are mostly (78%) not terminally ill, nor overwhelmingly asking to die. They suffer from multiple sclerosis, dementia, mental health conditions, or have become infirm after a fall. Only 5% of women had expressed a wish to die, although another 8% had a history of suicide attempts.
Despite all this men do not face prison: 60% walk free with a suspended sentence for manslaughter with diminished responsibility, 13% are convicted of murder. Women, however, are more likely than not to be convicted of murder, with a life sentence.
The CPS loosened its mercy killing prosecution rules in 2023 based on one, highly irregular killing by a woman, Mavis Ecclestone whose husband had told others he wanted to die. She had been found not guilty.
Some men kill their wives, injure themselves and then call for help. Men are overwhelmingly the survivors of ‘failed suicide pacts’. One man was the only one to write their joint suicide note. Remarkably calling for help reduces their likelihood of prosecution in our new looser guidelines. Women who are not terminally ill are said to have ‘went along with’ suicide pacts.
Abuse is not public: Domestic Homicide Reviews of mercy killings do not find evidence of domestic abuse despite perfect hindsight, court cases, forensic exposure, and access to databases and loved ones.
Only 2 men had noted histories of domestic violence. Startlingly, both those men are championed by assisted dying campaigners.
What did we review?
We reviewed news reporting, inquest findings, sentencing remarks and court of appeal judgements where killings and attempted killings were said by a judge, coroner or defence to be part of a mercy killing, or (failed) suicide pact. We found 102 of these over the last 25 years. We searched for and found only 5 domestic homicide reviews which reflected mercy killings.
This will not be the full picture: although all such cases should (until 2023) be prosecuted as homicide, this only applies to those known to police and where evidence is deemed sufficient to bring to court. As such there are likely to be many more ‘hidden homicides’. For instance, one FOI 9 suggests 5 women killed in mercy killings in the West Midlands between 2015 and 2020. None of those were pursued for prosecution, we can find no Domestic Homicide Review for them, they are truly hidden. As we will see later, secrecy in the death of a woman can lead to abuses.
Selected UK ‘Mercy Killings’ and ‘Failed Suicide Pacts’
Joan Mungall, (69), London, 2011
Joan was killed by her husband Stuart. She suffered from a degenerative condition—Pick’s disease—which may have been fatal within months. Described as positive about her condition, the court accepted she did not want to die. Nonetheless, her husband smothered her after he decided he could not bear to see her suffer, and he saw an “expression” in her eyes “like an animal who needs to be put down and cannot say it”. Campaigners noted his conviction for “helping his terminally ill wife Joan to die”. The prosecution pushed for a sentence less than 1 year and Mungall walked free from court with a conviction for manslaughter by diminished responsibility and a suspended sentence.
Ernestine Tindall, 88, Lincolnshire 2017
Ernestine was strangled with her dressing gown cord by her husband who had become convinced they might be moved to different care homes. He said "For years we've solemnly promised each other that if anything happens...if it gets too much for either of us, we know what to do, and I've done it...promise has been fulfilled...I've strangled her. All the pleading and pleading and pleading, and I finally done it." Manslaughter by diminished responsibility, suspended sentence.
Stephanie Packman (64), Kent, 2018
Stephanie had developed dementia, and was killed by her husband when he took her out of her care home, having spent time preparing to kill her. Carers had told him that they could not provide the 24 hour care that she now needed. Packman cut her throat and then injured himself. The judge described the killing as brutal, and Stephanie’s sister’s anger at her killing. Michael Packman received a suspended sentence for manslaughter by diminished responsibility.
June Knight (79), Essex, 2019
June was in a care home and receiving end of life care. Her son threw her from a balcony. Care home staff and officers tried to help her but she died from her injuries. The judge said “'This case, I'm sure, was a very finely balanced one as to whether it was in the interest to prosecute in the first place.” Suspended sentence for manslaughter by diminished responsibility.
