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.

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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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General Election 24

Morality

Politics

2 July 2024

4 min read

Make it a morally decisive election

This week we’re making more than a political decision.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

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The divide

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I still treasure my copy of the New Statesman from almost exactly 13 years ago, which was guest edited by the then Archbishop of Canterbury Rowan Williams. I’ve kept it partly because I organised the edition and deputy edited it on his behalf. And partly because it cost me my job as public affairs chief at Lambeth Palace after it provoked predictable Conservative backbench fury for his alleged meddling in politics.

Digging it out now, there are some surprises from near that beginning of the 14 years of Conservative rule that’s expected to come to its end this week. The first is how mild mannered is the archbishop’s leader comment that cause so much trouble. In the years since, politics has become brasher and blunter, more facile and reductive.

The second surprise is the fuss it caused at the time. Williams is politely critical of politics across the board and there’s a plus ca change moment when he wonders “what the left’s big idea currently is… we are still waiting for a full and robust account of what the left would do differently”.

And he could be talking about now as he concludes by hoping for a “democracy going beyond populism and majoritarianism… capable of real argument about shared needs and hopes and real generosity; any takers?”

A magazine cover lists articles on one side and an image of half a face on the other.

That final question may get its answer this week. But at this distance, the furore that Williams caused in government takes on a different perspective. We can see, partly as a consequence of what’s happened latterly, that he wasn’t really mounting a political argument at all. His was a moral case, a prophetic voice calling out how the government, any government, “needs to hear just how much plain fear there is.”

That fear hasn’t abated 13 years after that article. It has built around a faltering economy, an island mentality inflamed by the perceived threat of migration and a sense that a political elite has abandoned its people.

Political policies alone aren’t going to salve this pain. The response to it needs to be as much a moral as political one, as caught by the headline I wrote above Williams’ piece all those years ago: “The government needs to know how afraid people are.”

The government in power for the past 14 years has chosen not to address, or has ignored, or has been incapable of addressing the morality of our societal decay, favouring instead a search for eye-catching policies and initiatives that it has hoped, admittedly with some success until now, would also be vote-catching.

That it has now run out of road has as much to do with its moral as its political failure. When Williams published that piece, we were talking about the Big Society, the prime minister was on a mission to save the planet and urged us to “hug a hoodie.” Such moral imperatives seem very distant now and a moral degeneration in government has tracked the downward slide of the governing party in the opinion polls.

So we’re not asked just to make a political decision this week. We’re making a profoundly moral one.

We haven’t had a prime minister for whom morality was a governing principle since David Cameron laid claim to one (perhaps disingenuously) in his early days, before being led by his chancellor, George Osborne, into enforced economic “austerity” with surely one of the most cynical assurances of modern times that “we’re all in this together.”

Brexit did for Cameron and his successor Theresa May. She, I believe, is guided in public life by a personal morality, rooted in her Anglo-Catholic clergyman father, but by now there was no room for all that. Her “hostile environment” for illegal immigrants, with vans telling them to go home, was a moral low point which then found its hideous nadir in the Windrush scandal, with elderly people who had lived here all their lives threatened with deportation.

Boris Johnson thought that he could make a political virtue of his immorality, a demonic possession that made him believe that he’d be loved for it. So he fiddled while Covid burned, partying in Number 10 while those who had voted for him were denied access by his rules to their dying relatives.

I wrote in the Guardian that he wouldn’t be able to hide his immorality in Number 10 when he became leader and was sadly proved more right than I could have known. Liz Truss is said to be on an autistic spectrum, which is the kindest way to explain her mini-budget that offered tax-breaks for the wealthiest in the midst of a cost-of-living crisis for the rest of us.

Rishi Sunak is widely said to be a decent man, but it's too late. This government had already rotted from the head – witness the spivs in its ranks hoping to make a fast buck out of the date of the general election.

So we’re not asked just to make a political decision this week. We’re making a profoundly moral one. It’s time to turn the fear that the archbishop observed into moral indignation.

It’s not really about who we want in government. It’s what we need, morally, to expel from it.