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.

Jamie Gillies is a commentator on politics and culture.

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
Comment
Freedom of Belief
Politics
War & peace
5 min read

Iranians long for regime change, but weigh up the cost

Dreams are easier to utter than act upon

Steve is news director of Article 18, a human rights organisation documenting Christian persecution in Iran.

Smoke rises from the site of a bomb amid a high wide view of a city at twlight
Tehran.

I received an unexpected response from an Iranian friend of mine this week after asking how he and others were feeling in the wake of the ongoing crisis. 

My friend - like many, a staunch advocate of regime change in Iran - told me that despite his long-standing enmity against the Islamic Republic and its leaders, the conflict had if anything brought Iranians together against a new, common enemy. 

For while he and many others would love to live in an Iran that offered them greater freedoms, they are also fiercely proud of their country and, as he put it, will seek to defend it at all costs. 

Both this friend and other Iranians that I have spoken to since the bombs began to fall last Friday have highlighted how Iran’s “territorial integrity” has been breached by Israel, in violation of international law. 

And so while some might perceive an attack on a tyrannical regime and its nuclear arsenal to be an exception to this rule, it should hardly surprise us that those within the country affected may take a different view. 

Both the Israeli prime minister, Benjamin Netanyahu, and the exiled crown prince of Iran, Reza Pahlavi - whom many perceive to be the most realistic leader of any new revolution - have used their platforms to call on Iranians to seize this moment to rise up and reclaim their land. 

Yet, with bombs falling all around them and a weakened regime still known to be capable of brutally responding to any attempts to revolt, such dreams are easier to utter than to act upon. 

Meanwhile, as Tehranis are encouraged to flee their city and some have already seen homes, loved ones or livelihoods destroyed, it may well be that Iranians have other things on their minds at present than attempting to overthrow their oppressors. 

One very present concern for many Iranians at the moment will be the fate of loved ones who remain in prisons as the aerial bombardment continues. 

Tehran’s Evin Prison, for example, is on the edge of District 3, which residents were told they must evacuate on Monday ahead of another onslaught. 

But as the Australian-British former political prisoner Kylie Moore-Gilbert noted in an interview with Sky News, the prisoners in Evin had no option to flee and instead found themselves locked inside tiny cells, hearing the sound of bombs and rumours of what was taking place but without any real clarity. 

“Nobody's going to have a clue what's going on, and it's utterly terrifying to think that you're locked in a place, you can't flee, you hide, you can't take action to protect yourself, and you don't have access to information,” she said.  

There is not even any guarantee, Moore-Gilbert noted, that these prisoners will be being taken care of by the prison guards, who will no doubt have other things on their mind. 

“There are literally thousands, dozens of thousands, if not hundreds of thousands, of innocent people in prison in Iran, most of them Iranian civilians,” she said. “The prison population inside that country is enormous. The conditions are dire in the best of days. Do they even have electricity? Do they have running water? What on earth is going on? My heart goes out to them.” 

Among the many prisoners in Evin are a handful of Christians, detained or serving sentences on charges related to their religious activities but framed as “actions against national security”. 

Like many Iranians, Christians, as a long-oppressed minority, have every right to hope for a change in the country and a future Iran that would better embody the prophetic words from the Book of Isaiah, believed to have found their fulfilment in Jesus, of “freedom for the captives” and “good news for the poor”. 

And yet Iranian Christians must also wrestle with the biblical command to “submit to the governing authorities” and to “give to Caesar what is Caesar’s, and to God what is God’s”. 

It is, then, perhaps no surprise that in recent years, as hopes of regime change have regularly come and gone, that Iran’s Christians have tended to focus their prayers instead on the increase of “God’s kingdom”, as many more Iranians have continued to find new hope in the Christian faith. 

Such hopes, in theological terms, are built on firmer foundations than any dreams for a change in the nature and essence of tyrannical regimes like the one currently still clinging onto power in Tehran. 

And whatever the future brings, when this current crisis is over, the Iranians who have found their ultimate source of hope and joy in Jesus Christ will know that they still have something to hold onto, whatever they may have lost: the promise of God’s presence with them today and a bright future for tomorrow. 

It may be that another revolution is what many Iranians crave, but there is also something revolutionary, I believe, about the prayer that Jesus taught, which leaves the ultimate course of our lives in the hands of God. 

“Your will be done,” Christians have prayed throughout the centuries; and Iranian Christians will continue to pray this whatever the future holds for them. 

It is perhaps little wonder, then, that it is the Gospel message that Iranian Christians have continued to preach, in spite of persecution, and regardless of whichever direction the whims of popular support have turned. 

One of the passages that an Iranian colleague of mine most frequently recites in our team meetings is the call for us to “act justly, to love mercy, and to walk humbly with our God”, and I was reminded of this as I noted the response of British-Iranian bishop Guli Francis-Dehqani to the current crisis. 

The bishop, the bookies’ favourite to be the next Archbishop, prayed simply for the Lord to “have mercy”. 

As a lover of The Lord of the Rings, I am also reminded of the line from Gandalf, when Frodo is claiming that Bilbo should have finished off Gollum when he had the chance: 

“Do not be too quick to deal out death in judgment. For even the very wise cannot see all ends.” 

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