Betty Richings (83).Bournemouth, 2023
Betty had suffered a broken vertebrae in a fall. Her retired police officer husband strangled her after his mounting frustration at delays in her receiving medical care. Before her fall, Betty had provided significant care and support to her husband. The judge told him that “the mental torment engendered by the impossible situation in which you found yourself must have been intolerable”. Manslaughter by diminished responsibility, suspended sentence.
We have too high a tolerance for the killing of women who are disabled, or who were elderly or likely to die soon ‘anyway’.
Very limited data, if any, data is collected by the state on these deaths, and no learning or curiosity. Criminal court judges call these killings “exceptional”, despite their frequency and similarity. This is of relevance for the review by judges proposed in the current Westminster bill.
The judicial safeguard: even criminal court judges are not able to spot patterns in so called mercy killings
‘When I first saw him after it happened, he asked: “Can you forgive me?”
‘I said, “No, because you murdered my mother”. But over time I came to forgive him because it was not really him who killed my mother.
‘The appalling state he was in at the time made him a different person, not the wonderful father and husband that he really was.
If social services had provided more help to my parents, would this have happened?
‘This case raises serious questions about how we look after those with dementia and their carers, who often find it a huge ordeal.’
A son whose father killed his Alzheimer's-suffering mother in a sustained stabbing attack 10
Mercy killings triggered by partner’s escalating care needs:
Commonly, couples have no children, or family are distant or have lost touch.
Alternatively, children have tried and failed to have external care support brought in for their parents.
Many male killers reject caring support, before killing through ‘not being able to cope with her suffering’.
It is often the increasing care needs of the victim, or a major diagnosis for the killer, that triggers killing.
In particular transitions like one partner needing to go into a care home seem for some to be a trigger.
As Professor Jane Monckton Smith has previously said 11 on claimed ‘mercy killings’ of those with Alzheimer's: ‘When people talk about an Alzheimer’s related death being a “mercy killing” – that’s troubling. Firstly, the methods of killing in these cases are anything but merciful…Another scenario emerges when a person subject to coercive control becomes ill. When professionals come in to make decisions, that can annoy the controlling person, whose systems of control are disrupted.’
How might women be given death via abuse in assisted dying?
We must face up to the reality of an opportunity for abusers to seek lawful death for women
There is currently no state provided death in the UK. So we cannot fully predict how abuse of women may play out in practice here. However, most countries with lawful assisted dying do not look for domestic abuse of women within the operation of their safeguards. The Australian states do recommend referral of those who are suffering domestic abuse, but not data is published on whether that happens. And it is no bar to receiving Assisted Dying. Most international assisted dying safeguards focus on what is essentially property crime: whether a will beneficiary might be looking out for their money.
But we can look at what has happened here in the UK, and abroad, in deaths which are ‘assisted’. Our research shows that at least 5 UK men per year violently kill women who are disabled, elderly or infirm, under the guise of mercy killings. How will these homicidal men behave in a world where they can access legal death instead? We know that increases in care needs and transitions like needing to go into a care home can be a trigger for a small number of men to kill. We also know that some men are much more likely to leave a partner when they face a life-threatening illness 12. We should prepare for the reality that we see a new version of this if assisted dying is introduced: with women coerced by male partners who ‘cannot bear to see them suffer’ into seeking assisted dying. That these women may have been going to die anyway does not mean this is not a monstrous outcome.
Globally though, there is poor data availability: most academic and state research on Assisted Dying vulnerabilities looks at broad brush analysis of equalities data: e.g. are lower income people over or under represented in those seeking death? Is it good or bad if we see more women than men? This belies the lack of information available to researchers on those seeking state provided euthanasia or suicide. We will not know if women are being abused, if we do not look for this, and crucially, if their deaths are secret.
