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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Review
America
Books
Culture
Politics
8 min read

James Davison Hunter: diagnosing America’s health

A great experiment is depleted, and nihilism slips into the void.

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

Riot police stand guard outside a White House fence line.
The White House, June 2020.
Angela N., CC BY 2.0, via Wikimedia Commons.

It was unsettling. Disturbing. And in the months since, it has proven to be a powerful and haunting image, etched in my memory. Thinking about it now has exactly the same chilling effect. 

So, it was earlier this year. I was at the cinema with a friend, sitting comfortably and waiting for our movie to start. Our shared love of Sci-Fi had taken us there that afternoon. Not unexpectedly, up pops the reel of trailers. Fast paced, dramatic and with loads of loud music, they’re either enticingly engaging or mercifully short. 

On this occasion the climax of the reel saw America engulfed in a modern-day civil war. And the image?  

A man is pleading, ‘There’s some kind of misunderstanding here, we’re Americans, okay?’  

There’s a pause. The music stops. Silence. It’s a long pause. 

Then the camera pans to a man in military fatigues, with sunglasses and a rifle sitting ominously on his hip, cocks his head and responds: 

‘Okay … [another pause] what kind of American are you?’ 

Guns cocked, the trailer explodes back into life. 

Our movie was really good. My friend’s company, as usual, was delightfully affable. But the image that remains echoes with that question, ‘what kind of American are you?’ 

I have to confess, I love America. I studied there. I have good friends there. I gorge on American food. I watch American football with my son, every week, on a pay-per-view live stream with real US TV ad breaks (‘Go, Pack, Go!’). In my personal experience Americans are some of the kindest, most thoughtful and most generous of people.  

Maybe that’s why I’ve found the image so troubling. Not that it was some kind of fantastical dystopian depiction, but rather that it portrayed something altogether more plausible. Especially in the light of the ‘storming of the Capitol’ on January 6, 2021, the epidemic of mass shootings and the ongoing violent rhetoric on both sides of the political divide. 

How do you square the circle of America? How do kindness and generosity sit alongside gun violence? Is the country on the brink of civil war? 

Back in 1991 the University of Virginia sociologist James Davison Hunter’s book, Culture Wars: the Struggle to Define America suggested that cultural controversies would be increasingly significant in American politics. At the time not everyone agreed and some even pushed back against such an overblown prediction. Time, however, has vindicated Hunter’s reading of the runes. The ubiquity of his ‘culture wars’ epithet is the proof of his pudding. 

Hunter’s latest offering picks up the story once more. Using the present situation in America as a case study, his reflections ‘bookend’ his earlier thinking. However, Democracy and Solidarity is not an extended commentary exploring the rise of populism and the radical right, or the snowflake, woke elitism of the socialist left. Rather, it seeks to understand why the sentence that opens his preface is true: ‘Democracy in America is in crisis.’ 

Grievance and hurt issue in rage, the unchallengeable moral authority of ‘my personal experience!'

For Hunter, understanding what is going on in a culture requires diving deep into the sources it draws on. What forms it? What drives it? All too easily we focus on the observable and what we can see. The stuff that happens and the values, beliefs and institutions that comprise our common life.  

But that is to miss the deeper structures of culture that are formed by our tacit assumptions and the latent frameworks of meaning that nestle unseen and form the cultural architecture that surrounds us. The power of culture is demonstrated by how far it is taken for granted’. 

In an interview Hunter likened his approach to be the difference between weather forecasts and climate studies. Or, to put it another way, moving from ‘the politics of culture’ to ‘the culture of politics.’ 

Beginning at the beginning, Hunter goes to the origin story of the nation. Deeply influenced by the principles of the enlightenment the Founding Fathers of the United States set about their task of nation building. Proposed by John Adams, Benjamin Franklin and Thomas Jefferson in 1776, the national motto on the Great Seal of the United States, E Pluribus Unum (Out of many, one), summed up their political objective. The creation of solidarity. The glue that binds a society together. 

The genius of the Enlightenment in America was that it facilitated this solidarity. What was created was a ‘Hybrid-Enlightenment’, fusing the insights of French and British intellectuals in a context deeply influenced by the faith of religious dissenters, with the Puritans chief among them. The blending of the secular and faith insights from the Enlightenment was what provided its robust inclusivity and durability. For Hunter, this proved key because: 

“In the end, the hybrid-Enlightenment in America was a broad enough and opaque enough amalgamation to encompass substantial diversity and the tensions that diversity implied.” 

This opacity enabled different groups to see themselves in the enterprise and gave wider American society an ability to absorb a plurality of views, opinions, and traditions. A commitment to Enlightenment rationality also then provided the tools whereby differences could be ‘worked through’ in reasoned debate. Thus, the culture was a living thing, growing, evolving and developing. All the time maintaining the wider solidarity, the ‘buy-in’ from the different communities and constituencies that comprise America. 

