Reviving the Assisted Dying bill will reopen the Anorexia loophole

The loophole concerns the Bill’s definition of terminal illness and the possibility that people with severe anorexia could qualify for assisted death after becoming physically compromised through self-starvation. In three American states, women with anorexia have already been deemed “terminally ill” and died under similar laws.

By the time the Bill reached the upper chamber, even Lord Falconer, the Bill’s sponsor and one of assisted dying’s staunchest advocates, had tabled amendments to stop people with eating disorders qualifying for assisted death.

Which was an interesting development for a loophole he had spent months insisting did not exist.

Only weeks earlier, Falconer had sat opposite Victoria Derbyshire on Newsnight confidently explainingthat concerns about anorexia were misplaced because the loophole did not exist. Then he arrived in the Lords, introducing what he describedas “an important amendment designed to ensure that persons with anorexia cannot, by not eating, put themselves into a position in which they qualify for an assisted death.”

Apparently, the loophole existed after all.

Parliament had arrived at a slightly awkward position. Supporters of the Bill had spent months insisting fears around eating disorders were exaggerated, confused, perhaps the product of hysterical women misunderstanding legislation. Simon Opher MP urged colleagues not to “get too hung up” on anorexia. One witness dismissedthe assisted deaths of women with anorexia in Oregon as a “red herring” involving just "one or two people”.

Yet as more evidence emerged of dozens of women with so-called “terminal anorexia”, some as young as eighteen, being approved for assisted death abroad, it became harder to pretend the problem was imaginary.

In 2024, I conducted a study which identified at least sixty women who had ended their lives through assisted death abroad. These were not women with anorexia who also happened to have advanced cancer. Many were described as severely depressed and suicidal. Yet each was deemed to have the capacity to decide to end their life.

When Westminster began considering assisted dying legislation, I felt compelled to make Parliament aware of these cases. I gave evidence before the Commons Public Bill Committee. I workedalongside eating disorder clinicians, psychiatrists and MPs to raise concerns about how the Bill’s definition of terminal illness could apply to people with anorexia. Nearly every major eating disorder charity in the country signed an open letterurging MPs to pass amendments preventing people with eating disorders from becoming eligible for assisted death. The Public Bill Committee rejected every one of them.

At Report Stage, Kim Leadbeater finally acknowledged — after months of insisting that the anorexia loophole didn’t exist — that further drafting work would likely be needed to protect people with eating disorders, suggesting it could be dealt with in the Lords. And in the Lords, rather inconveniently for everyone who had spent months insisting the anorexia loophole was imaginary, an amendment was finally passed.

Now the problem may be returning.

Following the Bill’s collapse in the Lords, reports suggest some MPs are considering using the Parliament Acts to revive it. But the Parliament Acts would require the legislation to be "identical" to the Bill that left the Commons, before peers managed to pass amendments protecting people with eating disorders. Parliament is therefore being asked to force through the very version of the Bill that supporters themselves later acknowledged still put people with eating disorders at risk.

I have seen where legislation like this leads.

One of the cases we reviewed in our study involved a woman named Alyssa, who tragically ended her life in California after her doctors labelled her terminally ill. Alyssa had anorexia, OCD and depression. She was also a successful academic who wanted, in her own words, “to find a partner, and to experience pleasure, laughter, joy, and freedom, including from my own brain.”

Her doctors concluded she would “clearly have a less-than-six-month prognosis” if she stopped attempting to follow a higher meal plan, and suggested to Alyssa she would be eligible for assisted death under California law.

When Alyssa’s parents asked whether further treatments should first be attempted, pointing out that she “had not completed a full residential eating disorder program, never fully restored weight… and hadn’t had a feeding tube,” her physician acknowledged that most of those interventions “might ordinarily be undertaken prior to someone’s seeking end-of-life care.” But because Alyssa no longer consented to them, “everyone had to accept that they weren’t meaningful options.”

Alyssa was approved for assisted death and prescribed lethal medications under a law that, like the one which failed to pass in the previous parliamentary session, was supposed to apply only to the terminally ill.

What remains most disturbing about Alyssa’s case is that her clinicians knew she was suicidal. She was explicitly described that way in the case we reviewed for our study. But once doctors concluded she qualified for assisted death, the focus of care shifted from suicide prevention to facilitating her death.

If MPs now attempt to revive the flawed Bill through the Parliament Acts, they will also be reviving the same dangerous loophole that has already cost women like Alyssa their lives. Alyssa was not a red herring. She was someone’s daughter, sister and friend. And if legislation allowing people with eating disorders to end their lives on the NHS eventually passes here too, no MP will be able to claim they were not warned.

____________________

Chelsea Roff is the founder of eating disorder charity Eat, Breathe, Thrive.

LBC Opinion provides a platform for diverse opinions on current affairs and matters of public interest.

The views expressed are those of the authors and do not necessarily reflect the official LBC position.

To contact us email opinion@lbc.co.uk