The Long Debate on Assisted Dying

By the time Dr Charles Killick Millard rose to deliver his inaugural presidential address to the Society of Medical Officers of Health on 16 October 1931, discussion of its contents had already begun in the press. Millard’s speech, which was a call for the legalisation of euthanasia for consenting incurable patients, sparked both controversy and widespread support, and marked a breakthrough moment for ideas which had been debated in philosophical circles since the late 19th century. Four years later, encouraged by the response to the speech, Millard founded the Voluntary Euthanasia Legalisation Society (VELS) as a campaigning movement for euthanasia in Britain.

Central to the VELS campaign was a bill drafted by Millard. In 1936 a version of this bill was debated in the House of Lords, the first time the issue was voted on in Parliament. The bill was firmly defeated, with 35 votes against and 14 for, but Millard’s proposal nevertheless provided the model for almost every subsequent attempt to change the law. On 16 October 2024, the anniversary of Millard’s speech, Kim Leadbeater MP introduced another private member’s bill to the House of Commons. Though, unlike Millard’s original proposal, the patient and not the doctor would be required to administer the fatal dose, Leadbeater’s bill would legalise assisted suicide in similar circumstances and with similar safeguards to those proposed by Millard almost a century before. Supporting Leadbeater’s efforts is the campaign organisation Dignity in Dying, the re-named Voluntary Euthanasia Legalisation Society. Now that the bill has passed its Second Reading, assisted dying is closer to legalisation than at any point in the almost hundred-year history of the movement.

Gentlemanly examples

In many ways, the debate in the House of Lords over the 1936 Voluntary Euthanasia (Legalisation) Bill sounded remarkably like the debates of today. Supporters like Millard argued that Britain was an ageing society in which deaths from cancer were increasing. Despite advances in the treatment of pain, many terminally ill people were condemned to long and painful deaths. But it was within the means of medical practitioners to shorten this suffering and, on compassionate grounds, hasten a patient’s death. With appropriate safeguards, including the sign-off of two doctors, abuses of a new system could be minimised. The arguments against also sound familiar. No system of safeguards could prevent the unscrupulous from pressuring the incurable to accept medically assisted death and in any case a sense of being a burden was likely to complicate consent. The relationship between doctors and patients would be transformed for the worse. Once the door was opened, a slippery slope would be found behind it and, before long, euthanasia would be available to – or forced upon – other vulnerable people.

But while many of the issues were similar, there were also striking differences. Opening the debate in favour of the Voluntary Euthanasia (Legalisation) Bill on 1 December 1936, the Labour peer Lord Ponsonby said that fear of being a burden would likely account for a significant proportion of cases of voluntary euthanasia. Far from being an ethical dilemma, Ponsonby argued that this was a good and noble thing. He pointed to the gentlemanly example of the Antarctic explorer Lawrence Oates, who, rather than be a burden to his comrades, walked off to die in the snow; a terminally ill patient choosing euthanasia rather than be a burden to their family was to be applauded. Ponsonby’s remarks were a political misstep – given the fact that the bill made no reference to a sense of being a burden as grounds for euthanasia, it re-opened the question of the slippery slope which his opening speech otherwise sought to close.

To assuage such fears, the bill was carefully limited in its scope to the intolerably suffering incurably ill. Both Millard in 1931 and Ponsonby in 1936 were keen to stress that the law would not apply to the disabled or to elderly sufferers of dementia. But as the archbishop of Canterbury, Cosmo Lang, pointed out in the debate: ‘Many of those who are behind the noble Lord in bringing forward this Bill definitely contemplate its after-extension to other cases which for the present he has ruled out.’ Millard appears to have been open-minded in private about the eventual non-voluntary euthanasia of the disabled. Eugenic ideas appealed to many enthusiasts for euthanasia, though most mainstream eugenicists were sceptical of its eugenic benefits, preferring to prevent the births of undesirable categories of people rather than to hasten their deaths. Proponents often compared their religious opponents’ objections to the bill to their objections to birth control or sterilisation, both of which had been key to the programme of British eugenics in recent years.

