NHS: How far do we go to feed the sacred system?

Balancing safeguards and economic expediencies after the assisted dying vote.

Callum Elwood

Callum is a pastor, based on a barge, in London's Docklands.

A patient eye view of six surgeons looking down.

National Cancer Institute via Unsplash.

“Die cheaply, protect the NHS” It sounds extreme, but it could become an unspoken policy. With MPs voting on 29th November to advance the assisted dying bill, Britain stands at a crossroads. Framed as a compassionate choice for the terminally ill, the bill raises profound ethical, societal, and economic concerns. In a nation where the NHS holds near-sacred status, this legislation risks leading us to a grim reality: lives sacrificed to sustain an overstretched healthcare system.

The passage of this legislation demands vigilance. To avoid human lives being sacrificed at the altar of an insatiable healthcare system, we must confront the potential dangers of assisted dying becoming an economic expedient cloaked in compassion.

The NHS has been part of British identity since its founding, offering universal care, free at the point of use. To be clear, this is a good thing—extraordinary levels of medical care are accessible to all, regardless of income. When my wife needed medical intervention while in labour, the NHS ensured we were not left with an unpayable bill.

Yet the NHS is more than a healthcare system; it has become a cultural icon. During the COVID-19 pandemic, it was elevated to near-religious status with weekly clapping, rainbow posters, and public declarations of loyalty. To criticise or call for reform often invites accusations of cruelty or inhumanity. A 2020 Ipsos MORI poll found that 74 per cent of Britons cited the NHS as a source of pride, more than any other institution.

However, the NHS’s demands continue to grow: waiting lists stretch ever longer, staff are overworked and underpaid, and funding is perpetually under strain. Like any idol, it demands sacrifices to sustain its appetite. In this context, the introduction of assisted dying legislation raises troubling questions about how far society might go to feed this sacred system.

Supporters of the Assisted Dying Bill argue that it will remain limited to exceptional cases, governed by strict safeguards. However, international evidence suggests otherwise.

In Belgium, the number of euthanasia cases rose by 267 per cent in less than a decade, with 2,656 cases in 2019 compared to 954 in 2010. Increasingly, these cases involve patients with psychiatric disorders or non-terminal illnesses. Canada has seen similar trends since legalising medical assistance in dying (MAiD) in 2016. By 2021, over 10,000 people had opted for MAiD, with eligibility expanding to include individuals with disabilities, mental health conditions, and even financial hardships.

The argument for safeguards is hardly reassuring, history shows they are often eroded over time. In Belgium and Canada, assisted dying has evolved from a last resort for the terminally ill to an option offered to the vulnerable and struggling. This raises an urgent question: how do we ensure Britain doesn’t follow this trajectory?

The NHS is under immense strain. With limited resources and growing demand, the temptation to frame assisted dying as an economic solution is real. While supporters present the legislation as compassionate, the potential for financial incentives to influence its application cannot be ignored.

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation.

Consider a scenario: you are diagnosed with a complex, long-term, ultimately terminal illness. Option one involves intricate surgery, a lengthy hospital stay, and gruelling physiotherapy. The risks are high, the recovery tough, life not significantly lengthened, and the costs significant. Opting for this could be perceived as selfish—haven’t you heard how overstretched the NHS is? Don’t you care about real emergencies? Option two offers a "dignified" exit: assisted dying. It spares NHS resources and relieves your family of the burden of prolonged care. What starts as a choice may soon feel like an obligation for the vulnerable, elderly, or disabled—those who might already feel they are a financial or emotional burden.

This economic argument is unspoken but undeniable. When a system is stretched to breaking point, compassion risks becoming a convenient cloak for expedience.

The Assisted Dying Bill marks a critical moment for Britain. If passed into law, as now seems inevitable, it could redefine not only how we view healthcare but how we value life itself. To prevent this legislation from becoming a slippery slope, we must remain vigilant against the erosion of safeguards and the pressure of economic incentives.

At the same time, we must reassess our relationship with the NHS. It must no longer occupy a place of unquestioning reverence. Instead, we should view it with a balance of admiration and accountability. Reforming the NHS isn’t about dismantling it but ensuring it serves its true purpose: to protect life, not demand it.

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation. If we continue to treat the NHS as sacred, the costs—moral, spiritual, and human—will become unbearable.

This moment requires courage: the courage to confront economic realities without compromising our moral foundations. As a society, we must advocate for policies that prioritise care, defend the vulnerable, and resist the reduction of life to an equation. Sacrifices will always be necessary in a healthcare system, but they must be sacrifices of commitment to care, not lives surrendered to convenience.

The path forward demands thoughtful reform and a collective reimagining of our values. If we value dignity and compassion, we must ensure that they remain more than rhetoric—they must be the principles that guide our every decision.

