As MPs prepare to vote on amendments to the Terminally Ill Adults (End of Life) Bill later this month, we’re sharing a reflection from Nikki Dhillon Keane, Head of Safe in Faith, on the dangers posed by the bill for people with experience of domestic abuse and coercive control.
The questions raised by the proposed Terminally Ill Adults (End of Life) Bill are highly complex; it is difficult to imagine the deeply personal experience of terminal illness for patients and their families. Raising questions about the safety of proposed legislation should in no way be viewed as a lack of compassion for people nearing the end of their lives; rather as an attempt to ensure that all people affected by this legislation, particularly the most vulnerable, are safe from harm.
There is one particularly vulnerable group for whom this legislation could significantly increase risk: victims/survivors of domestic abuse. Often invisible, they have until very recently been totally absent from the debate around assisted suicide. For many people being subjected to domestic abuse, however, this danger is all too evident.
Shortly after the evidence session of the Committee stage of the bill began, I found myself listening to Helena (not her real name) who was telling me why she was worried about the bill. Helena is a survivor of domestic abuse, who used to live with her former husband in a country with legalised assisted dying. She explained her fear:
It is when your spouse wants to kill you, and the state gives them a totally legal way to do it.
As a disabled woman, Helena had a higher risk of domestic abuse. In the UK, one in two Deaf and disabled women experience domestic abuse during their lifetime. Helena continued:
My husband used to threaten to euthanise me if he got fed up with being my carer.
She tells me that legislation had expanded there to include chronic, and not just terminal, illness; the all-too-familiar slippery slope.
For almost 20 years, Helena was subjected to coercive control by her then-husband. Recognised in the UK as a criminal offence under the Serious Crimes Act 2015, ‘coercive control’ is the umbrella under which all the other forms of domestic abuse are perpetrated. Threats and isolation are common tactics, as is using whatever is available for the perpetrator to gain and maintain control.
If a victim has a disability or chronic illness, it is very common for that to be used by the perpetrator as part of the abuse, restricting access to medication, or aids such as wheelchairs or hearing aids. If the perpetrator also has the role of carer, the chance to escape or safely disclose abuse can be almost impossible. Disability or illness can leave domestic abuse victims completely trapped with their abuser.
I have spent most of the last 25 years working with victims/survivors of domestic abuse. Coercive control, which tends to escalate slowly and subtly over time, can be extremely hard to recognise, even for those being subjected to it. It is even harder to prove. Any signs of physical harm are probably well hidden, or more often not present at all.
Sometimes the first act of physical violence is the fatal one. More often, when domestic abuse becomes fatal, it is through suicide. An estimated three women take their life every week as a direct result of domestic abuse. A further 30 female domestic abuse survivors contemplate suicide every day.
Recognition of the causal link between domestic abuse and suicide is a very recent development in British law. Domestic Abuse Related Death Reviews (which, unlike Domestic Homicide Reviews, investigate domestic abuse-related suicide) were only introduced in May 2024. While this development is welcome, most health and social work professionals receive little or no training in coercive control, missing opportunities to prevent further deaths.
Proposed amendments to the assisted suicide bill would require mandatory training for professionals to help them spot coercion. Most likely, this is intended as an important protection against relatives, motivated perhaps by thoughts of a dwindling inheritance, gently pressuring a terminally ill relative to consider the option of a swift assisted death, rather than expensive palliative care. However, training to help professionals recognise a terminally ill person wishing for death as the only escape from the torment of abuse is a more complex matter.
Macmillan Cancer Support has released a toolkit for professionals working with cancer patients to help them recognise domestic abuse. As with disabilities, domestic abuse perpetrators can weaponise critical or terminal illness as part of their abuse. Domestic abuse victims and perpetrators can be of any age; sometimes perpetrators abuse their spouse for decades. We need to be aware that there is a very real possibility that someone nearing the end of their life may also be a victim of domestic abuse, and that this is likely to affect decisions about assisted suicide.
Given the high levels of suicidality among victims and the control that abusers have over them, it is easy to see how assisted suicide legislation could be twisted into a method for perpetrators to kill their spouse with impunity.
Professor Jane Monkton-Smith, a specialist in fatal coercive control, shared her fears about the bill in a post on X:
The CJS [Criminal Justice System] is just acknowledging the scale of possible criminal culpability in cases of domestic abuse related suicide, whilst at the same time a bunch of MPs seek to make it non-criminal.
Currently in the UK, a woman is murdered by her partner or former partner every five days. In countries where assisted suicide is legalised, there is (perhaps unsurprisingly) a significant lack of research into any potential links between legally assisted suicide and domestic abuse.
However, there is information from the UK regarding so-called ‘mercy killings.’ This is a term used to describe someone being killed illegally but with the claimed intent to relieve suffering. A disturbing review of over 100 UK mercy killings found that
mercy killings are not the wanted, hastened deaths that need assisted dying. They are overwhelmingly violent domestic homicides of women by men.
Whatever views people may have about what it means to die with dignity, it is clear that serious risks would arise from passing the assisted suicide bill into legislation. As Helena put it:
I just don’t want anyone living with the fear and threats that I had. Whatever we do, we need to make sure that we don’t open the door to another way for men to harm women and get away with it.
This article was originally published in the Tablet in February 2025. Since then, an amendment has been added which means any medical professional involved will need to have training in domestic abuse and coercive control. This is a positive move, but questions remain about whether the training would be sufficient to safeguard against an issue which is so complex and difficult to recognise.
Safe in Faith works to foster support for survivors of domestic abuse that is tailored to their needs as believers. They do this through resources and training, to enable clergy and parish staff to signpost people towards appropriate help, and to help psychotherapists and counselling professionals offer faith-informed support to survivors of domestic abuse. The project is also involved in academic research on the role of faith in domestic abuse.
