Article
Care
Comment
Economics
Ethics
4 min read

NHS: How far do we go to feed the sacred system?

Balancing safeguards and economic expediencies after the assisted dying vote.

Callum is a pastor, based on a barge, in London's Docklands.

A patient eye view of six surgeons looking down.
National Cancer Institute via Unsplash.

“Die cheaply, protect the NHS” It sounds extreme, but it could become an unspoken policy. With MPs voting on 29th November to advance the assisted dying bill, Britain stands at a crossroads. Framed as a compassionate choice for the terminally ill, the bill raises profound ethical, societal, and economic concerns. In a nation where the NHS holds near-sacred status, this legislation risks leading us to a grim reality: lives sacrificed to sustain an overstretched healthcare system. 

The passage of this legislation demands vigilance. To avoid human lives being sacrificed at the altar of an insatiable healthcare system, we must confront the potential dangers of assisted dying becoming an economic expedient cloaked in compassion. 

The NHS has been part of British identity since its founding, offering universal care, free at the point of use. To be clear, this is a good thing—extraordinary levels of medical care are accessible to all, regardless of income. When my wife needed medical intervention while in labour, the NHS ensured we were not left with an unpayable bill. 

Yet the NHS is more than a healthcare system; it has become a cultural icon. During the COVID-19 pandemic, it was elevated to near-religious status with weekly clapping, rainbow posters, and public declarations of loyalty. To criticise or call for reform often invites accusations of cruelty or inhumanity. A 2020 Ipsos MORI poll found that 74 per cent of Britons cited the NHS as a source of pride, more than any other institution. 

However, the NHS’s demands continue to grow: waiting lists stretch ever longer, staff are overworked and underpaid, and funding is perpetually under strain. Like any idol, it demands sacrifices to sustain its appetite. In this context, the introduction of assisted dying legislation raises troubling questions about how far society might go to feed this sacred system. 

Supporters of the Assisted Dying Bill argue that it will remain limited to exceptional cases, governed by strict safeguards. However, international evidence suggests otherwise. 

In Belgium, the number of euthanasia cases rose by 267 per cent in less than a decade, with 2,656 cases in 2019 compared to 954 in 2010. Increasingly, these cases involve patients with psychiatric disorders or non-terminal illnesses. Canada has seen similar trends since legalising medical assistance in dying (MAiD) in 2016. By 2021, over 10,000 people had opted for MAiD, with eligibility expanding to include individuals with disabilities, mental health conditions, and even financial hardships. 

The argument for safeguards is hardly reassuring, history shows they are often eroded over time. In Belgium and Canada, assisted dying has evolved from a last resort for the terminally ill to an option offered to the vulnerable and struggling. This raises an urgent question: how do we ensure Britain doesn’t follow this trajectory? 

The NHS is under immense strain. With limited resources and growing demand, the temptation to frame assisted dying as an economic solution is real. While supporters present the legislation as compassionate, the potential for financial incentives to influence its application cannot be ignored. 

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation.

Consider a scenario: you are diagnosed with a complex, long-term, ultimately terminal illness. Option one involves intricate surgery, a lengthy hospital stay, and gruelling physiotherapy. The risks are high, the recovery tough, life not significantly lengthened, and the costs significant. Opting for this could be perceived as selfish—haven’t you heard how overstretched the NHS is? Don’t you care about real emergencies? Option two offers a "dignified" exit: assisted dying. It spares NHS resources and relieves your family of the burden of prolonged care. What starts as a choice may soon feel like an obligation for the vulnerable, elderly, or disabled—those who might already feel they are a financial or emotional burden. 

This economic argument is unspoken but undeniable. When a system is stretched to breaking point, compassion risks becoming a convenient cloak for expedience. 

The Assisted Dying Bill marks a critical moment for Britain. If passed into law, as now seems inevitable, it could redefine not only how we view healthcare but how we value life itself. To prevent this legislation from becoming a slippery slope, we must remain vigilant against the erosion of safeguards and the pressure of economic incentives. 

At the same time, we must reassess our relationship with the NHS. It must no longer occupy a place of unquestioning reverence. Instead, we should view it with a balance of admiration and accountability. Reforming the NHS isn’t about dismantling it but ensuring it serves its true purpose: to protect life, not demand it. 

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation. If we continue to treat the NHS as sacred, the costs—moral, spiritual, and human—will become unbearable. 

This moment requires courage: the courage to confront economic realities without compromising our moral foundations. As a society, we must advocate for policies that prioritise care, defend the vulnerable, and resist the reduction of life to an equation. Sacrifices will always be necessary in a healthcare system, but they must be sacrifices of commitment to care, not lives surrendered to convenience. 

The path forward demands thoughtful reform and a collective reimagining of our values. If we value dignity and compassion, we must ensure that they remain more than rhetoric—they must be the principles that guide our every decision. 

Article
Comment
Economics
Politics
Trust
5 min read

Tariffs destroy trust so where do we go next?

Blunt weapons cause a mess in markets and lives.

