For many, the case for assisted dying is clear. But life – and death – is often not so simple

As it grows older, more liberal and less religious, the west is changing its mind about how it wants to die. Thirty years ago prescribing people the means to kill themselves was illegal everywhere bar Switzerland. But since then the practice has spread, reaching Belgium, the Netherlands, Canada, parts of the US and Australia, and perhaps soon, here.

Last week, calls to make assisted dying legal in Britain reached a new pitch. Earlier this month, the Observer published statements made by the late Diana Rigg on the right to die, as recorded by her daughter, the actor Rachael Stirling. Rigg was then dying of cancer: a “truly awful” experience. It was time, she said, to give “human beings political autonomy over their own death”.

Then last week Esther Rantzen revealed she would consider assisted dying if her lung cancer treatment failed. She had joined the Swiss clinic Dignitas, but her family could be prosecuted if they were to travel there with her. Parliamentary sentiment, the MP Kit Malthouse announced, had “moved significantly” in favour of the policy, bringing MPs more into line with a majority of the public. And now Keir Starmer has backed calls for a change in the law.

The case for assisted dying is compelling, especially when based on stories such as Rigg’s and Rantzen’s, on which it is easy to agree. When someone is of advanced age, in pain, of sound mind, facing a terminal illness and surrounded by loving relatives, it is difficult to argue they shouldn’t have “political autonomy” over their death. And risks, advocates say, can be mitigated. It is a matter of setting up reasonable safeguards. But as we teeter on the brink of a law change, it might be worth considering why this has been quite so hard for reasonable, liberal Canada to do. Assisted dying was legalised in Canada in 2016, only for those with terminal illness. The prime minister, Justin Trudeau, reassured critics that with his “frameworks” in place, “slippery slope” arguments about vulnerable patients being pressured into an early death were baseless. “That simply isn’t something that ends up happening,” he said.

But two years ago, access was widened to those with nonterminal conditions. And now it may be expanding again to include those whose only medical issue is mental illness. A stream of horror stories have leaked out of Canada. Among them was the case of Alan Nichols, hospitalised in 2019 out of concern he might be suicidal. Within a few weeks he had applied for an assisted death, citing hearing loss as his only medical condition. He was granted one. Roger Foley, a patient with a degenerative brain disorder, said he felt coerced into considering assisted suicide by hospital staff, who repeatedly brought the subject up. Reports claim some Canadians have chosen to be killed in part because of a lack of housing support.

Why can’t Canada get those safeguards in place? Well perhaps the issue is slightly less straightforward than some suggest. It’s easy to forget how radical it is to approach suicide in this way. At the heart of the debate, after all, is a question. If you see someone headed determinedly for the edge of a cliff, do you rush to stop them, or do you respect their autonomous decision and help them on their way? When it comes to the answer, assisted dying policies divide the population in two. In one group, the sincere wish to die is treated not as a decision but a symptom – evidence of mental unbalance, irrational by definition. This is the basis on which depression is diagnosed, defences are placed along bridges, and pro-suicide websites are shut down. For the other group, though, the thought switches categories: suddenly it is not a medical emergency, but a “right”.

What separates these groups? Not the determination to die, which after all can be as strong in a depressed teen as a terminally ill grandmother. No, membership is based entirely on how nice your life might seem to the observer – whether we agree with you that it is not worth living. Assisted dying, you see, is not really about autonomy at all, but the perception of others, and how valuable your life appears to them.

And that’s a problem. How your life looks and how it feels are two different things: the terminally ill may be strangely at peace, the healthy in mental torment. What happens, for example, if a robustly happy person who has long met the criteria for assisted dying suddenly gets depressed? Do they end up on medication or in the mortuary? It’s not easy to say with the guardrails taken off. But if, on the other hand, you decide to believe that patients know their own minds, regardless of how their lives may look, you could end up where Canada is, on the verge of granting state-sanctioned death to physically healthy people.

Things get muddy, too, where it comes to your reason for wanting to die. We don’t want it influenced by your job, income, housing situation, media consumption, coercive spouse, grasping relatives, or greedy nation state. But neither can we peer into your soul, place you in a social vacuum, or legislate that you must tell your doctor the truth.

And worst of all, making suicide easier – or even talking about it – can conjure it into being. When South Korea outlawed a fatal pesticide in 2011, suicides fell: the act was more difficult. Detailed media reports on the death of Robin Williams, who killed himself in 2014, were calculated to have led to more than 1,800 more suicides than would have been expected in the next four months. So could this policy drive more people into a suicidal state? And if you acquire this right to die, should your doctor even tell you? Or is that a dangerous thing to do?

It is tempting to argue for assisted dying using only cases such as those of Rigg and Rantzen, who would clearly benefit from the policy. But we should move carefully, and consider grey areas. It’s not as easy as that.

• Martha Gill is an Observer columnist

• In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counsellor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org

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