Reflections on the Assisted Dying Bill
Bodily Autonomy, Eugenics and the Pathologisation of Suicidality.
Context
On Friday, 29th November 2024, Members of Parliament voted in favour of the Terminally Ill Adults (End of Life) Bill (referred to as the "Assisted Dying Bill"). This bill would grant terminally ill adults, or adults with an expected lifespan of no more than six months, the legal right to request medically assisted death, provided several conditions are met, including the approval of a mental health practitioner.
While the Assisted Dying Bill has been lauded as a progressive step toward bodily autonomy for all and the right for some of society's most vulnerable and marginalised to determine their own fate, the reality is that legislation of this nature has always been enforced to eradicate marginalised, particularly disabled, people. This is because the United Kingdom, like its imperial allies across Europe, the United States, and Canada, is fundamentally ableist.
Ableism (N.)
‘Ableism is system of assigning value to people's bodies and minds based on societally constructed ideas of normalcy, productivity, desirability, intelligence, excellence, and fitness. These constructed ideas are deeply rooted in eugenics, anti-Blackness, misogyny, colonialism, imperialism, and capitalism. This systemic oppression that leads to people and society determining people's value based on their culture, age, language, appearance, religion, birth or living place, 'health/wellness', and/or their ability to satisfactorily re/produce, 'excel' and 'behave.'
You do not have to be disabled to experience ableism.
Working definition by Talila Lewis, updated January 2022, developed in community with disabled Black & negatively racialized folks. Read more
Further Understanding Ableism and Eugenics
The lack of rigorous engagement with Disability Politics, particularly the perspectives of negatively racialised disabled people regarding the ongoing COVID-19 pandemic and long-COVID, is reflected in why many non-disabled people view the Assisted Dying Bill positively rather than recognising it as a logical consequence of Western societies grappling with the repercussions of a mass-disabling event.
These societies, which already struggle to provide expensive healthcare services, don't want to bear the cost of keeping disabled people alive, and the solution they propose is to end our lives instead.
During the early years of the COVID-19 pandemic in the UK, many disabled people had Do Not Resuscitate orders placed on them without consent—one of the many stark signs of how disabled lives are devalued. At least 60% of recorded COVID-19 deaths in the UK during this time period were of disabled people. (Tapper, 2021).
Many argue that the safeguards in the Assisted Dying Bill are sufficient to prevent coercion and guarantee informed consent. However, our world is not run by the rule of law alone; it is run by the reinforcing systems of white supremacy, ableism, queerphobia, and capitalism.
"Checks and balances" have not reduced rates of perinatal mortality in the UK. Today, Black women are five times more likely to die during childbirth than other women. "Safeguards" failed to intervene on behalf of those routinely subjected to medical gaslighting and coercion at the hands of the National Health Service. It remains commonplace for gender marginalised patients to endure debilitating pain, totally untreated, because of medical bias.
While this bill is framed as a mercy for disabled patients, NHS waitlists are so long that some patients become terminally ill due to treatment delays, highlighting how the medical industrial complex itself creates the very conditions it now claims it will address.
Cancer patients have been a primary focus for proponents of the Assisted Dying Bill, so we would be remiss not to address this directly. Earlier this year, The Guardian reported that more than a third of cancer patients waiting for treatment face deadly delays (Gregory, 2024). Rather than addressing these horrific conditions—where sick people are systematically denied timely care—we are instead making it easier to die than it is to live with disability and illness.
Many patients, including those with cancer, are now being advised by GPs to seek private healthcare to expedite their treatment. This reveals a disturbing truth: we are participants in the systemic abandonment of those deemed politically undesirable, our consent being manufactured for their deaths.
This bill does not resolve suffering; it obscures the government’s failure to provide adequate care, offering death as the most viable option for those already neglected by a broken system.
Debt and Death
We must also understand that the decision to seek medically assisted death cannot be separated from the State-created conditions of debt and poverty. When access to healthcare, housing, and basic necessities is systematically denied, and when living with disability or chronic illness becomes financially and emotionally unsustainable, the State effectively pushes people toward viewing death as their only viable option.
‘Some people explain that income shocks, for instance driven by time off work sick or a benefit sanction, can undermine their financial security and stoke feelings of inadequacy and powerlessness, which can lead to suicidality. (Money & Mental Health Policy Institute, 2019).’
In the early years of the COVID-19 pandemic, approximately 2.5 million people living with mental illness who fell into pandemic-related debt reported considering suicide. (Money & Mental Health Policy Institute, 2021).
All of this has unfolded against the backdrop of global, political leadership disregarding and undermining COVID-19 safety protocols - from social distancing rules to the use and availability of personal protective equipment. This continues to force disabled and medically vulnerable people to fight for our lives alone.
As Long-COVID becomes more and more common, disabled people are also battling the medical-industrial complex’s refusal to diagnose, treat, or provide support for those living with it. At the same time, daily living and accessibility needs become even more difficult, and prohibitively expensive, to meet.
Until we create a society where those in debt or financial hardship—disproportionately including disabled people due to intentionally inadequate welfare systems—are adequately supported, it will never be safe to implement official assisted deaths within the NHS.
Pathologising Suicidality
People who do not wish to live have bodily autonomy, and should not be criminalised or pathologised for considering suicide or experiencing suicidal ideation. Pathologising suicidality is ableism, too.
The language in the Assisted Dying Bill clears a pathway for stigma and, in turn, criminalisation by distinguishing between “right” and “wrong” forms of suicidality—positioning disability as the “right” reason and all others as “wrong”. One of the clearest examples of this is a recent incident in which a Member of Parliament “corrected” Danny Kruger’s use of the term “assisted suicide”, claiming the term is offensive (ITVPolitics via X, 2024). This framing is especially troubling from a MP given the intentional underfunding of mental health services in the UK, and the fusing of mental health services with carcerality.
