Article

Assisted dying

Care

Comment

Politics

6 February 2025

6 min read

Assisted dying’s problems are unsolvable

There’s hollow rhetoric on keeping people safe from coercion.

Jamie Gillies

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

Justice

20 February 2025

7 min read

Just where does the arc of history bend towards today?

What happens when the optimism bubble bursts.

Roger Standing

Roger is a theologian and author with a particular interest in the relationship between faith and culture.

The feet and legs of someone walking on a white rug, beside the words Justice and Government woven in to it,

Obama's Oval Office rug.

The White House, via Wikimedia Commons.

"Yes we can!

Yes we can!

Yes we can!"

There was something magical about hearing Barak Obama speak to a crowd. The rhythm of his sentences, the rhyme of his words and the melodic cadence of his baritone delivery had the ability to hold you spellbound. It felt so positive, so uplifting, so inspiring.

The call and response with the audience only underlined the positivity of the impression: ‘Yes we can!’

It was listening to Obama that I first heard the quote:

‘The arc of history is long, but it bends towards justice.’

I loved it. Obama used it a lot, and so did I.

It seemed to epitomise the hopefulness his presidency embodied. Implicitly, it advocated the qualities of patience and persistence that are so important in working for a better world. It doesn’t happen overnight. It also acknowledged his rootedness in what had gone before, ‘As Dr King used to remind us …’. Obama was borrowing the line from one of his own heroes.

In fact, the quote was with him all the time in the Oval Office of the White House, to the right of his desk. Along with four other quotes it was woven into the perimeter of a 23 by 30-foot oval rug that almost filled the room.

The one-liner still delivers a punch, just as it did for Martin Luther King. However, I am increasingly convinced that it doesn’t stand scrutiny. As much as I want it to be true, and long for it to be true, I do not believe that it is.

The sentiment was of its time. Not the 1950s and 60s of Dr King, but the 1850s of the Unitarian minister Theodore Parker from Massachusetts. The germ of an idea originated with him in a sermon entitled, ‘Of Justice and the Conscience’. At this point it was a complicated paragraph rather than a pithy one-liner.

‘You see a continual and progressive triumph of the right. I do not pretend to understand the moral universe, the arc is a long one, my eye reaches but little ways. I cannot calculate the curve and complete the figure by the experience of sight; I can divine it by conscience. But from what I see I am sure it bends towards justice.’

Parker was also responsible for ‘government of the people, by the people, for the people’ that Abraham Lincoln would go on to cut and paste into his famous Gettysburg Address during the Civil War. It also appeared on Obama’s rug.

The intellectual circles of the 1850s were alive with many new ideas like progress, equality and the abolition of slavery, and ‘transmutation’ (or evolution as it would become known). In science, industry and social life things were moving forward and getting ever better.

As the century moved on this conviction continued to grow and become more widespread. By the early years of the twentieth century Parker’s thought itself had been distilled down into the single line we’re familiar with and included in popularly published collections of aphorisms.

Prosperity and progress informed the narrative of Western culture and ideas of evolution were imported into other disciplines. In anthropology, for example, this gave rise to ‘social evolutionism’ and the categorisation of societies into a developmental sequence ranging from ‘primitive’ to ‘civilised’.

Of course, it doesn’t take much imagination to recognise that there was a darker side to such notions. Here was also an underpinning for a colonial worldview and an intellectual justification for racial hierarchy. Western culture was more ‘evolved’.

These views were epitomised in psychology where, for example, in Freud’s Totem and Taboo (1913) he speaks of indigenous people as ‘the most backward and miserable of savages’, comparing the way they live with features of a neurosis and mental disorder.

The carnage of the First World War effectively popped the bubble of an overly optimistic ‘progressivism’. I do wonder whether we are now at another ‘bubble popping’ moment in the West.

Is your ‘bubble of optimism’ in danger of popping, or has it even popped already, like mine?

In the decades since the Second World War we have succumbed to our own narrative of progress. We have witnessed amazing technological advances and stunning scientific discoveries. The forward movement is obvious, and the promise of an even better future is clear.

