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
Culture
Death & life
Politics
3 min read

Is a funeral the right backdrop for diplomacy?

Where there's an unavoidable collision between the universal and the individual.

Jamie is Vicar of St Michael's Chester Square, London.

Trump and Zelensky sit and face each other.
Ukrainian Presidential Press Service.

There’s an episode of Yes, Prime Minister where a state funeral provides an opportunity for negotiations with the French over the Channel. As ever, this particular satire has aged well. Most of the coverage of Pope Francis’ requiem mass has focused on either the ‘spectacle’ or the chance for world leaders to connect. It's tempting to think that the main stage of St Peter's Basilica was actually a sideshow to the fringe events of politicians carving up the world. With all the planning and confections that go into usual geopolitical summits, Vatican City has provided a spectacular impromptu backdrop. 

As an Anglican priest, I have mixed feelings about this. All the photos world leaders have been pushing out seem not a million miles away from the shocking taste of selfies in front of an open casket (any casket, for that matter). On the other hand, when there’s matters of life and death to discuss, there’s no better venue than a funeral. 

Of course, this presupposes that leaders have the presence of mind to acknowledge the dead body before them (not 'passed away'), rather than simply going through the motions and thinking about the photo op. But the cogs of death cannot be avoided. 

Tim Hamer, writing for the Lowy Institute, says, ‘bitter rivals can acknowledge the rituals of mortality.’ Some of the figures about leaders attending recent funerals are staggering. Pope Francis' funeral was no different. Along with those Francis prioritised - those pushed to the margins - there was also a critical 'mass' of those at the very centre of society. There were 170 delegations, including 50 heads of state, 15 heads of government and 12 reigning monarchs. Emeritus Professor of International Relations at the University of Leicester, Geoff R. Berridge writes that: 

 “Because death is always with us … there is little doubt that the working funeral is now the most important ceremonial occasion in the world diplomatic system”.   

Therefore, the off chance of bilateral diplomacy must be taken to its full advantage. 

It is precisely because, while the bodies are lowered, funerals elevate us out of the everyday, the 24 hour news cycle and the doomscrolling, that they provide us with an opportunity to connect with what really matters. Less than 24 hours before he died, the pope delivered the words on Easter Sunday: 'Christ is risen! These words capture the whole meaning of our existence, for we were not made for death but for life… God created us for life and wants the human family to rise again!' As our multilateral world order falters, the human family just might be able to rise again when the powers-that-be meet at a funeral.  

We will have to wait and see if there is any fruit from the geopolitical meetings that have taken place. We can live in hope. If world leaders learnt any lessons from the enigmatic late pontiff, they would see that he was like Teflon to the political labels people tried to pin on him. You get the impression that he was aiming for something more lasting than soundbites, quick wins and popularity. 

I would also add that funerals are for the living. Once we've brushed aside any theological quibbles over the efficacy of praying for the dead, funerals are there to help us to grieve. They help us to process loss, which is why the 'mortal remains' remain. The ancient declarations, the homily, the breaking of bread and pouring of wine, yes even the theatrics help us to situate our own lives on a world stage where we are both bit parts as well as worthy of the undivided attention of many onlookers.  

In a world where geopolitics threatens to depersonalise and dehumanise countless millions of people, funerals unavoidably collide the universal with the individual. The context of worship and thanksgiving also lifts us out of the orbital pull of the ephemera of nation-states and our own lives to discover the possibility of revolving around Someone far grander and steadfast. Just like conducting diplomacy, there's no better place to consider death than a funeral. 

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