Abuses of power thrive on secrecy
Our current system has both inquiry and publicity
As we have seen, our existing law allows men to go free after committing terribly violent killings of women. But we only know this due to the layers of inquiry and publicity in our current system. Presently, when the state becomes aware of an “assisted” death, there will be:
a criminal investigation by police to establish facts
An inquest, usually public
for assisted suicides: almost always no prosecution
for mercy killings and failed suicide pacts, a policy of prosecution in all cases where there is sufficient evidence (until late 2023)
A criminal trial, with additional background information to support sentencing
Press reporting, so that the public can hear about what happened.
Post trial Domestic Abuse Related Death Review, accessing family, friends, state databases in order to find evidence of domestic abuse and learnings for state agencies.
This approach means that some involved in the death of another will feel unfairly pressured and exposed at time of grief. But it means we have a chance at understanding what happened, and catching those who have murdered.
The 2006 killing of Mandy Horne in Shetland was widely reported as a Romeo and Juliet, mercy killing by her husband - Mandy had MS. Both died so there was no investigation. Only through Mandy’s father and a curious Times journalist was it later revealed to be a very violent murder and suicide by Mandy’s husband: he’d also killed their pets. The night before she died, Mandy had asked friends to stay because she was scared of her husband.
This paper includes only limited information on deaths that are deemed to be assisted suicides: because these are rarely prosecuted, we don’t know about them. Since 2023, 2 men have been convicted of murder in mercy killings. But we don’t know if there are others who might once have been prosecuted (and found guilty of manslaughter or not guilty). There is no public information on these decisions.
But with state-provided assisted deaths, secrecy is built in
Secrecy is built into the latest assisted dying proposals in the UK. This is also true of countries thought to be exemplars like Oregon and the Australian states.
In Oregon, death certificates do not include a note of assisted dying. All provider information on assisted deaths is deleted after the annual report is prepared 13. This simple data report does not, and would not, reveal the kind of abuses we fear here.
Here is the kind of safeguarding failure that could hide someone coerced into homicide:
“The other case of non- compliance was where someone signed an application document on behalf of an applicant and was also a witness to the document, which is prohibited by the Act. After investigating the case, the Review Board considered this was an oversight and the case was considered clinically appropriate” Victorian Voluntary Assisted Dying Review Board Report, 2021-22
Note there is no consideration of whether the applicant had in fact consented to assisted death. There is no criminal investigation, no public trial or hearing, or news reporting for anyone to understand if there was a different story.
Even this failed safeguard is greater than that in the Leadbeater bill in the Commons, which explicitly allows another person as “proxy” to sign the forms. This person can have known the person for 2 years, or just be someone of good standing in the community. Essentially anyone.
We can also learn from Canada, which has shared history and common language, and a legal system drawn from ours. In Canada, there are stories now emerging of families who have tried to prevent their relative being given MAID—as they believe they are not terminally ill. Families cannot get access to medical records to understand if their relative was coerced 14. The state protects itself and those who are involved in delivering death.
There is a tremendous push for secrecy around these deaths before they happen—in the name of patient privacy…. Feminists know to be suspicious of secrets, especially when the result is the death of women. Abuses of power thrive on secrecy. Professor Janine Benedet KC on Canada’s MAID 15.
Here in the UK, former head of the family court James Munby says this on the Kim Leadbeater bill before parliament. This Leadbeater bill asks High Court judges to review the assisted suicide applications.
“ If there is to be a judicial process, it must, as I have said, be open and transparent. The very suggestion that the process should be private, confidential, shrouded in secrecy, is surely anathema to any judge who might be involved… we face an impossible choice: between an open and transparent process that might deter those for whom the scheme is designed, and a secret process destructive of the integrity of the scheme and corrosive of the judicial function.” Sir James Munby, former head of the Family Court 16
Scope for abuses of well intentioned law
Practical expansions of the definitions beyond parliament’s imagining
Even if the law does not change in response to campaigning and legal challenge, as it has elsewhere, day-to-day practice can widen definitions.
