This article references assisted dying, suicide, and eating disorders.
Today, MPs will have their first vote on the controversial bill to legalise assisted dying for terminally ill adults in England and Wales. It has been a particularly divisive subject ever since it was introduced by backbench Labour MP Kim Leadbeater earlier this year.
Given that one poll revealed 74% of the British public is in favour of legalising it, the vote isn't unwarranted, but as the debate dominates talk shows and fills column inches, there’s one view neglected from the discussion: that assisted suicide is a women’s issue.
While calls for assisted suicide in the UK centre around words like “compassion,” “choice,” and “autonomy,” critics assert that these issues cannot eclipse the threat it poses to people’s lives, especially to the disabled and chronically ill community. Women are also a potentially vulnerable group.
Why, you ask? Women are more likely to be disabled, to develop a chronic illness, particularly an autoimmune one, to live in poverty, to be left by a romantic partner when they become sick, especially when it’s a terminal illness, and to face the end stages of life with less money and a weaker support system than men. Women are also more likely to require care in a home; in 2021, there were 23 female residents for every ten male residents in care homes for people aged 65 and over, a gap that increases significantly with age.
The introduction of such legislation seems almost inevitable; however, could assisted suicide be used to further erode women's lives? Would it expose impoverished women to a “it’s for the greater good” mentality?
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“Women have always been caregivers, the ones who are selfless, who give up their careers to bring up children, and we’re the ones who may have less financial freedom as a result, so that puts us in a poorer economic state when faced with chronic illness,” says clinical psychologist Dr. Yvonne Waft, a wheelchair user herself who worries that two-tier mental healthcare could devalue her and her disabled daughter’s lives.
“There might be a point at which many women think, well, I'm worthless now; I can't care for others, and that's where there's a risk that we might be persuaded, even by well-meaning family and friends, to think about assisted suicide as a way out.”
“Also, women live longer, therefore live more into old age, disability, and frailty, and there's that toss-up at the moment: does the elderly lady stay in her own home, or does she go into a care home? And which one's the most cost-effective?” she tells GLAMOUR. “If you factor in, ‘you could just end it all,’ that would be a neat way to reduce costs. Women will be put in that position because not every woman has supportive offspring; not every woman has the financial means to make choices in that situation.”
It might sound overly dramatic or — because we’re women — “hysterical”, but research shows that 35.7% of people who died by medical assistance in death (MAiD) in Canada in 2021 cited a perceived burden on family, friends, or caregivers to qualify for the “unbearable suffering” required to use the system, a state of mind women would almost certainly be more likely to fall into. We are, after all, socialised to be the carers, not the cared for.
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Some believe these fears are potentially overstated. Ali Ross, a psychotherapist who has worked in palliative care, tells GLAMOUR, “I would suggest that [being a burden] is more of a superficial comment that gets heavily reported on, but when you're inquiring deeper into somebody's experience of why they want to end their life, that is not the fundamental reason. It might be the most accessible reason, but I wouldn't say it's the most grounded one.”
The same study showed that 17.4% of MAiD recipients in 2021 cited isolation or loneliness, and 56.6% referred to inadequate pain control; women are considerably more likely to spend their grey era living alone and to be undermedicated, misdiagnosed, and undertreated for medical issues. The UK’s palliative care system also faces significant underfunding, with Hospice UK saying there was a £47 million shortfall in 2023. In Switzerland, women and those who live alone are among the most likely to choose assisted suicide.
“Women are not treated as well and have a harder time being believed because certain conditions are seen as less believable, and often they impact on women more,” says actress and activist Liz Carr, who produced the documentary “Better Off Dead?” for the BBC. “There’s discrimination within pain management, too; that needs to be sorted out. When the solution becomes ending your life with social approval and relative ease, that’s concerning.”
Ross questions whether the overrepresentation of women may come down to the fact that women are more likely to seek healthcare. “Women tend to be more proactive in seeking care for themselves and others,” he says. “So, where there are the services available when it comes to medical care, including assisted suicide, you're just going to get more women coming forward to access it.”
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We simply won’t know what will happen until there is data to study, but there are factors that put women at higher risk of choosing assisted suicide.
There is also clear evidence that shows women are more likely to undergo assisted suicide for psychiatric conditions. Research published in The British Journal of Psychiatry revealed that women account for the vast majority — 67-77% — of people who request and receive euthanasia based on a psychiatric condition in countries where it’s legal, like the Netherlands and Belgium. The authors said, “While this is one of the most consistent findings emerging from the research on the topic, the gender gap and its meaning have received virtually no discussion.”
“Stigma is the festering blister in the healthcare system that no one wants to acknowledge,” founder and chief executive of eating disorder charity Eat Breathe Thrive Chelsea Roff tells GLAMOUR. “People diagnosed with mental illness are frequently ostracised and misunderstood, even by the clinicians tasked with treating them. Female patients with mental illness are frequently written off as attention-seeking or untreatable.”
