Assisted Dying logic makes perfect sense but imposes a dreadful dilemma

The case for assisted dying appeals to choice and autonomy, yet not all choices are good. It means vast numbers of people will face a terrible choice as their life nears its end.

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A black and white picture shows a woman head and shoulders, she is looking up and to the side in an unsure way.

Anastasiya Badun on Unsplash.

Two broad cultural trends have led us to our current debate over assisted suicide.

One is the way consumer choice has come to be seen as the engine of successful economies. Emerging from Adam Smith’s theories of rational choice based on self-interest, given a boost by Reaganomics and Thatcherite thinking in the 1990s, the provision of a range of choice to the consumer is usually argued, with some logic, as key to the growth of western economies and the expansion of freedom.

The other is the notion of individual autonomy. Articulated especially in the past by figures such as John Locke and John Stuart Mill, the idea that individuals should be free to choose to dispose of their property, their time and their talents as they choose, as long as they don’t harm anyone else, has become standard moral fare in the modern world.

Put these two together, and the logic of assisted dying makes perfect sense. What can be wrong with offering someone a choice? Why should the state restrict individual freedom to end your life in the way you might decide to do so?

Yet expanding choice is not always good. Forcing an employee to choose between betraying a colleague or losing their job is not a fair choice. There are some choices that are unfair to impose upon people.

Assisted dying will lead us to this kind of choice. Imagine a woman in her eighties, living in a home which is her main financial asset, and which she hopes to leave to her children when she dies. She contracts Parkinson’s or dementia, which will not kill her for some time, but will severely limit her ability to live independently (and remember about of third of the UK population will need some kind of longer-term care assistance as we get older). At present, her only options are to be cared for by her children, or to sell her house to pay for professional care.

With the assisted suicide bill, a third option comes into play – to end it all early and save the family the hassle - and the money. If the bill passes, numerous elderly people will be faced with an awful dilemma. Do I stay alive, watch the kids’ inheritance disappear in care costs, or land myself on them for years, restricting their freedom by needing to care for me? Or do I call up the man with the tablets to finish it soon? Do I have a moral duty to end it all? At present, that is not a choice any old person has to make. If the bill passes, it will be one faced by numerous elderly, or disabled people across the country.

Even though the idea may have Christian roots, you don’t have to be religious to believe the vulnerable need to be protected

Of course, supporters of the bill will say that the proposed plan only covers those who will die within six months, suffering from an “inevitably progressive condition which cannot be reversed by treatment.” Yet do we really think it will stay this way? Evidence from most other countries that have taken this route suggests that once the train leaves the station, the journey doesn’t end at the first stop - it usually carries on to the next. And the next. So, in Canada, a bill that initially allowed for something similar was changed within five years to simply requiring the patient to state they lived with an intolerable condition. From this year, there is a proposal on the table that says a doctor’s note saying you have a mental illness is enough. In the same time frame, 1,000 deaths by assisted dying in the first year has become 10,000 within five years, accounting for around 1 in 20 of all deaths in Canada right now. Some MPs in the UK are already arguing for a bill based on ‘unbearable suffering’ as the criterion. Once the train starts, there is no stopping it. The logic of individual choice and personal autonomy leads inexorably in that direction.

Of course, some people face severe pain and distress as they die, and everything within us cries out to relieve their suffering. Yet the question is what kind of society do we want to become? One where we deem some lives worth living and others not? Where we make numerous elderly people feel a burden to their families and feel a responsibility to die? In Oregon, where Assisted Dying is legal, almost half of those who opted for assisted dying cited fear of being a burden as a factor in their decision. Or would we prefer one where the common good is ultimately more important than individual choice, and where to protect the vulnerable, we find other ways to manage end of life pain, putting resources into developing palliative care and supporting families with dependent members – none of which will happen if the option of assisted dying is available.

Even though the idea may have Christian roots, you don’t have to be religious to believe the vulnerable need to be protected. Changing the law might seem a small step. After all, doctors routinely administer higher doses of morphine which alleviate pain and allow a natural death to take its course. Yet that is a humane and compassionate step to take. To confront numerous people, elderly, disabled and sick with a dreadful dilemma is one we should not impose upon them.

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Politics

25 September 2024

5 min read

Exploring Labour’s parameters of hope

At the party’s conference, meeting mayors and old friends rekindle a restless hope.

David Barclay

David is a partner with the Good Faith Partnership, collaborating on solutions to social problems.

A group of four people stand in front of an even banner, smiling

Labour mayors smiling, despite the weather.

@UKHospKate.

