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

Politics

5 March 2024

5 min read

Politics needs some deep stirring emotion

In politics, the struggle between our reason and desire is a fair fight.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A young woman in a blue suit stands at a wooden box in a parliamentary debating chamber looking upward while speaking.

British Youth Council parliamentary debate.

British Youth Council.

“The government you elect is the government you deserve.” So goes the famous quote, variously attributed to Thomas Jefferson, Joseph de Maistre and George Bernard Shaw. Of all these thinkers, Maistre is perhaps the most interesting, describing the business of government as a kind of religion, a political “faith” – one complete with dogmas, mysteries and even ministers.

Maistre was, somewhat surprisingly amid the turmoil of eighteenth-century France, a staunch monarchist. His argument was that, if the authority of a political leader was only a product of social convention, then that authority would always lack a sufficient degree of legitimacy, leaving the door wide open for violence and strife. His solution was to defend the divine right of kings. This was a controversial position, as much then as it is now.

Aside from his famous quote about elections, Maistre’s political philosophy is oft-criticised as polemical, hearkening back to a golden era of European monarchy that never really existed. Nevertheless, within his writings, Maistre laid bare a reality that we often prefer to keep veiled: that our political will is as much about what we find to be emotionally compelling as it is about what we find to be rationally convincing, indeed, the latter is very much dependent on the former. The more social scientists are able to demonstrate the reality of subtle phenomena such as confirmation bias, unconscious bias, and racial prejudice, the more we see that we are often being governed by pre-cognitive or non-cognitive instincts, even those of us who like to think that we are better than that. In the end, we have to concede that when it comes to politics, as with so much else, the struggle between our faculty of reason and the desire of our heart is a fair fight.

“They have few standards by which to judge between falsehood and truth in revolutionary movements.”

Amy Buller

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In 1930’s Europe, there was certainly a lot of emotionally compelling politics around. Fascinated by the language and culture of the German people, thinker and educator Amy Buller made repeated visits to Germany from the 1920’s onwards, often accompanied by reading parties of British academics, church leaders and university students. In those decades, as the political landscape of Germany began to shift, her purpose became less about countryside walks and studying, and more about the facilitation of urgent, open and honest dialogue between Buller, her fellow travellers, and their German counterparts in the churches and universities wherever she had contacts. As Hitler rose to power, and even before the full horrors of Nazism became widely known, Amy was compelled to find out why so many people, especially young people, were being attracted by what she saw as a “brutish” ideology.

In 1943, amid the violence and destruction of World War II, Buller published a book, Darkness Over Germany, which gives a first-hand account of the many people that she and her travelling parties had met, and the conversations that had taken place. Like Maistre, Buller proposed that without God, politics was a dangerous kind of faith in something, one that tended towards violence. In the introduction to her book she writes of “…the tragedy of a whole generation of German youth, who, having no faith, made Nazism their religion.”

It’s common these days to hear complaints about the political apathy of the young, with polls commonly reporting that only about 50 per cent of British 18 to 24-year-olds are intending to vote in the next General Election. However, there are those who raise the caution that this may not be a symptom of apathy, so much as a symptom of the cultural and structural injustices that put barriers in the way of young people engaging with our nation’s political life. Young people are not likely to “believe in” a political system from which they feel excluded. As Buller’s writing notes – when this happens, young people are likely to put their “faith” in something else.

Maistre’s solution was perhaps too extreme for modern sensibilities: asking the politically minded populace to believe that their leaders were imbued with the authority of God, by God. In the twentieth-century, Buller took a more moderate view. As the Nazis began to view her with suspicion, trips to Germany became increasingly difficult to arrange, so she travelled elsewhere to places such as Hungary and Bulgaria. Wherever Buller went, she found more and more young people who wanted to talk to her about their political hopes and ideals. Summarising the whole, Buller suggested that Europe’s political landscape was eschewing “shallow rationalism” and instead being shaken by a “deep stirring” of emotion, particularly among young people. She recorded the observation:

“They all want change, and they all want a chance to play a part in that change, but so few have any religious faith, which means that they have few standards by which to judge between falsehood and truth in revolutionary movements.”

In a recent report, published by the Jo Cox Foundation, increasing the public’s “political literacy” was highlighted as a key response to prevent the outbreaks of abuse, intimidation and violence towards elected officials. As any educator will tell you, literacy is a two-way street – it includes not only the “shallow rationalism” of knowing information, or knowing where to access information, but also the ability to communicate that information effectively to others. Such communication comes from a much deeper, embodied kind of knowing, one which requires one to have assimilated knowledge and worked with it, feeling its malleability, and testing its apparent truth-claims against an internal standard of what is true and false, or right and wrong.

For Buller, this internal standard was inextricably linked to faith. To the end of her life, she remained open minded as to what form this faith might take, albeit her own religious practice was firmly Christian. Cumberland Lodge, the educational charity she set up to promote her aims, was from the start open to those of all faiths and none, and she warmly welcomed dialogue between those of different faith groups, including atheism. But in 1943, as Amy Buller looked with hope towards the prospect of a post-war Europe, she summed up the political landscape as follows:

We are now faced with the greater task of bringing healing to the nations, including our own, I am convinced this cannot be done without a faith in God adequate to the tremendous task of reconstruction.

Given Amy Buller’s open-mindedness, one can read the word “God” in this statement its broadest possible sense, as referring to whatever moral compass one takes as an internal standard of what is true and false, or right and wrong. But the point remains that the political will is therefore not a matter of rational thought, or not only of that, but is an expression of feelings and instincts that run far, far deeper.