I read an op-ed in The Times last week from a former sufferer of anorexia who stated rather bluntly, “As an anorexic, I’d have longed for assisted dying.”
It’s a side of the swirling debate around assisted suicide and euthanasia that we don’t often hear. When the majority of people think about the euphemistically named process of “assisted dying,” we are nearly programmed to think about old people “wasting away” in hospital beds. Or about our loved ones suffering from degenerative neurological conditions. We’re asked by many proponents of the practice: Would you want your loved one to suffer? Wouldn’t you want them to get out of this world peacefully?
That’s likely why polling on this issue has swung largely in favour of assisted suicide. And why opponents are on the back foot. Look at Britain, where a swathe of polls have indicated that the majority of the British public supports a change in the law. Three-quarters of respondents in one poll by the campaign group ‘Dying with Dignity’ said they would support making it lawful for someone to seek assisted suicide in the UK, “with just 14% against.”
Of course, just because people believe something is perfectly fine, doesn’t mean it is. Just because we want something doesn’t mean we should have it, or that it’s in our best interests. We want many things, and we can do many things in law, that are not always good for us. But the op-ed in The Times, from a writer called Hadley Freeman, is worth reading.
As she writes: “Funny thing, anorexia. When politicians can blame fashion magazines or social media for causing it, you can’t get them to shut up. But when this country is on the verge of potentially enabling extremely ill women to make choices about their mortality they would not make if they were less ill and had better treatment, suddenly they want to move on.”
Freeman was referring to the ongoing fallout from the committee examining Labour MP Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill, which is on the cusp of becoming law. Last week, Leadbeater’s fellow Labour MP, Simon Opher, told the parliamentary gathering: “it is very important that this committee doesn’t get too hung up on anorexia.”
And indeed it didn’t. The committee voted against closing legal loopholes that would allow patients with anorexia to choose death under the Bill.
Charities had warned that those with eating disorders may be at risk after they were “overlooked” in the proposed legislation. In late February, proposals that would have prevented people with the condition from being able to access assisted dying “as a result of stopping eating or drinking” were rejected by MPs scrutinising the proposed legislation.
This was despite the fact that eating disorders experts wrote in an open letter that this bill was putting people with anorexia — who are overwhelmingly girls and women — at “grave risk.” It makes perfect sense, given that assisted dying for reasons solely related to an eating disorder has occurred in multiple countries – including those which restrict the practice to individuals with a terminal condition. California, Colorado, and Oregon, have all seen cases of assisted suicide carried out for those with eating disorders.
One review of a set of peer-reviewed studies by researchers from the University of Zurich and King’s College London, published in Frontiers, identified 20 government reports and 10 peer-reviewed articles describing at least 60 patients with eating disorders who underwent assisted suicide between 2012 and 2024.
“Reports emphasized that patients with EDs who underwent assisted death had terminal, incurable, and/or untreatable conditions and had adequate decision-making capacity to make a life-ending decision. Most government reports did not include descriptive-enough data to verify psychiatric conditions,” the review notes. There is obviously substantial concern about oversight and public safety, and in many cases, clinical rationales were used to “affirm” that patients suffering from eating disorders were in fact eligible for assisted suicide.
Labour MP Naz Shah told the UK committee: “If we wish to protect people with anorexia and other eating disorders, we must rewrite this Bill.”
“I must underline, this is not a hypothetical point. It is not some clever objection that has been dreamed up without reference to the real world. It has actually happened. It has happened not once, but dozens of times in countries that have assisted dying.”
Only a scattering of MPs acknowledged the risks posed to people with anorexia, including Shah, Danny Kruger, and Rebecca Paul. The others decided it was not worth much thought. A reason for that, of course, is that it’s much easier to focus on those suffering fatal physical illnesses – those who are older and nearing the end of their lives anyway – than a young person who has anorexia. It is an uncomfortable thing to reckon with.
In her op-ed, Freeman recalls how, by the age of fifteen, she was on her fifth hospital admission for anorexia. When doctors told her mother to prepare for the very real chance that she would die, she said that sounded “to my nutrient-starved, illness-addled brain — great, because it confirmed I was good at anorexia.”
Freeman spoke about a friend she had made on the hospital ward, a girl named Nikki Hughes, who was “a talented artist, kind and funny.” Freeman recalls how Nikki talked about the art she would make when she was better, and how she told her off when she was caught hiding food. It was two years later, when Freeman was recovering from the illness and had returned to school that she opened up the newspaper to see a photo of Nikki. She had died.
“The hospital she was in at the time was told it could not “override her wishes” to starve herself to death and it would be assault if it tried to save her life with a feeding tube,” Freeman writes.
As she acknowledges through her own painful experience, anorexia is a complicated illness – it is a mental illness that leads to physical complications which exacerbate the mental ones.
“Even more complicated, the more ill a person becomes, the more they resist treatment (eating, in other words) and the more they want to die. Offering an anorexic assisted death is like offering her liposuction: her desire for it is a symptom of her illness,” Freeman pens.
“Right-to-die campaigners love to talk about autonomy, but such terms are meaningless when it comes to women whose minds are crazed by starvation.”
Danny Kruger, a Conservative MP who has been a stalwart against the extremely flawed legislation, pointed out that a growing number of anorexics are being classified as “terminal” by the NHS and given palliative care – a development which has been described by the Royal College of Psychiatrists as “troubling.”
What’s more, woefully inadequate care for those with eating disorders is “costing lives” in Britain – that has been acknowledged by MPs. It comes at a time when eating disorders, including bulimia, anorexia and binge-eating, all serious mental health problems, are on the rise in England. In the UK, it is estimated there are 1.25 million people with eating disorders – with a disproportionate number being below the age of 25. So, gaps in care, combined with rising cases, and a rail-roaded assisted suicide Bill, all sound like a combination for potential disaster.
Freeman in her piece pointed out that it is impossible for most people to comprehend the mind of an anorexic, which tells some that death is preferable to eating. This, she said, is why it is so unforgivable that MPs have decided not to get “hung up on those who do.”
That hits the nail on the head. Anorexia shouldn’t be a death sentence. As MP Naz Shah said, eating disorders are treatable. Many people recover and in the fullness of time, recover their zest for life, moving beyond the stage where their entire world is based upon their decision whether to eat or not. Many look forward to life again, and are able to live a full life. There is no way to guarantee that assisted suicide would not be used as a replacement for adequate treatment in some cases, if legalised.
What also hits home is that the discussion around assisted suicide and euthanasia is simply not broad enough. The media and politicians and advocacy groups too often focus on the ‘easier’ cases – the cases of older people losing their will to live. The cases where most of the public feel it would be ‘merciful’. But in the bid to jam this Bill through, the risks posed to young people – like girls developing anorexia at an increasingly young age and with increasing severity – have been perilously ignored.