Article
Assisted dying
Care
Comment
Politics
6 min read

Assisted dying’s problems are unsolvable

There’s hollow rhetoric on keeping people safe from coercion.
Members of a parliamentary committee sit at a curving table, in front of which a video screen shows other participants.
A parliamentary committee scrutinises the bill.
Parliament TV.

One in five people given six months to live by an NHS doctor are still alive three years later, data from the Department of Work and Pensions shows. This is good news for these individuals, and bad news for ‘assisted dying’ campaigners. Two ‘assisted dying’ Bills are being considered by UK Parliamentarians at present, one at Westminster and the other at the Scottish Parliament. And both rely on accurate prognosis as a ‘safeguard’ - they seek to cover people with terminal illnesses who are not expected to recover. 

An obvious problem with this approach is the fact, evidenced above, that doctors cannot be sure how a patient’s condition is going to develop. Doctors try their best to gauge how much time a person has left, but they often get prognosis wrong. People can go on to live months and even years longer than estimated. They can even make a complete recovery. This happened to a man I knew who was diagnosed with terminal cancer and told he had six months left but went on to live a further twelve years. Prognosis is far from an exact science. 

All of this raises the disturbing thought that if the UK ‘assisted dying’ Bills become law, people will inevitably end their lives due to well-meaning but incorrect advice from doctors. Patients who believe their condition is going to deteriorate rapidly — that they may soon face very difficult experiences — will choose suicide with the help of a doctor, when in fact they would have gone on to a very different season of life. Perhaps years of invaluable time with loved ones, new births and marriages in their families, and restored relationships. 

Accurate prognosis is far from the only problem inherent to ‘assisted dying’, however, as critics of this practice made clear at the – now concluded – oral evidence sessions held by committees scrutinising UK Bills. Proponents of Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill and Liam McArthur’s Assisted Dying for Terminally Ill Adults (Scotland) Bill have claimed that their proposals will usher in ‘safe’ laws, but statements by experts show this rhetoric to be hollow. These Bills, like others before them, are beset by unsolvable problems. 

Coercion 

Take, for example, the issue of coercion. People who understand coercive control know that it is an insidious crime that’s hard to detect. Consequently, there are few prosecutions. Doctors are not trained to identify foul play and even if they were, these busy professionals with dozens if not hundreds of patients could hardly be counted on to spot every case. People would fall through the cracks. The CEO of Hourglass, a charity that works to prevent the abuse of older people, told MPs on the committee overseeing Kim Leadbeater’s Bill that "coercion is underplayed significantly" in cases, and stressed that it takes place behind closed doors. 

There is also nothing in either UK Bill that would rule out people acting on internal pressure to opt for assisted death. In evidence to the Scottish Parliament’s Health, Social Care and Sport Committee last month, Dr Gordon MacDonald, CEO of Care Not Killing, said: “You also have to consider the autonomy of other people who might feel pressured into assisted dying or feel burdensome. Having the option available would add to that burden and pressure.” 

What legal clause could possibly remove this threat? Some people would feel an obligation to ‘make way’ in order to avoid inheritance money being spent on personal care. Some would die due to the emotional strain they feel they are putting on their loved ones. Should our society really legislate for this situation? As campaigners have noted, it is likely that a ‘right to die’ will be seen as a ‘duty to die’ by some. Paving the way for this would surely be a moral failure. 

Inequality 

Even parliamentarians who support assisted suicide in principle ought to recognise that people will not approach the option of an ‘assisted death’ on an equal footing. This is another unsolvable problem. A middle-class citizen who has a strong family support network and enough savings to pay for care may view assisted death as needless, or a ‘last resort’. A person grappling with poverty, social isolation, and insufficient healthcare or disability support would approach it very differently. This person’s ‘choice’ would be by a dearth of support. 

As Disability Studies Scholar Dr Miro Griffiths told the Scottish Parliament committee last month, “many communities facing injustice will be presented with this as a choice, but it will seem like a path they have to go down due to the inequalities they face”. Assisted suicide will compound existing disparities in the worst way: people will remove themselves from society after losing hope that society will remove the inequalities they face. 

