UK Covid Inquiry: Hourglass Feedback
Hourglass’ Position on End of Life Bill
Safeguarding Choice: Hourglass’ Position on the Terminally Ill Adults (End of Life) Bill
At Hourglass, our mission is clear: we work to end the harm, abuse, exploitation and neglect of older people across the UK. With 2.6 million people affected by the abuse of older people in the UK each year, our focus is firmly on protecting their rights, wellbeing and autonomy.
The ongoing debate surrounding the Terminally Ill Adults (End of Life) Bill has brought to the fore deeply personal and ethical questions. As a charity that exists to protect and support older people, we understand that this is a complex and sensitive issue.
Hourglass has taken a neutral position on the Bill — not because we are indifferent, but because we recognise and respect the often very personal views on both sides of the argument. More importantly, our neutrality allows us to focus on what matters most to us: ensuring that older people are free to make their own choices without fear, pressure or coercion.
Autonomy and Protection Must Go Hand in Hand
We believe in a world where older people are empowered to make informed, independent decisions — including those about the end of their lives. Everyone deserves to be treated with dignity and respect, and that includes respecting their choices.
But we also know that older people are at greater risk of abuse, including coercion which is often very subtle in nature. Older people may feel – or be made to feel - like a burden, they may fear becoming dependent on others, or face pressure from family, caregivers or even professionals. These dynamics must not be overlooked when discussing assisted dying.
Evidence from other countries suggests that this is not just a theoretical risk. In Canada, more than 35% of those who chose assisted dying cited “feeling like a burden” as a factor in their decision making. In Oregon, similar concerns have been echoed by almost half of those seeking assisted death. This highlights the very real possibility that older people may be influenced by internalised or external pressure, rather than making a truly free choice.
A Neutral Stance, A Safeguarding Focus
Our neutral stance means we care deeply about both autonomy and protection. Our primary concern is ensuring that if legislation is introduced, it must include strong, clear safeguards to protect those who are most at risk.
We have concerns about the current Bill. In particular:
The risk of coercion must be taken seriously, with systems in place to detect and prevent abuse in all its forms.
Judicial oversight — the decision to replace High Court involvement with a panel of medical professionals may dilute the level of scrutiny needed for such a significant decision.
Mental capacity assessments must be thorough, consistent and carried out by trained professionals who understand the complexities of abuse and manipulation.
We are calling for robust safeguarding measures that prioritise the safety, dignity and independence of older people – and we hope the MPs will make the appropriate amendments when the Bill reaches its Report Stage later this month.
Listening to Older People
At the heart of everything we do is a commitment to listening to older people. Their voices must be central to any legislation that affects their lives, especially something as profound as assisted dying.
If an older person chooses to end their life in the face of terminal illness, that decision should be entirely their own, made without fear or pressure. It is the role of society, of charities like Hourglass, and of lawmakers to ensure that those conditions are met.
Hourglass will continue to be a voice for older people — championing their right to live free from harm, while also supporting their freedom to make choices about their future. Our neutrality on this Bill is not a lack of opinion, but a clear stance: older people must be protected, respected and heard.
Let us know your thoughts — we want to hear from older people, families, carers, and professionals. Only by having open, honest and respectful conversations can we build the Safer Ageing Society for which we are all campaigning.
You can read our evidence to the Public Bill Committee here:
Overarchingly, Hourglass has a neutral view on the proposed Terminally Ill Adults (End of Life) Bill. However, we are concerned by elements of the Bill revolving around safeguarding, oversight and regulation, and we are anxious to ensure that older people are not at risk of coercion, abuse, and pressure to end their lives on account of the Bill.
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