Providers—doctors tasked with approving and delivering assisted suicide—may expand the definition of terminal illness to encompass illness that they decide cannot be treated. This may include eating disorders, with more than 60 people killed by assisted suicide worldwide. This includes the US where only those with a terminal illness are supposed to access assisted suicide. One woman with anorexia, Jane, told researchers at Eat Breath Thrive charity that she was offered MAID in Colorado:
“I was told that, although I wasn’t yet 30 years old at the time, [my doctor] would ‘make an exception’ for me and ‘allow’ me to die, if that was my choice. It didn’t feel like my choice — I felt coerced... I’m not sure how to describe it, but something inside me wouldn’t let me take the MAiD. Jane, anorexia survivor 17
There were 26,000 people admitted to hospital with eating disorders in 2023, 97% of them women 18. Without treatment, they may be deemed to be terminally ill and approved for assisted suicide under the Commons bill.
Further, in Canada, denying food and drink can allow people to meet the “reasonably foreseeable death” in the eligibility criteria for the MAID programme. This decision by the doctors who provide MAID assessments now wildly expands the scope of the law in Canada—even to those who say they don’t want certain treatments for future ailments.
“[a] person may meet the ‘reasonably foreseeable’ criterion if they have demonstrated a clear and serious intent to take steps to make their natural death happen soon or to cause their death to be predictable. Examples might include stated declarations to refuse antibiotic treatment of current or future serious infection, to stop use of oxygen therapy, or refuse turning if they have quadriplegia, or to voluntarily cease eating and drinking.” Canadian Association of MAiD Assessors and Providers 19
Softening the moral boundary on killing dying, disabled or elderly women
If it becomes acceptable for women to seek death, will society care less if an already life limited, disabled or elderly woman is killed? In Canada, they do not have our long tradition of giving those who ‘mercy’ kill partners a suspended sentence. But since MAID was introduced, one man has successfully claimed so:
Consider the recent manslaughter conviction and compassionate sentence given to Francois Belzile, who deliberately gave multiple insulin injections to his disabled female partner, killing her. Although he was initially charged with first-degree murder, the prosecutor was willing to accept a guilty plea to manslaughter, and the judge sentenced him to house arrest because he allegedly suffered from “caregiver burnout.” It seems unimaginable that a woman who killed her husband in similar circumstances would be viewed so sympathetically. Professor Elizabeth Sheehy. 20
This is the opposite outcome to a previous and high profile Canadian carer killing, where a man called Latimer was imprisoned for murdering his 12 year old daughter in the 1990s. Now MAID is here, Belzile’s lawyer told the judge in sentencing, “things have changed since Latimer… at least in Canada”. This post-MAID argument appears to have worked in gaining only house arrest for the killing of Belzile’s female partner.
Encouraging suicidality of vulnerable women
Nowadays we know that normalisation and publicity around suicide can inspire suicidality in others. Assisted suicide provided by the state brings an alarming new dimension to this—particularly in the UK proposals in parliament which allow doctors to suggest assisted suicide to patients.
The family of one victim of MAID track 1 in Canada describe how she was approved for death after suffering mental health conditions in response to a car crash. Otherwise healthy, she restricted her diet and this was enough to have her deemed terminally ill. Her daughters were able to seek temporary psychiatric hold for her but their mother was given euthanasia on release.21
Canadian women seem 2 times more likely to seek MAID track 2—which allows for those with non “reasonably foreseeable” deaths to die 22.
Women make up 69-80% of those given psychiatric euthanasia where this has been launched, such as in Belgium 23.
In the 1980s young, sometimes disabled, women were commonly reported to have used suicide manuals provided by assisted dying campaign groups the Voluntary Euthanasia Society and Scottish EXIT, although these manuals were claimed to be for the incurably ill 24.
One stalker in Scotland has already been convicted of repeatedly arranging calls from Dignitas for her victim 25.
