The ever-so-powerful and noble campaign led by Dame Esther Rantzen has resulted in Parliament looking again at assisted dying. This issue deserves the time and space to be debated at length.
Let us be clear about definitions. Kim Leadbeater MP said her proposals would give eligible adults nearing the end of their lives the right to choose to shorten their deaths if they wish.
The details have not been finalised, but reports suggest that the bill is likely to be similar to a proposal in the House of Lords, which would allow terminally ill adults with six months or fewer to live to get medical assistance to end their own lives. Though I am always open to evidence-based policymaking, it is far from clear that this is an idea whose time has come. I present to you seven cogent reasons for really thinking about this issue, three philosophical and four practical.
Firstly, perhaps the most obvious flaw in the proponents’ case is the paradox at the heart of their argument: that this is about ‘rights’ or ‘freedom’. The Economist argues that: “The case for assisted dying is, at its core, one of individual freedom”.
‘Rights’ and ‘freedom’ can be both a means and an end.
Broadly speaking, however, we think of rights and freedom as consequential for the practical effect that they have. It is hard to sustain the argument that a ‘right’ or ‘freedom’ to die is any such thing, as the consequence is the very embodiment of the absence of freedom. But even if you disagree with that, if we extrapolate from the logic of the argument that this is about autonomy and choice, then why should there be any restrictions on who can choose to end their life?
Secondly, at its simplest: life is worth living. To love and to be loved; to care and to be cared for – these are the quintessence of the human species. We seek to emphasise ‘quality of life’ at our peril. The logical consequence of the ‘quality of life’ argument is the elevation in the worth of one group of people’s lives over another. Once it is conceded that the ‘quality of life’ should be our lodestar in this debate, the result is the inevitable but inexorable debate over whose quality of life should prevail. This raises two important questions: what is the yardstick by which we measure ‘quality of life’? And who gets to decide what that yardstick is? Not only is this a recipe for division, but the practical consequence of this is too grave to consider.
Thirdly, the story of humanity is one of progress. Medical advancement and technological change have meant that human beings, on average, live far longer (and healthier) lives than we did just two centuries ago. This is progress. Indeed, the basis of all public policy and medicine must be rooted in the assumption that it is better for human beings to live as long as possible. Legalising assisted suicide is the precise inversion of everything that medicine and public policy ought to do. To legislate in this way would be a profound regression in the story of humanity.
Fourthly, the proponents argue that their concern is to end pain and suffering. But look at the international evidence. In the US State of Oregon, often held as the model for assisted suicide, pain does not feature in the top five end-of-life concerns.
The evidence from Washington is similar. In fact, people’s concerns centre on fear: the loss of dignity, autonomy and enjoyment of life’s activities. This argument also brings into focus the arbitrariness of a six-month threshold. If it is supposed that alleviation from suffering and pain is our lodestar, then six months to live is random. And, most obviously, as Lord Neuberger, former president of the Supreme Court, articulated: “There seems to me to be more justification in assisting people to die if they have the prospect of living many years a life that they regarded as valueless, miserable and often painful, than if they have only a few months to live.”
Fifthly, even if it is supposed that assisted suicide is the means to escape prolonged pain and suffering, then that is a greater argument for improved palliative care. Some argue that assisted suicide and improved palliative care are not mutually exclusive. Ideally, I would agree with this, but this is questionable for two reasons. If palliative care was the best it could possibly be, then the argument in favour assisted suicide would surely fall away. Moreover, in crudely economic terms, legalising assisted suicide may ultimately reduce the scope for improvement in palliative care. This is because a reduced demand for palliative care may mean that the state and the market would have reduced incentive to invest and innovate to improve methods of pain relief and the like.
Sixthly, it is no longer necessary to theorise about the risks of the ‘slippery slope’. Again, look at the international evidence. Where legal, the numbers of people seeking assisted deaths is increasing: they now make up 4% of all deaths in Canada and 5% in the Netherlands.[6] The categories of eligibility are expanding, too. In 2021, Canada loosened its euthanasia laws to no longer require that a patient’s condition be terminally ill, allowing people whose condition is serious and incurable to request it. Canada has since delayed its verdict on allowing mental-health patients to be considered for assisted suicide. But in the Netherlands, Belgium and Switzerland, assisted suicide is available for those with severe mental health problems. These are the thorniest of issues to resolve, particularly when our collective understanding of mental health issues remains rudimentary. Regarding mental health, it is noted that “Doctors must be able to tell between a considered, rational wish to die and a suicidal impulse, a distinction many clinicians feel unable to make”.
Lastly, this proposal is particularly worrisome for those who are vulnerable. The concern is one of coercion: those who are vulnerable, whether the elderly, disabled, or disadvantaged in some other way, may feel pressure to end their lives prematurely, whether from the state, family or some other third party. The state has grown due to it assuming a protective role for those we collectively deem to be vulnerable. As Giles Fraser has said: “human beings are at their most expensive when they are at their most vulnerable”. This change would remove a layer of protection because no matter how watertight the bill, it is questionable how any law would ever be able to fully protect the most vulnerable.
None of the above is borne of religious conviction: I do not have any.
But I do have personal experience, being there with my grandad in some of his last days as he battled cancer. Undoubtedly, he suffered unbearably and intolerably. But that did not stop those last moments of laughter and him being content in the knowledge that he had his family around him. I will treasure those moments, as I know he did. It is inconceivable that anyone in his position should ever feel any pressure or coercion. It is critical that those with disabilities and those with personal experience of terminal illness share that in this debate, and we also put the case for how to improve palliative care.
Far from seeing this issue as one which separates us out on either side of the “right side of history”, we should debate, argue and discuss agreeably knowing how consequential this decision may be.
This article was first published in Conservative Home on 16.10.2024