Then, supported and monetised by the market economy, our lives are tempted, enhanced and festooned by the latest products and services that our money can buy. From smart doorbells to wearable tech and TikTok to ChatGPT our world is constantly changing and upgrading and the movement forward is undeniable.

The narrative runs in our wider life too. We celebrate the triumph of the suffragettes, the defeat of fascism and the collapse of old-school communism. Francis Fukuyama may have been premature declaring the end of the Cold War as the ‘end of history’ in 1989, but it did seem like Western-style liberal democracy was what the world was striving for.

Then there are the advances in our shared life together in Britain. If Acts of Parliament in some measure illustrate the pulse of the nation, the direction is clear. Take, for example:

the Sexual Offences Act 1967
the Sex Discrimination Act 1975
the Race Relations Act 1976
the Childrens’ Acts of 1986 and 2004
the Disability Discrimination Act 1995
the Human Rights Act 1998
the statutory instruments protecting against discrimination in employment on grounds of religion or belief (2003), sexual orientation (2003) and age (2006)
the Gender Recognition Act 2004
the Equality Act 2010
the Marriage (Same Sex Couples) Act 2013

This list isn’t exhaustive and there are campaigners who are very keen to add to it. But we live inside this narrative, and we know the plot. It is familiar to us. And it would be so easy to be seduced into a new myth of inevitable progress, ‘The arc of history is long, but it bends towards justice’.

‘Social evolutionism’ was so deeply embedded in late Victorian culture that its ‘self-evident’ truth went largely unchallenged. The vast majority believed their own hyperbole and complacently embraced the fruits of burgeoning industry and an expanding empire. They lacked the self-critical capacity to comprehend the flaws in their worldview and to understand what their world was capable of in the infernal, apocalyptic catastrophe that was unleashed in 1914.

Maybe, embracing a more contemporary myth of progress has a similar effect on us. We presume that our way of life will inevitably continue moving forward unchallenged. That we have a right to experience a tomorrow that will always be better than yesterday. And that those who do not subscribe to our notion of ‘progress’ are clearly inferior, ill-informed or backward in some way. But such a mindset also lacks a culturally self-aware and critical edge and is oblivious to how easily things could fall apart.

At this moment in time the world seems far less secure than at any point in my lifetime. Our community hosts refugees from Ukraine and Hong Kong, a friend has only recently returned from working with a voluntary agency in Israel and I am about to meet up with another friend who has just flown in from the United States.

Populist, anti-democratic and disruptive forces are more blatantly at work around the world than for many a long year. Developments in AI, cyber-terrorism and digital warfare create a disembodied sense of ‘existential threat’. And then there is the climate crisis. Fires in California, floods in Europe and the unprecedented sequence of six tropical cyclones in the Philippines in late 2024 seem to have had little impact in accelerating the response to global warming.

Is your ‘bubble of optimism’ in danger of popping, or has it even popped already, like mine?

Of late I have found helpful insight in observations made by Jesus. Rather than fixating about what might happen in the future, he encouraged those who had attached themselves to him to live in the moment,

'Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.'

For those who were concerned about what might be happening and felt the world was falling in around them, he offered reassurance. He counselled that such events did not signal the end of the world. Rather, this was simply the kind of thing that happened.

'You will hear of wars and rumours of wars, but see to it that you are not alarmed. Such things must happen … these are the beginning of birth pains.'

Rather, the early Christian ethic was rooted in God’s loving, supporting and strengthening presence during unstable times.

Writing to the Christian community that had formed itself in Rome, the apostle Paul was convinced that whatever befell them – trouble, hardship, persecution, famine, nakedness, danger, or weaponised violence – that nothing would be able to ‘separate us from the love of God that is in Christ Jesus our Lord.’

And right at the base of this ethic that Jesus advocated was an unswerving commitment to ‘love your neighbour as yourself’

Which takes us back to Obama’s rug and the West Wing office.

On the left-hand side of his desk was a quote from President Theodore Roosevelt:

'The welfare of each of us is dependent fundamentally upon the welfare of all of us.'

And that really is it. History may not bend towards justice, and hard-won progress we’ve achieved can likewise be lost, but our future will always hang on the ‘welfare of all of us.’