Suicidality after domestic abuse
We are now recognising that suicide of women after domestic abuse is potentially more common than homicide by their abuse partners 26. As we have seen, women seem particularly vulnerable to the offer of suicide by state. It is impossible not to imagine a scenario that a woman in abusive situations would find it easier to access NHS assisted dying than support to create new life away from her abuser. The law’s safeguards must prevent this woman ever being given easier route to death by the state.
Coercion by ‘the process’
As others have raised, people can find themselves going along with a process if they feels it may please the doctor27. And for those with conditions which are challenging to treat, it may feel like here is a clear, efficient process, and finally something that doctors know how to help with. Consider this family quote from the Australian VAD handout 28:
“The voluntary assisted dying process was really the first time that any medical and allied health practitioners had given such understanding and empathy to my sister's suffering, and that was such a relief."
This funnelling is to some extent built into the Leadbeater bill which requires any doctor who refuses a patient Assisted Dying, to automatically refer them to someone else who can reassess them.
This easy path is a particular worry for women who suffer with immune conditions or eating disorders which are deemed difficult by the medical profession.
This is playing out in Canada’s MAID Track 1 29:
“We're not collecting the data properly-or at least it's not being reported-except we have seen some increases in striking things. The largest area of increase, I believe, was the "other" category. That went up to 15%-and that's 15% of 13,000 deaths, I'll remind you. It is now the third most reported category. In that, there is a gender gap' its 17% women to 12.8% men. The "other" category also includes frailty. You see a similar gender gap, with more women getting MAID for multiple comorbidities, such as arthritis and hearing loss, with 12% versus about 8.3% for males. In all of this, about one-third of people get it citing that they feel they are a burden on their family. There is even more of a gender gap if you then break it down to the non-reasonably foreseeable death, track two, numbers. There, the gender gaps go to up to 60% higher for females than for males.” Dr. K. Sonu Gaind
Self coercion—feeling a burden
Women live longer on average, with more years of poor health 30. This leaves women in potentially more vulnerable position for longer, and likely to wonder if they are a burden. This is a feeling reported by many who seek assisted suicide:
· 35.3% in Canada perceiving they were a burden on family members31
· 43.3% in Oregon being a burden on family/friends or caregivers 32
· 35.2% of Western Australian patients approved for VAD said they were a burden on family, friends/caregivers, or concerned about it 33.
In Western Australia, 1.6% of all deaths are through assisted dying having only launched in 2021, ’feeling a burden’ should be a red flag for those making the assessments of coercion into dying:
“If a patient is requesting access to voluntary assisted dying because they are concerned that they are a burden on their carers or family, their situation should be explored. This may include investigating additional options for supportive care or respite care. The Coordinating Practitioner and Consulting Practitioner should also seek to understand why the patient has raised this concern and what they mean by it. Some people may say they feel like they are a burden because members of their family are struggling, while others may use this to start a conversation about their struggles with their current situation. Such comments should also raise a 'red flag'...“ Western Australia Practioner Handbook. 34
Despite more than a third of those approved reporting they felt a burden, Western Australian medics decided that everyone who applied for VAD was eligible in acting voluntarily and not being subject to coercion in 2023-24 35. Feeling you are a burden is no bar to being given death by the state. It is startling that despite the prevalence of domestic and elder abuse in Australia, the assisted dying safeguards for these picked up absolutely no one at all.
Coercion from those providing death—real lessons from private (and illegal) assisted dying in the UK
In 1979 and 1980 the UK’s Voluntary Euthanasia Society (VES) would respond to calls from the public with a visit from Mark Lyons. The General Secretary of the VES– Labour Councillor and Oxford Don Nicholas Reed– would triage callers before sending Lyons to them. Lyons dreamed of saving the NHS from “the ailing population”, and would charge £30 per visit.