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Economics

23 October 2024

1 min read

Budgeting for discontent

The Chancellor can't please everyone, but is contentment possible?

Paul Valler

Paul Valler is an executive coach and mentor. He is a former chair of the London Institute for Contemporary Christianity.

A woman stands behind a lectern against a blue and red backdrop.

Chancellor Rachel Reeves speaks at a recent event.

HM Treasury.

As the Chancellor Rachel Reeves seeks to raise billions in this Autumn budget, the news media are all over the downsides. Poor pensioners freezing during winter and businesses complaining of the tax burden are political headlines. Tough choices must be made, but we are rarely happy when it comes to money.

Economic discontent is ironically a cultural norm in first world countries. In the west we have become used to what psychologists call the hedonic treadmill – adjusting our expectations to any new benefits and finding ourselves wanting even more, to try to maintain the same level of happiness. It’s a mentality that dooms us to discontent. Socrates said, ‘He who is not contented with what he has, would not be contented with what he would like to have.’

Contentment seems to be a forgotten virtue today, and increasingly elusive in a society striving for happiness through wealth. Yet being content in life is a more valuable form of wealth than money. There is something enormously attractive about a tranquil state of mind and heart. Contentment does not mean passive acquiescence; there is a noble side to being passionately discontented about something that is unjust – especially when we are fighting for others. William Wilberforce demonstrated that with his campaign for the repeal of laws allowing slavery.

Our personal challenge is to be content in ourselves, whatever the circumstances. Oscar Wilde said, ‘True contentment is not having everything, but being satisfied with everything you have.’ Practising paying attention to what we do have and being thankful for it. That attitude of gratitude is a recognised way to lift our mood and strengthen our resilience. But thankfulness doesn’t solve every problem. Warm words may help warm hearts, but they don’t heat cold homes. Although gratitude is proven to improve our wellbeing, it’s not enough to compensate for all the problems of life. Because here’s the deal; life is tough and then you die, and there are many worse things than economic woes.

Pain, grief and loss are all too common, and they can test our resilience beyond what feels like our ability to endure. Chronic physical or mental illness for example; or being permanently disabled. Or the life-sapping effort to parent children with special needs; or caring for a parent/partner with dementia - especially when it goes on and on. Sometimes horrible events happen like violent abuse, or the deep grief of relationship breakdown or bereavement. This level of suffering pushes us to the end of ourselves, to the place where something more than psychological self-help is needed. What is the secret of contentment then?

I don’t envy the Chancellor, and I do not trivialise the very real challenges raised by having to make tough economic choices.

This is where the secular and the Christian worldview are radically different. Secular philosophers call people to show their own self-sufficiency and superior reason when enduring suffering. This can feel principled and stoic, but it lacks empathy and hope. Christianity accepts the reality of our own weakness and insufficiency, recognising that we can’t fix everything ourselves. Instead of trusting in humanity, we choose to trust God both for this life and the life to come. And this trust and hope is linked to a deeper form of contentment, which transcends pure rationality.

Of course, sceptics say this is just psychological comfort from an imaginary friend, and it doesn’t make sense, because surely any good God would not allow us to suffer in the first place. But any realist must acknowledge that a lot of human suffering comes from the damaging exercise of our own free will. Wars and slavery are examples. If God were to override our free will, we would be robbed of the authentic capacity to love, which makes us fully human. The coexistence of free will, suffering and God is a complex issue.

The experience of millions of Christ followers is that trusting God is much more than imaginary comfort. God is real and prayer changes things; the most ordinary, natural and chance experiences can be affected by it. And prayer changes us. In our vulnerability, if we choose to trust God something changes, we begin to relax, things become a bit easier to bear. In fact, the apostle Paul claimed that Christ’s power was perfected in his own weakness.

Contentment is a strange peace that comes from trusting God in the middle of difficult circumstances. One of the great old hymns was written by a man who lost his four daughters in an accident at sea, and also lost all his money in a fire. The refrain says, ‘It is well, it is well with my soul.’ This isn’t denial or delusion, it is the inner sense of quietness that God can give. Only an eternal perspective allows for that kind of contentment.

I don’t envy the Chancellor, and I do not trivialise the very real challenges raised by having to make tough economic choices. Britain is clearly in a place where some stringent fiscal discipline is needed, and that will inevitably cause some hardship and difficulties. But in the face of all the discontent that is so freely shared in the news, there is another way to respond. Instead of complaining about our flawed Government or moaning about our circumstances, we can change our perspective to put our trust in the ultimate Authority. And in doing so can find a peace that the world cannot give. Contentment is a treasure beyond the wealth of nations.