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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Editor's pick
America
Culture
Leading
Politics
8 min read

Molly Worthen on the charismatic leaders of America's cosmic drama

The plots and plotters that hold us spellbound

Nick is the senior editor of Seen & Unseen.

Viewed from behind, Trump raises a fist.
Trump on the stump.
White House via Wikimedia Commons.

What happens when Americans lose faith in their religious institutions—and politicians fill the void? In Spellbound: How Charisma Shaped American History from the Puritans to Donald Trump, Molly Worthen sweeping history helps us understand the forces that create leaders and hold their followers captive. 
 
Everyone feels it. Cultural and political life in America has become unrecognizable and strange. Firebrands and would-be sages have taken the place of reasonable and responsible leaders. Nuanced debates have given way to the smug confidence of yard signs. Worthen asks just how did we get here? 
 
Worthen, a historian argues that we will understand the present moment if we learn the story of charisma in America. From the Puritans and Andrew Jackson to Black nationalists and Donald Trump, the saga of American charisma stars figures who possess a dangerous and alluring power to move crowds. They invite followers into a cosmic drama that fulfils hopes and rectifies grievances—and these charismatic leaders insist that they alone plot the way. 

Author and historian Tom Holland loved this book.  

“The great story of charisma in American history, from the Massachusetts Bay Colony to MAGA, has never been more thrillingly told, never more learnedly explicated.” 

In this extract, entitled Plotlines, Worthen introduces her four categories of charismatic leader: Prophets. Conquerors, Agitators, and Gurus.  

Plotlines

Over the past several years, whenever I told friends or family that I was writing a book about charisma, they responded with a reasonable question. Which charismatic figures would I include? They peppered me with suggestions: What about Elvis Presley, or Dolly Parton? Michael Jordan or Muhammad Ali? Surely I had to say something about Taylor Swift, right? 

None of these fascinating people appears in this book. As you read it, you will probably think of a dozen others whom you wish I had included, and I’m sure you’ll have a point. I have mostly stuck to individuals who worked to build a movement in organized religion or politics, rather than musicians, artists, or athletes. Even within the spheres of religion and politics, I’ve been selective in order to craft a manageable story and bring into focus the patterns and transformations of charismatic leadership over the course of American history. 

Sometimes this is an inspiring story, because charismatic leaders often turn up—and people decide to follow—out of a desperate response to alienation and injustice. People in anguish seek a savior. Yet charisma has no fixed moral standing. It can carve a path to freedom or to enslavement; it can lead people to embrace the rule of law or to sneer at it. Charisma causes problems for democracy as well as for authoritarian regimes. Without a sustained analysis of charisma over the long haul of American history since European settlement began, we are doomed to bumble along, blandly observing that ordinary people declare many allegiances that seem to contradict their own material interests and sabotage democracy—but never understanding why. 

Over the past four centuries, five types of charismatic leaders have surged to dominance, each offering a variation on the great paradox, a different way for followers to hand over control while feeling liberated. I use these categories both to classify leaders and their movements, and to chart historical change: each type reacts to the type that came before, and responds to the pressures and anxieties of its own era. Like all typologies, this one maps imperfectly onto real people. Almost no one is a “pure” example of these categories, and some leaders are interesting precisely because they react against their age’s dominant type. But these categories have compelled even leaders who defied easy labels—that’s most of them—to respond to the ascendant charismatic style of their age. 

The Prophets take us from the end of the Middle Ages into something beginning to resemble our own world. They drew on ancient patterns of contact with the divine to challenge authorities and captivate followers with the terror and ecstasy of God’s presence. They hewed close to tradition, operating in a time when Old World strictures still constrained life in the New World rather tightly. But some used those traditions to undermine reigning institutions, whether by violent rebellion or illicit gatherings—and so provoked a backlash. If the Prophets conceived of freedom in terms of divine salvation, they often harnessed mystical power for this-worldly ends. Usually this meant dismantling any structure that stood in God’s way. 

The Prophets were, essentially, destroyers. In their wake they provoked an age of builders. 

The Conquerors rose to prominence in the early nineteenth century—an age of mythology, mass media, and frontier enthusiasm in the European American imagination. They swung away from the age of the Prophets, who had so much to say about how powerless humans are. 