One woman called the VES in distress at her osteoarthritis as ‘I didn’t want to be a burden to anyone’. But she called again to tell them she did not want to die. Ignoring this, Lyons rang her doorbell, told her “you are not going to pull through” and gave her two violent options for death: he would force feed her pills and suffocate her, or he would hold her head underwater in the bath. He told her “There will be no questioning of my commandment, none at all”. She gave evidence from a stretcher in court on his anger at her mind change: “I had tears in my eyes, I thought ‘this man has come to kill me’...now he was a devilish creature”.
Both men were investigated for 250 deaths, and convicted on charges relating to 7 people, 5 of them women: including sufferers of multiple sclerosis, fibromyalgia, depression and cancer. Reed was jailed (later attempting to appeal his case to the ECHR) and Lyons walked free with the “traditional penalty for Euthanasia, a suspended sentence”.
The VES was not a fringe organisation: the executive committee at the time included a leading author, a professor of philosophy, the chairman of the Liberals Lord Beaumont, and past Vice Presidents included Nobel Laureate Sir George Paget Thomson . One Labour MP protested outside Reed’s criminal trial in his support. VES (then also known as EXIT) now campaigns in the UK as Dignity in Dying 36.
There should be a lesson for us here: high calibre leadership, organisational safeguards and good intentions do not protect against individuals whose wish to kill overrides them.
References
1 Dignity in Dying, “A milestone on the journey to assisted dying law reform, where compassion is no longer a crime” , (2022), from: https://www.dignityindying.org.uk/news/a-milestone-on-the-journey-to-assisted-dying-law-reform-where-compassion-is-no-longer-a-crime/
2Humanists UK, Humanists UK calls for compassion in cases of ‘mercy killings’ and suicide pacts, (2022), from: https://humanists.uk/2022/04/06/humanists-uk-calls-for-compassion-in-cases-of-mercy-killings-and-suicide-pacts/
3 Dignity in Dying comment on George Hugh Webb Court of Appeal judgement, 2011, from: https://www.dignityindying.org.uk/news/dignity-dying-comment-mr-webb-case/. Judgement in R. v Webb (2011), from: https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA/Crim/2011/152.html&query=(violen) “The marriage between the appellant and his wife was not always happy. In the early years, from time to time, Mrs Webb had cause to complain about her husband's behaviour. He was irascible and on occasions, according to her, she was treated with violence. But however that may be, during the last fifteen years of her marriage and her life they were a devoted couple within the terms of their own relationship and he cared for her in circumstances to which we must come.”
4 Dignity in Dying in The Times, 'Man investigated for murder after ‘helping sick wife die’ 23 years ago', (January 2022), https://www.thetimes.com/article/132cbb40-70c0-11ec-9b00-681c4404af37.
5 Devon Live, ‘Ex-Tory Devon councillor 'helped his first wife to die' years before hitting second with a mallet’, July 2022, https://www.devonlive.com/news/devon-news/ex-tory-devon-helped-first-6560308. Devon Live ‘Councillor who attacked wife with wooden mallet could have jail term increased’, (January 2018), from: https://www.devonlive.com/news/devon-news/councillor-who-attacked-wife-wooden-1083022, “Mrs Laing said she thought she was going to die during the bloody attack but managed to escape the family home they shared and raise the alarm with neighbours.”