Medical authority

In his inaugural lecture, and consistently over the following years, Millard cited religious authorities such as the writings of Church of England clergymen in favour of his ideas. While the Anglican bishops in the Lords voted against the bill, their speeches expressed complicated feelings and an acceptance that it was a fraught ethical dilemma. The archbishop of Canterbury felt that while the law should not encourage suicide there were cases where it was right to lay down one’s life for one’s friends and he followed Ponsonby in pointing to the example of Captain Oates. The bishop of Norwich queried whether euthanasia was a religious or ethical question at all. Catholics were the most hardline religious opponents of euthanasia and Lord FitzAlan, a Catholic, led the opposition in the Lords debate. But while FitzAlan argued in part based on his faith, he also invoked opposition to the bill from Muslims and Jews. Britain in 1936 was a more religious country than Britain in 2024, but the bearing of religion on the law was fraught. Not for the last time, this appears to have weighed heavily on the Anglican bishops, constitutionally privileged to sit in the House of Lords, but uncertain of their role as moral legislators for the nation.

In fact, the archbishop of Canterbury said that the complexities of medicine at the end of life ought to be left to ‘the relationship of mingled intimacy and responsibility which exists between the doctor and the patient’. It was not religious authority but medical authority which secured the bill’s defeat. At the beginning of the debate, both Ponsonby and FitzAlan referred to the presence in the chamber of Lord Dawson and Lord Horder, two well-regarded physicians. There was uncertainty about how they would vote and Ponsonby described Dawson as ‘looking mysterious’. When the doctors rose, they made several arguments which would be recognisable today: that it would be a slippery slope, that patients could be pressured by family and friends, that terminal illness was in practice hard to define, that the question was complicated by psychological suffering.

But their most striking arguments were those concerning the role of the doctor. Dawson did not oppose euthanasia in principle, but argued that the bill would codify in law what was best left to the expertise of medical practitioners. The danger of the bill was in its bureaucratisation of the relationship between doctor and patient. Horder likewise protested the state’s intervention into the doctor–patient relationship, bemoaning that under the proposal euthanasia would be administered not by a doctor known to the patient but by what he called ‘strangers from Whitehall’. Horder’s opposition to the bill also reveals the complicated and ambivalent relationship between eugenics and euthanasia, as he was at the time president of the Eugenics Society, many of whose members were also members of the VELS. Though he did not mention it in the Lords, Dawson had in fact carried out an illegal involuntary euthanasia earlier in the year, having administered a fatal dose of cocaine and morphine to King George V on his deathbed.

Original problem

The Voluntary Euthanasia Legalisation Society did not expect to win the debate, and were delighted despite their defeat that they had secured such a prominent platform and sparked such widespread national discussion. But after the war, revulsion at the Nazi euthanasia programme was a setback to the cause. When a bill was introduced to the Lords in 1950 it provoked such opposition that it was withdrawn without a vote. The association of VELS with the Nazi regime was simplistic, but not entirely unfair. Millard’s openness to fellow travellers meant that in 1950 he lobbied for the release from British custody of Sigbert Ramsauer, who had been an SS camp doctor at Dachau, Mauthausen and Loibl, on the grounds that the medical killings he had carried out were euthanasia. It was not until 1969, during a period of social reform led from the backbenches, that Parliament debated euthanasia again. Before the unsuccessful debate on the 1969 bill, the Earl of Listowel, who had spoken in the debate in 1936, wrote that the latter had ‘started a trend of public opinion that has been growing steadily ever since’. The idea that a change in the law is inevitable, that a groundswell of public opinion cannot, in the long run, be prevented, seems to be as old as the issue itself.

Summing up the debate in 1936, Ponsonby called it ‘an extremely interesting discussion of an entirely new problem’. Almost 90 years later, the problem can no longer be said to be new. But in the 1930s, in a culture steeped in ideas about eugenics, more comfortable with the patrician authority of medical experts and with a greater emphasis on the social benefits of euthanasia, the arguments sometimes take on shapes which are unfamiliar and even shocking. Tracing this debate to its origins reveals a question that is recognisable, with answers which are alien.

George Morris is a British Academy Postdoctoral Fellow at Queen Mary University of London.