On Friday, November 29th, the House of Commons in the UK voted on the Assisted Dying bill. It was a free vote, which is traditional on issues of conscience in parliament, allowing MP’s to vote as they believed to be right, rather than along party lines.

The bill now goes to committee stage and the House of Lords, and may be amended along the way, but it is highly likely to become law, allowing for those with six months or less to live to request entry onto an assisted dying pathway. I do not intend to discuss the legislative process, or pro’s or cons of different systems in place around the world. Instead I want to explore the thinking and feeling that therapists will need to be doing as the UK changes the legality of assisted dying.

Therapy, is as I heard it wonderfully put this weekend, a heart activity. There is a myth that therapists can’t, or don’t have opinions and beliefs. This is of course, nonsense, to be human is to have feelings about the things we experience. The process of therapeutic training however is one which is intended to allow us to know our own hearts, and if needed build protective fences around them. A slight aside, this has always been the quite simple rebuttal to the anti lgbtq therapists who promote their invented “exploratory therapy” model. One can have any view one wishes, believe three impossible things before breakfast if it makes you happy, but your job as a professional is to have a clear barrier between those personal beliefs and the best interests of the person seeking therapy. 

One of the ways we build those protective barriers for our own hearts is by honestly and without equivocation naming what lies within. To use the anti-lgbtq activist example again; Imagine a therapist who realises they have a strong disgust response to cis gay men having sex, or a feeling that a trans woman can’t be the gender they are because they didn’t experience the same puberty as a cis girl. They have two options, to name these feelings and explore their origins and what they might need to be competent to work with LGBTQ people, or to push them down, so they fester in the darkness.

What thoughts, feelings and ideas might we need to explore to be safe and competent to work with clients once AD becomes law? 

A slight sidebar, it is entirely possible legislation will include specialist counselling, something similar to the the old OFSTED adoption counselling model, this is not to say that every therapist will be working with those on the pathway, but it may still come up from friends, family members, colleagues, medical staff or others directly or indirectly impacted by the legislation. 

How do you feel about assisted dying for others? 

It might feel like a simple question but it is the place we all need to start. If our heart is a garden, with many pathways, we need to see what lies in the undergrowth. We cannot avoid projection, collusion or even advice giving if those areas are not clear and visible to us. Supervision can be a safe environment to explore our landscape around this issue. Our own intersections and experiences will impact any views we do have. Many disabled people have advocated for AD, while as many are concerned that in an ableist society there will be pressure on disabled people to consent. Our own experiences of grief, loss, death and disability are all important here, not because they should be in the room overriding the client but precisely because unless we can name them, hold them gently and place them to one side we cannot work with what the client brings.

What do those we consider authorities say about Assisted Dying?

I cannot in a short blog explore all of the different religious attitudes to AD, nor do I wish to say one stance is superior to the other. In working with people of faith, whatever their faith, I enter into their frame, leaving my own behind, making space for them to explore their faith needs whether they are in alignment or opposition to their other needs. It may well be the case that for some therapists their faith needs are in opposition to working with people who take a particular view of AD. Without wanting to sound like a cliche, this is an area to take to supervision and explore honestly. There is no one size fits all solution. One person of faith may be fine with keeping their own beliefs within their heart’s walled garden, another will realise that this is work they have to refer on, which is both loving and ethical. Sometimes the most ethical thing is to have humility and say “this is work I cannot do”. The core is being honest with ourselves though, congruence, that often overlooked core condition, which does not pretend we do not have thoughts, feelings, or beliefs that we are afraid to admit to. Some of the greatest harms of therapy occur when we lose sight of humility and congruence. 

How will we feel when this becomes live in our therapy rooms?

We may never encounter a situation involving AD. However now is the moment to consider how we might respond, since once a client brings it, it is too late to do the processing. Journaling, discussion groups, peer supervision, supervision, reading, podcasts, there are a lot of ways we can consider the issue now, before we have to be ready, in the moment, to listen with an open heart.

Some prompt questions to consider might be –

Do I personally think AD is moral

How do I feel about suicide

How do I feel about countries which allow AD for mental illness and other chronic health conditions

What is my own experience of terminal illness

How do I feel towards medical professional in this situation

Do I trust the state when it comes to AD

How do I feel about my own disabilities

Remember these are a series of prompts, not an exhaustive ethical framework, they are not intended to cover every single question that might arise, but instead are jumping off points for exploring our own hearts with humility and honesty. As the legislation moves towards law there will no doubt be wiser minds than mine who will issue ethical guidence, and despite my cynicism towards all the membership bodies in the UK, hopefully the BACP, UKCP and NCPS will publish guidance. However we can start the work in our hearts now, work which will never be without value and worth.