There is a strong economic case for assisted dying, but we daren’t admit it
The national debate on assisted dying is both moving and frustrating. The dark magnitude of British terminally ill teacher Nathaniel Dye’s words – “my very death depends on it” – weighs on the nation’s conscience.
The tragic warnings of caution echoing from as far as Canada are no less haunting. I cannot get out of my mind the words of Sathya Dhara Kovac, 44, from Winnipeg, a sufferer from a degenerative disease who chose assisted suicide after failing to get adequate home care support: “I could have had more time if I had more help.”
Yet our debate has been shambolic. The Government has failed to uphold vital neutrality. Wes Streeting has acted like a mouthpiece for NHS bureaucracy – voicing concerns about immediate costs – and made it harder for Labour MPs to vote based on conscience rather than party politics.
Equally, the MP spearheading the Bill, Kim Leadbeater, has imperilled the entire exercise by calling for MPs to “step back” so we can hear from those with personal experience. This is a naked bid to bludgeon criticism with an emotional sledgehammer. It is an unacceptable attitude. The Bill, should it pass, would require meticulous guardrails to minimise the risks of people being pressured into suicide.
Most alarming of all is the disintegration of this flawed debate.
Assisted dying is being framed by advocates and critics alike as a question of principle versus pragmatism. The Bill’s backers insist that it is a question of easing suffering. Its detractors contend that, while the Bill might “come from a position of compassion” the “best intentions can lead to unintended consequences” – such as people ending their lives for fear of being a burden. Some on the Right are inclined to see assisted dying as the sentimentalising pet project of bleeding heart liberals, which sober conservatives are obliged to pick apart.
This interpretation is misguided. For one thing, cold utilitarianism favours assisted death. The taboo that nobody dares to articulate is that assisted dying will leave society financially better off. The NHS spends most of its resources on palliative care for people in the final six months of their life.
What if those funds could be redirected towards investing in drugs that could slow the advancement of dementia, for instance, in others – drugs which are currently deemed to be too expensive for the NHS?
Assisted dying will also help people protect their family wealth. Those who are being forced to spend savings and sell assets to pay for end-of-life care will at least have an alternative option. While this might sound grotesquely materialistic, for many the ability to leave a parting gift to their family, and the reassurance that while they may no longer be with them in life, they can at least contribute to their security in death, is more precious than another few months in a hospice bed.
Critics of the Bill have warned that legalising assisted dying could lead to a slippery slope, with not just the terminally ill but the chronically ill becoming eligible and under pressure to end their lives. This argument seems naively narrow. The fact is that there may well be justification to expand the law in time, not due to mission creep but technological advancement. AI-powered medical progress favours breakthroughs in life extension over those in chronic illness.
We are thus more likely to see the rapid development of precision cancer treatment medicine than we are cures for crippling diseases such as Alzheimers or multiple sclerosis. Therefore, society may soon be faced with a large number of very old people eking out miserable and painful lives. If the wishes of some of these people to die are not heeded, an unreformed NHS will almost certainly collapse. It is unlikely that we will hear this other side to the “pragmatic” argument in Parliament, as such truths are considered off limits.
More importantly, perhaps, we are no more likely to hear MPs confront the moral question at the heart of the debate: what is more precious to us – bare life or human freedom?
Those of us who favour assisted dying believe that human autonomy trumps the sanctity of our basic biological existence.
Our critics take the opposite view that, while freedom might be important, no person should ever have to die for the sake of another person’s liberty, nor should the state have the murder of citizens on its conscience. They believe that if a single person is pressured into killing themselves or feels compelled to do so out of inadequate welfare support, that makes the legalisation of assisted dying intolerable. But the fact is that when a society decides on a moral principle, this always carries with it acceptance that collateral evil will ensue. Our commitment to “innocent until proven guilty” means that there are undoubtedly murderers walking our streets with impunity and countless victims have died over the centuries because we insist on a minimum threshold of evidence before locking up predators. We accept such evil in our society because we hold so dear the principle of justice. Why do we not show the same unbending commitment to freedom?
Given that there are so few remaining libertarian MPs, the moral case for assisted dying, which not only calls for compassion but invokes the cause of liberty, is unlikely to get much of an airing. That is a shame. What sets our species apart from others is its capacity to imagine alternative futures and make choices accordingly. We are nothing without our freedom. Yet, when it comes to liberty, the sanctity of human will is a particular blind spot. It is striking that we see no problem with legalising abortion – invoking arguments about female bodily autonomy – but are ambivalent about granting people agency in choosing the manner of their death.
There is also something quite cruel about a society that will deny what the mind wills but the weakened body cannot execute, lest it have the death of the “vulnerable” on its conscience.
To be fair to struggling MPs, it is harder than ever to have a discussion about death, because the phenomenon has never been more terrifying.
Death used to strike like a lightning bolt, even the most tortuous plagues, such as the Black Death, killed people within a week. Today, death sprouts, saps, and steals people away, piece by piece. However, we must find a way to accept it. That starts with legalising assisted dying.