Some of the Conquerors wielded military power, but all of them pursued what we might call metaphysical conquest. They fought to control spiritual forces. As the predestinarian Puritanism of earlier generations lost its appeal, more people placed an almost fundamentalist faith in the power of free will. It was tempting to think of spiritual forces—perhaps even the Holy Spirit— as a kind of technology, ready for manipulation. The stakes in these campaigns were high at a time when new advances in science impinged on everyday life. Waves of immigration made the country more religiously and ethnically diverse. Americans felt both freer and yet more confined than ever before. 

The Agitators gained sway at the turn of the twentieth century, protesting modernity as a raw deal and democracy as tyranny in disguise. The Conquerors had, overall, expanded government authority over Americans’ lives and advanced a golden idea of progress. Now the pendulum swung back toward calls for destruction. The Agitators found a market for attacking the state and denouncing so-called progress as a lie. They defined themselves as outsiders whether they were or not, and discovered that gaining material power does not mean that one must stop telling a story of exile and affliction. This proved to be an important lesson in an age of world war and economic disaster: global crises have a way of transfiguring an outcast dissenter into a credible threat tot he standing order. Meanwhile, Christians grew wilder in their displays of New Testament charisma—because, paradoxically, it was easier to grapple with what Max Weber called the “iron cage” of modernity by embracing ever more outlandish signs of divine power. 

The Experts were, on the face of things, the Agitators’ opposite in charismatic style. They were builders. In the wake of World War II, they capitalized on a backlash against the nightmare years of fascist demagogues, embraced the zenith of traditional institutions’ authority across Western culture and politics, and nurtured Americans’ faith in the power of technology and bureaucracy to solve large-scale problems. 

They claimed the mantle of reason and procedure and did their best to relegate the political or religious clout of charisma to the distant past or primitive cultures. 

But in fact, the three decades after World War II witnessed an explosion of religious revival in America—led by Christians who spoke in tongues, looked for the end times, and claimed to heal through the power of the Spirit. Even in the domain of credentialed and supposedly secular healing, the line between medicine and spirituality grew fuzzier. These years were the Experts’ apogee of cultural prestige, but Americans’ long- standing ambivalence about intellectual elites persisted. The most successful leaders capitalized on those mixed feelings. They nursed the tension between the Cold War celebration of science and freedom and, on the other hand, the lurking sense that technological leaps obscured eternal truths and needed the organizing power of a good story. 

By the end of the twentieth century, as Americans lost faith in established media, churches, government, and nearly every other bulwark of modern society, the destructive strain of charismatic leadership re-surfaced in the form of the Gurus: preachers of self-actualization and get-enlightened-quick schemes, promoting God’s new temp job as personal assistant. Old-fashioned Pentecostal revival persisted too, but its leaders struggled to prevent the culture wars from capturing the Holy Spirit. 

The Gurus looked, at first glance, like the Prophets and the Agitators. But in the generations since those earlier eras, it had become harder to pay obeisance to tradition—which was just fine, since the erosion of institutions had weakened traditions anyway, and opened a path for Gurus to achieve more influence than their destructive predecessors. Religious and philosophical tradition, in the hands of the Gurus, was no longer a firm guide but a palette for painting illusions of independence. Sometimes they used it to depict a new reality impervious to fact-checkers. 

“Guru,” which means “remover of darkness” in Sanskrit, was originally a religious term. But in the third decade of the twenty-first century, the most prominent guru in the country was a businessman named Donald Trump. Trump was not, personally, a paragon of conventional religious devotion. Yet his political career depended on a hunger among his most dedicated supporters that can only be called spiritual. Like so many relationships between charismatic leaders and their followers, it stumped and angered those on the outside. Against the backdrop of the American charismatic tradition, however, his success makes perfect sense. 

How, then, did early modern mystics and Puritan heretics who heard the voice of the Holy Spirit give way to devotees at a modern presidential rally, jostling toward the candidate iPhone-first, praying for a selfie? By the early twenty-first century, most religious institutions in the West had declined into husks of their former authority—at least by the usual measures. Today commentators turn more than ever to materialist explanations for political dysfunction, polarization, and the culture’s general crisis of confidence. They cite growing social inequality, impassable disagreements on policy, persistent racism and xenophobia, evil automated forces lurking on the internet. All true—yet all insufficient accounts. If we define the religious impulse as a hunger for transcendent meaning and a reflex to worship, then it is a human instinct only slightly less basic than the need for food and shelter, and Americans are no less religious than they have ever been. They will always find a way to satisfy these desires, even if charisma carries them down strange and costly paths. 

 

Spellbound: How Charisma Shaped American History from the Puritans to Donald Trump, Penguin Random House, 2025.