6 My Death My Decision, Suspended sentence for failed mercy killer, 4 May 2017, from: https://www.mydeath-mydecision.org.uk/2017/05/04/suspended-sentence-failed-mercy-killer/
7 Liverpool Echo, ‘RAF veteran, 95, who tried to murder wife with hammer in 'mercy killing' is spared jail’, (April 2017), from: https://www.liverpoolecho.co.uk/news/liverpool-news/raf-veteran-94-who-tried-12941210
8 Andrew Mitchell MP, Co-Chair of the All Party Parliamentary Group on Choice at the End of Life comment in Dignity in Dying, Comment on the Van Der Ploeg case, 15th August 2020, From: https://www.dignityindying.org.uk/news/comment-on-the-van-der-ploeg-case/
9 West Midlands Police, FOI Response Domestic Homicide (324A/22), from: https://foi.west-midlands.police.uk/domestic-homicide-324a-22/
10 Daily Mail, ‘Brother of gameshow host Leslie Crowther stabbed frail dementia-suffering wife 58 times due to the strain of caring for her’, July 2011, from: https://www.dailymail.co.uk/news/article-2046481/Leslie-Crowthers-brother-Frank-stabbed-dementia-suffering-wife-58-times.html
11 Counsel Magazine, ‘Order out of chaos: Professor Jane Monckton-Smith’, (November 2021), from: https://www.counselmagazine.co.uk/articles/order-out-of-chaos-professor-jane-monckton-smith
12 Glantz, Michael J et al. “Gender disparity in the rate of partner abandonment in patients with serious medical illness.” Cancer vol. 115,22 (2009): 5237-42. doi:10.1002/cncr.24577 and Karraker, A., & Latham, K. (2015). In Sickness and in Health? Physical Illness as a Risk Factor for Marital Dissolution in Later Life. Journal of Health and Social Behavior, 56(3), 420-435. https://doi.org/10.1177/0022146515596354
13 Oregon Health Authority, Oregon's Death With Dignity Act (DWDA) FAQs, from: https://www.oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/faqs.aspx
14 Coelho, R. et al. (2023) ‘The realities of Medical Assistance in Dying in Canada’, Palliative and Supportive Care, 21(5), pp. 871–878. from: https://www.cambridge.org/core/journals/palliative-and-supportive-care/article/realities-of-medical-assistance-in-dying-in-canada/3105E6A45E04DFA8602D54DF91A2F568
15 Elizabeth Sheehy in A Conversation on Feminism, Ableism, and Medical Assistance in Dying. / Grant, Isabel; Benedet, Janine; Sheehy, Elizabeth et al. In: Canadian Journal of Women and the Law, Vol. 35, No. 1, 01.06.2024, p. 31-72.
16 Sir James Munby, The Transparency Project, ‘ASSISTED DYING : WHAT ROLE FOR THE JUDGE? Some further thoughts, November 2024, from: https://transparencyproject.org.uk/assisted-dying-what-role-for-the-judge-some-further-thoughts/
17Chelsea Roff & Dr. Catherine Cook-Cottone , ‘The Dangers of Physician Assisted Suicide in Eating Disorders’, (July 2024), Eat Breath Thrive, from: https://www.eatbreathethrive.org/ebt-blog/report-assisted-suicide
18 NHS data provided in ’Eating disorder patients could qualify for assisted death’, The Times, November 2024
19 Canadian Association of MAiD Assessors and Providers, ‘The Interpretation and Role of ‘Reasonably Foreseeable’ in MAiD Practice”, Providers (February 2022), from: https://camapcanada.ca/wp-content/uploads/2022/03/The-Interpretation-and-Role-of-22Reasonably-Foreseeable22-in-MAiD-Practice-Feb-2022.pdf
20 Elizabeth Sheehy in A Conversation on Feminism, Ableism, and Medical Assistance in Dying. / Grant, Isabel; Benedet, Janine; Sheehy, Elizabeth et al. In: Canadian Journal of Women and the Law, Vol. 35, No. 1, 01.06.2024, p. 31-72.