Paul Valler is an executive coach and mentor. He is a former chair of the London Institute for Contemporary Christianity.

A gold coin with the DOGE dog on it, lies over the face on a $50 bill.
So doge-y.
Kanchanara on Unsplash

‘When America sneezes the rest of the world catches a cold’ quipped economists almost a century ago after the Wall Street crash.  A comment that might equally apply to the more than 10 per cent drop in stock markets caused by President Trump’s sudden raised tariffs on imports to the USA.  The impact of the American economy on the world is inescapable.  It represents almost a quarter of global GDP and the dollar is the leading reserve currency, accounting for around 60 per cent of international foreign exchange reserves.  Size is what enables America to bully the rest of the world. 

For decades the American trade deficit has been an elephant in the room and Trump is to be applauded for recognising it and addressing the problem. Unfortunately, the way he has gone about it has caused another, bigger problem. Changing the direction of the global economy is like turning a tanker, it cannot be done easily or quickly, but Trump’s style is to attack, like hammering at a nail.  Every issue in geopolitics looks like another nail, waiting for him to hammer out a negotiated deal.  Full marks for courage, but not for wisdom. The blunt weapon of trade tariffs is designed to bring wealth and power back towards the USA, but blunt weapons often cause a mess, and sure enough a global mess is what we now have.  A US/China trade war with higher prices that could end up stoking inflation and a government own goal.   

Panic selling of government bonds signalling a loss of confidence following Trump’s dramatic tariff boost is reminiscent of the impact of Liz Truss’ sudden and radical UK tax cuts, which were also driven by an ideology, but ended up as a wrecking ball.  Even some of Trump’s backers have warned of an economic nuclear winter.  In the long run, Trump has done the world a favour by highlighting a structural issue that needed correction, but his economically violent methods of addressing it look increasingly unwise.  If a global depression does happen on the back of all this, then coupled with the rise of autocratic and belligerent leadership, we would face a worrying parallel to what happened in the 1930s when the world eventually slid into war.   

Tariffs are like walls, barriers to cooperation and the epitome of economic selfishness.  Make America Great Again is selfishness writ large - a society pursuing wealth and power without the cohesive framework of values that are so essential to cooperation and community wellbeing.  A psychology of self-centredness that damages relationships at the national level.  This is what I find most concerning about Trump’s approach; not just the economics but the long-term legacy of relational damage that could last well beyond his Presidential term. 

Our fears reveal just how much we trust in wealth above everything else, and how much the fear of scarcity affects our mental health.

Michael Schluter in his book The Relational Lens defines five principles, or measures, of relational health.  They are directness, parity, common purpose, continuity and breadth.  Applying those five measures helps us see why Trump’s tariffs are the polar opposite of relational.  He introduced these escalating penalties remotely and not in face-to-face negotiations.  Exploiting the power of America instead of showing respect for the status and needs of other nations.  Tariffs have no common purpose with other countries, only a selfish agenda.  There is no continuity with previous trading protocols.  And it is all purely financial, with no reference to the broader holistic impact.  All in all, a relational disaster.   

Despite living in the ‘first world’ we remain gripped with fear of loss.  Our fears reveal just how much we trust in wealth above everything else, and how much the fear of scarcity affects our mental health. Markets are not entirely rational; they are driven by algorithms that stem from this psychology of greed and fear.  Emotions and trading swing wildly with a herd instinct that often drives behaviour.  As Rabbi Jonathan Sachs said:  

‘Markets have no moral compass; we have outsourced morality to legislation by the State.’   

But the worry now is that the current US administration shows signs of ignoring morality and even riding roughshod over the courts.  No wonder people feel afraid. 

Where can we find hope in all this turmoil?  Is there a better response than gritted teeth and the mantra: ‘this too shall pass’?  I think so.  There is life beyond the market.  Jesus said: ‘life does not consist in an abundance of possessions.’  We can choose to step back and look at all this with the true perspective that money isn’t everything.  We can cultivate gratitude for what we do have.  We can learn contentment.  Yet I feel for those who have experienced financial loss, and don’t want to minimise the reality of hardship.  In fact, something important and practical all of us who are privileged can and should do is to be vigilant in watching out for those who are poor and disadvantaged.  To look after those with a real need for the basics of life and help them through this tough time when economic disruption could make life even harder.  For those with a faith this is part of working out how our faith makes a positive difference where we are. 

Perhaps the supreme irony of this crisis is President Trump’s insistence that Americans must trust him.  Ironic, because the one thing that his tariff actions seem to have undermined more than anything else is trust.  The trust that is essential to the functioning of both markets and civilisation as a whole.  Face to face discussions must be the way forward now, to rebuild trust and find more nuanced, mutual approaches to solving America’s trade deficit.   

There is one person we can always trust though, and his name is written clearly on the American One Dollar bill. In God we trust. Let’s pray that Trump and his America returns to that imperative and turns back to a more Christ centred philosophy of loving our neighbour as ourselves, reflected in a more bilateral approach to diplomacy and agreement.

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