Politicians should also assess the claim that assisted deaths are “compassionate”. The rhetoric of campaigners vying for a change in the law have led many to believe that it is a “good death” — a “gentle goodnight”, compared to the agony of a prolonged natural death from terminal illness. However, senior palliative medics underline the fact that assisted deaths are accompanied by distressing complications. They can also take wildly different amounts of time: one hour; several hours; even days. Many people would not consider a prolonged death by drug overdose as anguished family members watch on to be compassionate. 

Suicide prevention 

 It is very important to consider the moral danger involved with changing our societal approach to suicide. Assisted suicide violates the fundamental principle behind suicide prevention — that every life is inherently valuable, equal in value, and deserving of protection. It creates a two-tier society where some lives are seen as not worth living, and the value of human life is seen as merely extrinsic and conditional. This approach offers a much lower view of human dignity than the one we have ascribed to historically, which has benefited our society so much.  

Professor Allan House, a psychiatrist who appeared before the Westminster Committee that’s considering Kim Leadbeater’s Bill, described the danger of taking this step well: “We’d have to change our national suicide prevention strategy, because at the moment it includes identifying suicidal thoughts in people with severe physical illness as something that merits intervention – and that intervention is not an intervention to help people proceed to suicide.” 

 Professor House expressed concern that this would “change both the medical and societal approach to suicide prevention in general”, adding: “There is no evidence that introducing this sort of legislation reduces what we might call ‘unassisted suicide’.” He also noted that in the last ten years in the State of Oregon – a jurisdiction often held up as a model by ‘assisted dying’ campaigners – “the number of people going through the assisted dying programme has gone up five hundred percent, and the number of suicides have gone up twenty per cent”. 

The evidence of various experts demonstrates that problems associated with assisted suicide are unsolvable. And this practice does not provide a true recognition of human dignity. Instead of changing the law, UK politicians must double down on existing, life-affirming responses to the suffering that accompanies serious illness. The progress we have made in areas like palliative medicine, and the talent and technology available to us in 2025, makes another path forwards available to leaders if they choose to take it. I pray they will. 

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Article
Change
Politics
7 min read

Hope is a choice, insist on it

Amid loveless politics, remember hope cannot exist in isolation.

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

A crowd of people stand in the side steps of the Lincoln Memorial
Easter services, Lincoln Memorial.

The other day – a cold grey day, the kind of day that makes summer seem as distant as a star – I encountered a woman who stood out. She was cheerful despite everyone else’s winter gloom, and she was wearing a home-made tabard. The tabard was covered in a layer that seemed to be made of tape and clingfilm, and underneath it were little Ukrainian flags, images, facts, and small everyday items like soap. I have seen her before dressed the same way. She stood out, I think, because of her attire but also because of the defiance she radiated – a defiant joy, but also belief that it is worth hoping and acting in the ways we can, even when all the evidence seems to tell us those actions make no difference. The news of Russian’s invasion on Ukraine in 2022 has lost its initial shock power. We are creatures who like stories, and so we like news that has a clear beginning or end. The messy middle can be hard to stick with, precisely because we do not know what comes next or how long it lasts. And so our attention moves on. This, coupled with our felt powerlessness in something so big and distant, can mean it is easy to lose hope, to stop taking action.  

But the woman who raises awareness most days in this creative way, with suggestions for what items to donate or how to send funds or how to host refugees, has been making me re-look at hope. Her posture – her insistence on hope as choice – feels life-affirming and countercultural. For a moment, she snaps me out of despair for the world. She faces looks of bemusement and seems to say, if not this, then what?  

What keeps us moving forward when the world seems heavy? Where does hope spring from, even in the face of overwhelming odds? Hope, I have learned, has been tangled with humans for as long as we’ve walked the earth. It ensured the survival of our ancestors because it drew them towards a future that might be better than today. It kept them going.  

In Greek mythology, Pandora opened a box out of curiosity despite being told not to. All kind of curses contained in the box spilled out into the earth. She wrestled the lid back on but not until it was almost too late. Almost, but not entirely. One thing remained in the box: hope. This myth always brings to my mind memories of visiting a slave fort that still stands on the coast in Ghana. The walls were oppressive, the words above the gate that led to the slave ships were haunting: ‘door of no return’. And yet I learned that there were songs. Spirituals and other songs that passed the time, helped members of different tribes feel connected when they were all shoved together, and conjured hope despite all the evidence to the contrary.  

Optimism asks us to sit back and hope for the best; hope knows that we have work to do to bring forth a better future. 

