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

Culture

Politics

Re-enchanting

21 March 2024

6 min read

Re-enchanting councils - and glum councillors

Local government could be a place of humanity and beauty more than lifeless language and procedures.

Elizabeth Wainwright

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

A marbles staircase rises on four sides of a chamber.

Glasgow City Chambers' staircase.

Michael D Beckwith, CC0, via Wikimedia Commons.

At the local level in politics, I have found there is a stereotype that persists more than that of the corrupt politician. It is the glum councillor, the pothole poser, or sometimes the councillor looking glum while pointing at potholes. These are the photos that turn up on election leaflets, and in local news, and there are lots of them here in Devon because potholes are numerous and huge.

When I was a district councillor, I tried to push back against this image – I would smile, avoid photos with potholes, share the good stuff found in the community alongside working to improve what wasn’t working. But, looking around the council chamber, it was hard to deny. Sometimes the glumness would slip into sleep; I’ve seen councillors prodded awake ahead of important votes that impact tens of thousands of people. That is not just glum councillor, that is irresponsible, disengaged councillor.

And though the responsibility lies with them, this never surprised me. In my four-year term, I too felt a disillusionment creep in. And I am perennially hopeful; my default is to see possibility. But four years in a context of budget cut after budget cut, endless bureaucracy, lifeless language, and an aversion to trying things differently, even I started to slump in my seat. I never fell asleep, but sometimes my soul did.

Author-farmer Wendell Berry – who speaks with much affection and wisdom about the importance and strength of local community – said that

“unlike the local community, the government and the economy cannot be served with affection, but only with professional zeal or professional boredom.”

I have seen that professional boredom in the language, in the sterile council chamber bare of life, where processes and procedures rule more than humanity; where passionate members of the public would attend meetings only to be told they couldn’t input because they hadn’t pre-registered; where a meeting that finished before the allocated time was seen as successful, regardless of content. I’m sure it should feel more hopeful, more vision-led, more life-giving to be involved in local decision-making – it should be about placemaking more than simply ticking boxes and balancing budgets.

There are, of course, councillors who care deeply, and there are councils where local decision-making is being reclaimed by to serve the local community, economy, identity – like the independent councillors elected onto the town council in Buckfastleigh in South Devon who made it more plain-speaking, more accessible and more engaged; and the Flatpack Democracy movement started in Frome Town Council that has sparked similar local ‘revolutions’. But I think there is something else needed, if local government is to replace lifelessness with hope and vision. Something more upstream of the how.

When the spirit of the age feels like cynicism more than delight, more than beauty, more than possibility, it impacts our relationships and the places that should thrive on good relationships like local government.

In his essay The Joys of Storytelling, Ben Okri says, “In a fractured age, when cynicism is god, here is a possible heresy: we live by stories, we also live in them...if we change the stories we live by, quite possibly we change our lives.” I would often imagine a story of local government that makes space for enchantment. Former monk Thomas Moore speaks of reenchanting as a reawakening to the depth of soul that embraces us and the world. Councils, like lots of spaces, feel disenchanted. Perhaps much of our current disenchantment is symptomatic of our alienation from ourselves, from each other, and from our shared humanity – and from the belief that this shared state of being is strong enough to take the weight of our world, even as heavy as it feels now. When the spirit of the age feels like cynicism more than delight, more than beauty, more than possibility, it impacts our relationships and the places that should thrive on good relationships like local government. Everything dulls; we disconnect from our spirit-breathed humanity, we forget that we were pulled from the soil by a gardener God who made us to be with each other, surrounded by beauty and life.

In the book Faith, Hope and Carnage, the musician and writer Nick Cave says that the “luminous and shocking beauty of the everyday is something I try to remain alert to, if only as an antidote to the chronic cynicism and disenchantment that seems to surround everything, these days. It tells me that, despite how debased or corrupt we are told humanity is and how degraded the world has become, it just keeps on being beautiful. It can’t help it.”

Cave’s words echo Dostoevsky who wrote in The Idiot that ‘the world will be saved by beauty’, which in turn, echoes earlier sentiments from the likes of Plato, Aristotle, and Thomas Aquinas who taught that God is truth, goodness and beauty. In the Bible, Jesus pointed again and again to these things too – in people, in creation, in God. They feel like good things to point the way now; more timeless and apolitical than any current ‘vision’ in government, more tangible than a distant government, more life-giving than purely balancing budgets as a goal. Of course, local government also needs better and more reliable funding, more efficient processes, passionate people, and lots more – but I think these things are more likely to come, in part, from a re-enchanted local government that draws on the “luminous and shocking beauty” of the everyday, and of local people and places. To start to make space for that re-enchantment, government could experiment with three things (which, more than funding, need people willing to try, to think beyond business-as-usual, to take existing resources and think about how they can be used even slightly differently).

It may not need to overcome death, but local government could embrace local people, their humanity, their aliveness.

First, it could move away from language that is detached from emotion and care and life. The word ‘enchant’ has its root in words – cantare means ‘to sing’ – Councils could aspire to make language beautiful more than bureaucratic, clear instead of obscure. It could invite local people into decision-making using life-giving and locally meaningful words and ideas, rather than excluding them with jargon and lifeless language. For this, we’d need the help of local storytellers, poets, writers, speakers – people who can wake us up with the power of words.

Second, local government could bring that “luminous beauty” into the space, rather than sealing conversations and processes away in characterless buildings. Meetings I’d go to were usually in bland rooms, with beige walls, nylon grey carpets, lukewarm coffee. Letting even some of the beauty of this world in – perhaps with colour, architecture, art; perhaps with stories and creativity and food; perhaps with some meetings outdoors in the beauty of the world – would, I think, breathe life into the space, and into relationships, and so into what becomes possible.

Lastly, re-enchanting local government must include re-humanising it, because humanity at its best is relationship and soul and care; it contains the same possibility that was present in Eden when all this was dreamed up. If, as Christians believe, humanity is made in God’s image, then God is endlessly creative; God is about the detail of our lives as well as world-shaking stories; God is about life – life that is so alive it overcomes death. It may not need to overcome death, but local government could embrace local people, their humanity, their aliveness; it could ask them to show up as themselves, with all their strengths and weaknesses, their ideas and hopes and fears, rather than shut them out because they cannot bend to inflexible meetings and procedures and language. It would not shy away from these things; it would use them to create new life and thriving places.

Re-enchanting local government could, I think, bring us closer to beauty, to the goodness of each other, to the truth of people and places. From there, I think it becomes possible to restore relationships, to imagine what government might be at its best, and to view it as a place-based way of knowing and actually serving people. I think it becomes easier from there to look downstream – to re-think processes, the voting system, and the rules of ‘business as usual’ – and perhaps even to fix potholes and the glumness that goes with them.