Opacity also meant that tensions and contradictions were part and parcel of the endeavour from the start. There may have been a promise of freedom, equality and universal justice for all, yet historically these have been denied to large tracts of the American population. But still the centre held, and solidarity was maintained. As Abraham Lincoln presciently reflected in his Second Inaugural Address, given on March 4 1865, shortly before his assassination and the end of the Civil War: 

“[We] read the same Bible and pray to the same God, and each invokes His aid against the other. … [Yet] the prayers of both could not be answered—that of neither has been answered fully.” 

The problem today, as Hunter discerns it, is that the elements of the hybrid-Enlightenment are unravelling.  He sees a number of contributory causes to this escalating collapse.  

Right at the centre is an amoral, materialistic and individualistic neoliberalism which reduces everything to economics and the market. This is deeply corrosive of community and solidarity.  

Then there is the fruit of postmodern scepticism that has filtered down from the intellectuals into the general population. Truth is deconstructed, experts are distrusted and misinformation, disinformation and fake news abound. 

Widespread immigration also plays a part. It intensifies American pluralism and brings into the country those who are unfamiliar with the legacy of the hybrid-Enlightenment and for whom the national mythos of America is either strange or incomprehensible. Far from being taken for granted, their worldview does not fit. 

The growth of identity politics further complicates the unravelling. Solidarity, rather than being found in the national vision, is achieved by defining ‘us’ over and against ‘them’. It doesn’t foster cohesion, it seeds division. Grievance and hurt issue in rage, the unchallengeable moral authority of ‘my personal experience!’ As with Nietzsche, this acts as a narcotic against the hurt, an anaesthetic for the pain.  

Of course, identity politics has no room for reasoned debate and mutual resolution. All that matters is the outcome of the zero-sum game where the justice of my position is both acknowledged and acted upon, and you lose. Whether that identity falls on the political right or left, it doesn’t matter. Family, sexuality, public education, the news media, the arts, the law, electoral politics, you name the issue the game play is the same. 

Solidarity always involves drawing boundaries. Even the hybrid-Enlightenment drew the line between what was acceptable and what was unacceptable. Who was a part of us, and who was not. Without boundaries there is no identity. It is just that now, identity politics require the boundaries to be much more tightly drawn. “What kind of American are you?” 

In all of this, America’s cultural resources for ‘working through’ these issues have been seriously depleted as the hybrid-Enlightenment has unravelled. Into the void, observes Hunter, a form of cultural nihilism slips in. It is far from being all-pervasive, and he maintains that few Americans are nihilists. Yet as a cultural reality he sees it in the prevailing tendencies towards ‘epistemological failure’, ‘ethical incoherence’ and ‘existential despair’. Then, deriving from these he adds a fourth, ‘political annihilation’ and the will to obliterate everything that obstructs acquiring power by destroying enemies completely. 

Does it all seem rather depressing? 

Hunter admits that he has neither proposals nor a plan to address the crisis he so eloquently describes and accounts for. Yet he concludes: 

“… truth be told, I myself am very hopeful – not because I don’t see the seriousness of the problem and its dangerous implications, but because I believe that the times are full of real opportunity if one has the eyes to see them. Sadly, my eyesight is not very good. … [but] without real images of a better world, without myths of a completion of the past in the future, without a world ordered towards goodness, truth, and beauty … We become something like Nietzsche’s ‘last men’.” 

I’m grateful to Hunter. I think I understand my American friends, their country and their present challenges better for his insights. As for the possibility of a civil war, he thinks it’s unlikely as the ‘red and blue’ are too intermingled and economically interdependent across the country. In the meantime, political violence will continue to be a very real threat. 

As for the future he hopes for, it requires a paradigm shift to imagine and articulate a new vision of public life. It needs the cultural resources of a reconstituted humanism, drawing on the rich insights available in a genuinely pluralist society. Resources that embrace the faith wisdom of exemplars like Martin Luther King, Mohandas Ghandi and Thích Nhất Hạnh. Resources that include a retrieval of the fundamental principle of forgiveness. Without the realism to accept that none of us are perfect, we’ll never be able to live together. As the influential political theorist Hannah Arendt wrote in The Human Condition (1958): 

“Without being forgiven, released from the consequences of what we have done, our capacity to act would, as it were, be confined to one single deed from which we could never recover; we would remain the victims of its consequences forever.” 

Arendt’s insight is altogether more telling when seen in the light of her experience as a German Jew under the Nazis. And if forgiveness is too high a bar, at the very least we have to somehow learn to let things go and move on. 

Hunter is under no illusions, such a paradigm shift remains a long haul away.  

But he is hopeful.