As abolitionists, we do not support enshrining assisted death into law, as its legal presence expands carceral systems. We believe in Mad Liberation and recognize that "mental capacity," a key criterion for assisted death, has long been viewed as a socially undesirable trait the UK has worked to systemically erase.
Islam and Suicidality
As Muslims, many of us are taught that taking one’s life is a sin, and this belief can make it difficult to talk about suicidality, even though we know that Muslims do experience suicidal thoughts and die by suicide. The Quran reminds us that sin is a personal matter between you and Allah, and that individual attempts to police and punish the behavior we consider sinful in one another reflects a carceral mentality - not an Islamic one.
The story of Maryam (AS) in the Quran teaches us to approach suicidality with compassion and respect for autonomy. During labor, Maryam (AS) says, "I wish I had died before this, and was a thing long forgotten." Allah's (SWT) response was not to condemn her or to belittle how she felt, but to meet her with love and care. Allah (SWT) reminded her that she was deserving of compassion and encouraged her to do what she needed to get through the moment.
This story teaches us that, while suicidality may make us uncomfortable, our faith empowers us to centre the suicidal person's autonomy and to approach them with compassion and care,
The Illusion of Choice
By contrast, the assisted dying bill is falsely framed as compassion, when in reality it stems from a system that systematically denies disabled people care, justice, and life. There is nothing compassionate about a country that tells them, at every turn, they are undeserving of basic dignity.
Enforcing legal limits on the right to someone’s bodily autonomy is not liberation. We live in a two-tiered policing system, and it’s naive to think otherwise.
Consider the critiques of the pro-choice movement that serve as the foundation for the Reproductive Justice framework -- viewing abortion as solely a matter of a legal right means we ignore the realities of access. Legal rights often only produce an illusion of choice, ignoring how racial capitalism and white supremacy function as coercive forces restricting access to abortion and coercing disabled people into premature death.
When the conditions for survival are deliberately made so difficult by the government, the passing of this bill signals the further codification of eugenics.
The notion of choice within this system is illusory, particularly under capitalism, where the structural conditions of suffering—poverty, racial terror, ableism—are the real drivers of suicidality and the perceived need for death.
Many mad, mentally ill, neurodivergent, and disabled (MMINDD) people choose death not out of a desire for autonomy, but as a way to avoid burdening loved ones, or because they feel trapped by the conditions they face.
This mirrors how many people choose abortion not just for personal reasons, but in response to overwhelming forces like climate change, generational poverty, and systemic violence.
In a society that forces these impossible choices upon people, true autonomy remains out of reach. We can honour the difficult choices people make today by working to eliminate the oppressive conditions that make such choices seem necessary. Only by dismantling these systems can we begin to create the conditions for true liberation and bodily autonomy.
Some Final Words
What about vulnerable people living with or being cared for by abusers?
The checks, balances, and safeguards we rely on are largely ineffective at preventing abuse. Healthcare professionals, working in a system that severely undervalues them and pushes them into poor health and life outcomes, often lack the capacity to recognise various forms of abuse. Furthermore, systems such as the criminal legal system, the so-called family welfare systems, and the medical system are themselves sites of abuse, perpetuating cycles of harm and neglect. Abusers often collude with one another within these systems, further enabling the exploitation and mistreatment of vulnerable individuals.
Victims and survivors continue to fight against a system that seeks to silence them, and they are often disbelieved—even when they meet society’s narrow criteria of what a "perfect" victim looks like. Many disabled people in abusive situations will be at real risk of being coerced into this program if it becomes law.
What about the unhoused members of our communities?
We have long seen how eugenics is operationalised through laws that target homeless and unhoused people, especially those deemed to be exhibiting symptoms of mental illness.
Let’s look at Canada.
‘As a Canadian, it’s true that I’ve been watching the debate over assisted dying in the UK with a sense of doom...Last month, the Associated Press reported that many MAiD deaths could be attributed to poverty and mental illness. One woman with a disability who requested a wheelchair ramp for her house said she was offered MAiD instead. Another man, who had experienced housing insecurity, cancelled his assisted death after his rent was successfully crowdfunded.(Martin, 2024).’
Conclusion
Denying the lived realities for multiply-marginalised people in the UK is not just naive—it is profoundly harmful. The systemic neglect of disabled people, who are continually pushed through society’s cracks, represents a direct step toward normalizing and codifying eugenics.
What does it say about us as a country that we prioritize “death care” over life care? At a time when we are grappling with a cost-of-living and housing crisis, and as the NHS faces relentless privatization under successive governments, what does it mean that this bill could make assisted death the most appealing option for someone fearing they may become a “burden” on their families—financially or otherwise?
We live in a deeply individualistic society, shaped by the capitalist systems that dictate our lives. In contrast, many cultures and communities across the world maintain a collectivist ethos, rooted in caring for elders and disabled people within families and communities. Here in the West, however, needing care is often seen as shameful or a sign of weakness, and those requiring support are labeled burdens.
When we factor in the ongoing cost-of-living crisis and the extreme gatekeeping of disability and care resources, how can we possibly claim that passing the Assisted Dying Bill in this context would be free from coercion or pressure?
This bill cannot be separated from the socioeconomic climate in which we live. A holistic, critical perspective is not just helpful—it is essential.
Written in love and rage,
Ad’iyah
Resources
How to be a safer person to suicidal people (@the_deathsongdoula) -
Suicidal people & relation autonomy (@the_deathsongdoula) -
Resources on suicidality (@connectwithoumou) -
Working towards psychiatric abolition (@embracing.ambiguity)
Inclusion London’s statement on the passing of the Assisted Dying Bill, with actions