If weather can set the tone for events then the meteorological omens for the Labour Party Conference this year were hardly promising. By the time I’d made it to Liverpool Dockside from the train station I was already soaked and cold, and wondering if anything our new Government was going to say would cut through the gloom and kindle some much-needed hope and optimism.

The downbeat mood of bedraggled conference-goers searching for umbrellas felt like a pretty fair reflection of the wider public as a whole. A recent piece of research found that ‘broken’ was the most common word used to describe the state of the country, and if Keir Starmer had a honeymoon period as Prime Minister it has clearly already long passed. We have become used to politics as a force of chaos and division, and as the events of this summer revealed all too starkly, this state of our public life has left our communities highly vulnerable to the forces of hate and violence that lie closer to the surface than most of us like to admit to ourselves.

Yet my experience over 48 hours in Liverpool did give me cause for optimism, even if that came from some slightly unexpected places.

Mayors are uniquely unburdened by the departmental silos of Westminster and Whitehall, as well as having a direct mandate from the people and communities they are serving.

One of those was the energy of new MPs. Amongst the large intake of Labour MPs there are some seriously impressive people with a vitality and creativity that has been sorely missing from British politics in recent years. I got the chance to speak to Josh MacAlister, the new MP for Whitehaven and Workington, who is a case in point. Josh set up Frontline, a graduate social worker training programme modelled on Teach First which has had huge success in boosting recruitment into a vital part of our public life. He was then asked by the last Government to lead a landmark review into Children’s Social Care, which is without doubt one of the most broken aspects of British politics with private companies making obscene profits from providing terrible care to vulnerable children, leaving a trail of human misery and financial ruin for local Government in its wake. Now he is looking to put the review’s recommendations into practice with a Government that seems far more likely to spark radical change in this area than it’s predecessor. As a foster carer myself who has seen the human cost of the current system up close and personal, meeting Josh gave me real hope that we can do better for the most vulnerable children in our country.

The other politicians who seemed very much in the limelight in Liverpool were Mayors, who now cover more and more of our English cities and regions and are taking an increasingly significant role in our public conversations. I’ve had the opportunity to work closely with the former Mayor of Bristol Marvin Rees, and saw first-hand the incredible impact that place-based political leaders can create by convening different leaders and organisations from across the public sector, business and charities around common goals.

Mayors are uniquely unburdened by the departmental silos of Westminster and Whitehall, as well as having a direct mandate from the people and communities they are serving. So seeing increasing amounts of resource and powers flow to Mayors is undoubtedly another cause for hope.

One of my areas of passion is refugee and asylum inclusion, and I was part of several conversations over the Conference on how Mayors and other regional actors could play a bigger role in this policy area. As Marvin Rees used to say as Mayor of Bristol, city leaders see the issue of migration and human mobility in a fundamentally different way to national leaders, because nation-states are defined by borders and therefore constantly obsessed with controlling them, whereas cities by definition exist due to the movement of people, good and ideas, and are therefore much more interested in how policy can lead to greater welcome and connection in order to harness the strengths of having a diverse population. It is this kind of mindset and perspective shift that having stronger Mayors could bring into British politics, and to me at least it feels like a breath of fresh air.

History teaches us that really significant change happens rarely from the top down but rather through constellations of leaders and organisations with similar worldviews but distinct resources and perspectives.

My final source of optimism for change came not for politicians at all but from the friends and colleagues I was able to catch up with or bump into. Having been around the world of politics for nearly two decades, things like Party Conferences are a lovely opportunity to touch base with people I might not otherwise get to see.

Over lunch with an old friend from the Bristol Mayor’s Office, we were reflecting on how being part of a wider political movement can create opportunities for collaboration and mutual support over the years and in different professional and personal contexts. As someone whose ancestors were actively involved in the Abolition Movement and the Clapham Sect, I often find myself thinking about the social dynamics of change and how movements and coalitions grow and evolve. History teaches us that really significant change happens rarely from the top down but rather through constellations of leaders and organisations with similar worldviews but distinct resources and perspectives. At a time when it often feels like party politics lacks the imagination and courage to really answer the demands of the time, I find real hope in this idea that we can all organise ourselves and our institutions for change, and we all have a responsibility to build a stronger web of relationships to make that happen.

So, if like me you are longing for some positive change in this country, I think the Labour Party Conference did have some real signs of hope. But it’s not a passive hope that somehow having ‘the grownups in charge’ will by itself guarantee real progress. Instead, it’s a restless, active hope that says nothing will happen without us making it happen, and particularly joining the dots between people of goodwill to build something better than our status quo.