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. 

Review
Books
Culture
Economics
Politics
5 min read

Abundance and the attempt to build a better world

Is this policy the antidote to the zero-sum game of politics?

Josh is a curate in London, and is completing a PhD in theology.

Construction worker climb a steel framework.
Josue Isai Ramos Figueroa on Unsplash.

What do you do when more money won’t solve a government’s problems? Abundance: How We Build A Better Future, the new book by Ezra Klein and Derek Thompson is an extended polemic against a form of government—particularly as practiced by US liberals—that stymies policy delivery. However technocratic that sounds (and the book often is), it forces readers to confront deeper questions about the nature of politics.  

At the heart of the book is a critique of what the authors, drawing on the film Everything Everywhere All At Once, call 'Everything Bagel Liberalism'. In the film topping are added to bagel to the point that it becomes a blackhole. So too, Klein and Thompson suggest, with so much well-intended policy, in which in seeking to tick every possible box and satisfy a range of regulators it becomes a delivery blackhole and little is actually done. The authors ask whether parties of the left are focused on measuring spending to the exclusion of measuring what gets built.  

The first chapter gives a good sense of their approach.  It tells a familiar story about the way in which so many are being priced out of cities because of a lack of affordable housing. However, in doing so, it highlights a surprising harm: that geographical proximity remains an important enabler of technological innovation so a lack of affordable housing in cities means a loss of creativity. 

The diagnosis is perhaps even more surprising coming from American liberals. Special interests—including those seeking to protect the value of their own houses—weaponize interlocking sets of well-intentioned legislation to prevent homes being built. Subsequent chapters apply that similar logic—regulation and a lack of focus resulting in inaction—to infrastructure, government capacity, scientific research and the implementation of new inventions. 

The book's strength is that it is not particularly detailed in its policy proposals. Klein and Thompson instead offer abundance as a lens through which policy development can be viewed: what do we need more of and how do we get it? This lens can be applied from within a wide range of ideological frameworks. It is not itself a worldview but a challenge that any politics should be obsessed with effective delivery not simply desiring the correct end-state.  

The book is unapologetically focused on America and the failures of progressive governance, particularly in California. (One of this book's peculiar legacies will be to leave many who have never been there perpetually invested in California's struggles to build high-speed rail.) Nevertheless, the approach already has its advocates in the UK - for example, the Centre for British Progress which set out its stall last week, and it is not hard to see how an agenda here that could be seized by a less hesitant Starmer government.  

Any plausible political analysis must hold together the reality of scarcity and abundance. Losing sight of either unmoors us from the actual world we find ourselves in.

Indeed, perhaps the book might feel more realistic if it had other countries in mind. Reviewing Abundance, Columbia economist Adam Tooze describes the book as painful to read, characterising it as a manifesto for the Harris presidency that never was. Indeed, according to the authors, the book was originally scheduled for release in summer 2024 to influence the Democratic platform leading up to the 2024 elections. Instead, it appears in 2025 amid Trump's assault on institutions, Tooze's Columbia among them.  

In an interview on Pod Save America, the authors argued that the book is still relevant, offering a framework with which Democrats can oppose Trump. Thompson described the Trumpian view of politics as fundamentally shaped by scarcity. He suggests that behind 47th president's policies—most notably the tariff agenda—is the conviction that every interaction is zero-sum; for you to gain, I must lose.  On this analysis, the way to oppose a politics that pits groups against one another over limited resources—housing, trade, jobs—is to figure out how the government can provide more and argue for it. In its critique and its hopefulness, Abundance offers those who believe in institutions a way to navigate—even work with the grain of—the anti-institutional temperament of contemporary politics.  

There might be something to this messaging, but scarcity plays an unmissable role in Klein and Thompson's argument. Remember that they characterise what they oppose as "Everything Bagel Liberalism", policy that tries to achieve every outcome and loses focus in doing so. They may conceive scarcity differently to Trump, but their book is a warning policy cannot deliver as much as we think. It is a call for us to oppose, to compete against those special interests—whether they be residents’ associations wanting to hold up house prices or politicians wanting to cut research grants—whose policy priorities overload the bagel.  

At heart, the book is a reminder that ultimately the salient scarcity in politics is not housing or trade or even money. It is time. Abundance cautions governments that unfocussed policy yields the time entrusted to them by the governed.  

Humans cannot lead politics completely beyond its zero-sum logic. The world is so often a violent competition over resources and government must restrain that violence while avoiding being co-opted as a means of exploitation.  And yet, politics is also—even primarily—an avenue through which communities answer a primal summons to be fruitful, abundant.  

Ultimately, any plausible political analysis must hold together the reality of scarcity and abundance. Losing sight of either unmoors us from the actual world we find ourselves in. Yes, there is so much broken and warped to reckon with, and we must grapple too with our finitude’s bluntness, but so too is creation replete with goodness, among them our capacity to invent and deliver what we need together. 

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