Ideas of hope have been with us always. And yet I find that hope can feel hard to conjure now, staring into the face of an increasingly unknowable and uncertain future:  authoritarian leadership that seems to be on the ascendancy, impacts of the climate crisis that are coming into startling clarity, and loneliness that has been declared a global health concern by the World Health Organisation. It is easy to feel that things are falling apart. Faced with these things and more, hope can seem naive, wishful, hard to get hold of.   

Perhaps one reason for this is that hope, in the age of the individual, is harder to come by because hope is relational, it cannot exist in isolation. It is transmitted through community, story, and care for others. Those old slave songs sang of hope because, I imagine, people had the reality or memory of each other. Hope said: people have been good, and they will be good again. Hope is insistently communal. It asks us not to bear the weight of the world on our own, but to face each other and distribute that weight via a web of relationship. Perhaps now, accessing a hope that can carry our burdens and our fears means first re-finding each other.   

Hope and blind optimism are, of course, different things. Rabbi Jonathan Sacks said that “Optimism is the belief that the world is changing for the better; hope is the belief that, together, we can make the world better.” Optimism asks us to sit back and hope for the best; hope knows that we have work to do to bring forth a better future. And so perhaps that’s why lately, hope has felt exhausting. I’ve worked with communities internationally and locally for two decades on all kinds of projects, always asking, is this how things have to be? How might we imagine and build better? And yet still the climate worsens, inequality persists, bad leaders get into positions of terrifying power. It is easy to stand back and despair, to question, to wonder if all the hard work has been in vain.  

Jesus knew this exhaustion. He knew what it was to work, encourage, and love hard, often to face rejection, mockery, and ultimately death. But still Jesus chose to enter into the persistent mess of the world. He chose the day in, day out work of becoming flesh. He affirmed the dignity of the marginalised, calling them into action, knowing that action would keep that dignity alive. He knew that new life would come through suffering, not by denying it.  

 

Strongman authoritarian leaders aren’t the problem, they are a symptom of a society who are divided and not encountering each other well 

Perhaps hope is hard too because though it is a posture which faces the future, it also asks that we live with integrity, love, and care right now, in this fractured world. Hope is not writing off the present in favour of some distant time or place. It is not wishing this world away so that we hasten to another one. It says, we can work for a better future, but we should not put off good work until then. That better future will only come if we invite it into our present, whatever the outcome might be. Hope is in living deep and timeless and world building values, even if there are no obvious or immediate results. Czech playwright and former dissident Vaclav Havel who led his nation after the collapse of communism said that

“Hope is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.”

If a principle is right for the future, it is right for now, even if that requires work. If I espouse values of kindness, love, community, and imagine a future where these things rule, and yet ignore the marginalised, or distrust people not like me, or cut off people I don’t agree with, then my hope for the future is no more than optimism, because I am not willing to do the difficult work of living as if that future were here now.   

Hope is turning outwards and living these values with others, even when honestly sometimes it seems easier and more appealing to turn inwards and single-handedly try and fix things — a myth that has grown in our age of individualism, celebrity, and our self-referential rhythms of life.   

Hope has lately been asking me to take a Beatitudes perspective on things. In his Beatitudes, Jesus flipped the logic of the world on its head. The last will be first, the poor will inherit the kingdom, the weeping will find joy. Like the Beatitudes, hope asks me to take a different approach. When I look at the world through this lens I find new ways to think. Perhaps, for example, things aren’t getting worse but instead are becoming clear, truths are being unveiled – and so climate change is not the problem, rather, it is a symptom of a greedy economic system in which we are all complicit; Strongman authoritarian leaders aren’t the problem, they are a symptom of a society who are divided and not encountering each other well, and of money and distrust having too big a say in how we govern ourselves. This doesn’t mean we should stop addressing the symptoms, but that we have new possibilities in our scope for action.  

Now, as we enter another cycle of — at best — strange politics that is steeped in lovelessness and will have unknowable outcomes near and far, the thing I search for alongside wise voices is hope. And searching for hope means living a good future now, and finding others who can carry both despair and beauty with me. Novelist and critic John Berger said that

“Hope is not a form of guarantee; it’s a form of energy, and very frequently that energy is strongest in circumstances that are very dark.”  

So let us call on that energy, that light in the dark today. It is how we build the future.  

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