21 Globe and Mail, ‘A complicated grief: Living in the aftermath of a family member’s death by MAID’, January 2021, from: https://www.theglobeandmail.com/canada/article-maid-death-family-members-privacy/
22 Ontario Chief Coroner’s Office MAID Review Committee, ‘MAiD Death Review Committee Report 2024 - 3‘, (October 2024),from: https://cdn.theconversation.com/static_files/files/3518/2024.3_NRFND_Vulnerability_Final_Report_%281%29.pdf?1729708747
23 Nicolini, Marie E et al. “Psychiatric euthanasia, suicide and the role of gender.” The British journal of psychiatry : the journal of mental science vol. 220,1 (2022): 10-13. doi:10.1192/bjp.2021.95
24 For example: a 58 year old woman who had been depressed, as told in Diss Express, ‘Exit member took own life’, 25 May 1984. A 40 year old woman who had previously been suicidal, as told in Wolverhampton Star,‘Woman’s ibrary book suicide’, November 1995. A 30 year old woman who had been depressed, The Times ‘Suicide Finding to go to DPP’, 26 May 1983
25 Press and Journal, ‘Stalker subjected victims to calls from undertakers and Dignitas assisted suicide clinic’, (June 2021), from: https://www.pressandjournal.co.uk/fp/news/aberdeen-aberdeenshire/3600534/stalker-subjected-victims-to-calls-from-undertakers-and-dignitas-assisted-suicide-clinic-2/
26 the national Domestic Homicide Project , ‘The Domestic Homicides and Suspected Victim Suicides 2022-2023 Report’, March 2023), from: https://www.vkpp.org.uk/news/report-reveals-scale-of-domestic-homicide-and-suicides-by-victims-of-domestic-abuse/
27 “Canadian physicians face fewer restrictions on their interactions with applicants, and are instead told they have a “have a professional obligation to initiate a discussion about MAID if a patient might be eligible for MAID” by the Canadian Association of MAID Assessors and Providers, which provides guidance to professionals on the subject.41 This is particularly dangerous from those on low incomes or the mentally ill, who might be coerced through power dynamics common in doctor-patient relationships, or who may be more likely to misinterpret the discussion as medical advice.” Social Market Foundation, Slowly, Carefully, Compassionately Canadian lessons on assisted dying ‘, (November 2024), from: https://www.smf.co.uk/publications/canadian-lessons-assisted-dying/
28 Government of South Australia Voluntary Assisted Dying Review Board, ‘Annual Report 2022-23’, (October 2023), from: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/services/community+and+specialised+services/voluntary+assisted+dying/reporting/voluntary+assisted+dying+reporting
29 Parliament of Canada, Dr. K. Sonu Gaind evidence to the Special Joint Committee on Medical Assistance in Dying, (28 November 2023), from: https://www.parl.ca/documentviewer/en/44-1/AMAD/meeting-40/evidence
30 Office for National Statistics, Health state life expectancies, UK: 2018 to 2020, (2022), from:https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2018to2020
31 Government of Canada, ‘Fourth annual report on Medical Assistance in Dying in Canada 2022’, October 2023, from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2022.html
32 Oregon Health Authority, ‘Death with Dignity Act Annual Report Year 26 (2024)’, from: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ar-index.aspx
33 Western Australia Voluntary Assisted Dying Board, ‘Voluntary Assisted Dying in Western Australia – Annual Report 2023–24’, (5 November 2024), from https://www.health.wa.gov.au/Reports-and-publications/Voluntary-Assisted-Dying-Board-Annual-Report
34 ‘ Western Australian Government Department of Health, ‘Western Australian Voluntary Assisted Dying Guidelines’ Section 8.4, (2023), from https://www.health.wa.gov.au/Articles/U_Z/Voluntary-Assisted-Dying-Board
35 Western Australia Voluntary Assisted Dying Board, ‘Voluntary Assisted Dying in Western Australia – Annual Report 2023–24’, (5 November 2024), from https://www.health.wa.gov.au/Reports-and-publications/Voluntary-Assisted-Dying-Board-Annual-Report
36 Reporting in The Times 15th-31st October 1981: from https://www.thetimes.com/archive. Daily Telegraph 16—31st October 1981. Dignity in Dying, ‘Voluntary Euthanasia Society changes name after 70 years to become Dignity in Dying’, (23 January 2005), from: https://www.dignityindying.org.uk/news/voluntary-euthanasia-society-changes-name-70-years-become-dignity-dying-23-jan/