In the face of such astounding figures and following the questionable science that created a new diagnosis of “terminal anorexia” in 2022 based on a study using just three cases, Roff and her team conducted a study to determine how many people with eating disorders were being permitted to use assisted suicide.
“Our study identified at least 60 cases where physicians helped patients with eating disorders to end their lives using lethal medications, including cases in the United States, where assisted suicide is supposed to be tightly regulated and restricted to terminal conditions. Of the 19 cases identifying the patients' gender, 100% were female,” she says.
Roff continues: “There was so little oversight and reporting in the US that it was impossible to identify all the assisted deaths of people with eating disorders from public records. The lack of transparency raises grave concerns that violations and abuses of the law may go unnoticed and unreported.”
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Waft worries that the women’s greater experience of trauma — we develop PTSD at twice the rate as men — could predispose them to electing for and being granted assisted suicide if the legislation were to expand. “We know that women experienced trauma on a massively bigger scale, particularly sexual trauma,” she says. “What’s to stop anybody from pushing someone down that route? You know, ‘we could invest millions in putting this person in inpatient care, or we could tell them about assisted suicide’ — it’s dangerous ground.”
Despite the safeguards promised by this bill, other countries have proven that these can be overcome. In Carr’s documentary, a Canadian woman shares how her mother utilised MAiD without an official diagnosis, with one of the required healthcare providers approving her during a 30-minute phone call. In the Netherlands, a 17-year-old girl with borderline personality disorder (BPD) was granted assisted suicide, a condition which until recently was rarely given to anyone under the age of 18. Women are three times more likely to be diagnosed with BPD. Another got permission to end her life due to being trapped between “eating rituals and untreatable gloominess.”
“I’ve seen the bills that have been proposed in the UK, and they are full of loopholes; the safeguards are not sufficient to prevent anorexia from qualifying as a terminal condition,” Roff says. “We don’t even have standardised tools for assessing mental capacity in these irreversible, life-ending decisions. Patients aren't required to undergo a psychiatric evaluation before they are given deadly medications. In Oregon last year, only three patients were referred for psychiatric evaluations — two in the previous year. It's harder to get a gun in some states than an MAiD prescription!”
A fear echoed by many is that the introduction of assisted suicide would create a two-tier healthcare system that dismisses or even encourages suicidality in disabled and chronically ill patients, a group in which women are overrepresented. “If a non-disabled person tells their doctor they don't feel their life is worth living, they get referred for therapy, but if a person with a disability or chronic eating disorder says the same thing, they get offered assisted suicide,” Roff explains.
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Worries also rally around the possibility that this legislation will become a “slippery slope” of expansions that prioritise economic benefits over the well-being of patients, particularly in an era of the ever-increasing demonisation of disabled and chronically ill people. The amount of money saved through assisted suicide is often touted as justification for its implementation; a study published by the Canadian Medical Association Journal estimated that MAiD would save the Canadian healthcare system up to $136.8 million a year. Indeed, it’s an attractive idea when the NHS faces a £1.7 billion black hole.
“Everyone should have a pain-free, peaceful death, but when we're having our NHS ripped to shreds, our social care system to bits, when we've seen our financial support taken away with austerity cuts, what about our assistance to live?” Paula Peters, a disabled person who campaigns on this issue, tells GLAMOUR. “I just want the right support to live my life and be part of society; I'm not expendable, and I think that's why this government really wants to bring this in, so they don't have to provide financial support or healthcare.”
“I always felt that this is ultimately about disability, and it will be used for socioeconomic reasons,” Carr tells GLAMOUR. “We create suffering by not providing for people's needs and their services, and then we say, we'll help you end that suffering by helping you end your life. What they do is they jump to assisted suicide as being the logical thing, the compassionate response — I find that devastating.”
And it’s already happening in countries that have assisted suicide. Recently, a Canadian veteran and Paralympian shared that when fighting for a stairlift to be installed in her home, it was suggested that she look into MAiD instead. Follow-up research revealed at least three other similar cases.
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“I think there needs to be at least a few years of discussion around it, and there has to be unbreakable safeguards,” visual artist Michelle Baharier tells GLAMOUR. “It's a slippery slope, and especially for people with learning disabilities because they will have the most difficulty being heard.”
We saw elements of this blase attitude toward the value of disabled life during the COVID-19 pandemic when disabled people, most commonly those with learning or developmental disabilities, had do-not-resuscitate (DNR) notices placed on their medical records without their knowledge or consent.
Multiple perspectives crowd the field of debate around assisted suicide, and its introduction would undoubtedly alleviate suffering for some, but is it worth the risk? Are we ready to introduce it when our social and healthcare systems are on their knees? Could it endanger already marginalised groups by cheapening their lives or empower them to make an informed choice?
“My fears are not about the euthanasia van coming round and shoving you in the back, it's worse than that, it's that we would choose it ourselves,” says Carr. “We'll choose it because we don't get the right support, or we'll choose it because, yes, we are socialised into certain beliefs, and that hugely relates to women, who I think are more likely to consider their families, their children.”
If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity, 365 days a year on 0808 801 0677 or beateatingdisorders.org.uk.
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