Article
Care
Comment
Economics
Ethics
4 min read

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

Balancing safeguards and economic expediencies after the assisted dying vote.

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. 

Article
Culture
Freedom
Justice
4 min read

Free speech for me, but not for thee

A hate crime hoo-ha and the limits of free speech

George is a visiting fellow at the London School of Economics and an Anglican priest.

Two brown bears fight while baring their teeth.
Zdeněk Macháček on Unsplash.

It was the the legendary Manchester Guardian editor CP Scott who said “Comment is free, but facts are sacred.” His dictum hay have held a century ago, but it doesn’t stand up today. In post-truth societies, facts are anything but sacred. And, leaving aside for now whether the opposite of sacred is freedom, comment isn’t free either. 

I don’t mean in the sense of whether or not you have to pay for it – you’re not paying for this, for example – but whether comment, as Scott took it for granted to be, is an act of freedom. Graham Linehan, the Father Ted comedy writer, temporarily lost his freedom to a squad of police officers at Heathrow airport for a social media post he’d tweeted: "If a trans-identified male is in a female-only space, he is committing a violent, abusive act. Make a scene, call the cops and if all else fails, punch him in the balls." 

The subsequent hoo-ha has precisely been about whether Linehan should have been free to make his comment. The police, under prevailing hate-crime laws, felt obliged to arrest him. Subsequently the media, politicians and assembled chatterati – even the Met Police commissioner weighed in – wailed how ridiculous it all was and, adopting serious-face, what a threat it represented to free speech, which is one of the most potent graven images of our time. Facts may be free these days, but comment is sacred. 

 Except it also depends whose comments and opinions are deemed sacred. So some people’s speech is more free than others. Take the Free Speech Union (FSU), founded by the liberally-challenged Toby Young. Here, right-wing freedom of speech is inalienable and non-negotiable. So silly intrusions into the views of Islamophobes and critics of trans-activism? Outrageous. But supporters of Palestine Action (PA), nearly 1,000 of whose supporters had to be arrested by police for peacefully holding placards? Not a word. They’re all lefties, you see. 

As Hugo Rifkind pointed out in The Times, neo-conservative and FSU director Douglas Murray was asked by Daniel Finkelstein whether his free-speech principles extended to PA’s superannuated supporters. Apparently not. And Reform UK’s Richard Tice simultaneously believes that protesters outside asylum hotels are “part of who we are”, but that the correct response to PA protesters is to  “arrest and charge the lot. Jail them.” Forgive me, but I thought a central tenet of faith in free speech is that it’s consistently applied? 

“Part of who we are ” used to be a tolerant, inclusive and pluralistic society. Not just campaign for our lot and bang up all the rest. And I’d contend that we should self-regulate freedom of speech rather than legislate for it. The Met Police commissioner, Sir Mark Rowley, seems to agree with that: “Regulations that were understandably intended to improve policing and laws that were intended to protect the vulnerable are now tying officers’ hands, removing appropriate professional discretion — which some call common sense.” 

That “common sense” is much beloved of freedom-of-speech warriors at places such as FSU. But they always get to define what it is and who gets to benefit from it, because it’s tribal. “If they pick on you, we’ll pick on them,” declares Young on his FSU website. It’s freedom for my tribe to say what it likes, not yours. And freedom of speech is meaningless if it’s not for everyone, including your political enemies. 

Where we agree is that freedom of speech should not be adjudicated by the law. There are enough laws without legalising what people can’t say or write. Where, I imagine, we disagree is that it shouldn’t be adjudicated by Young and Murray and Tice either. As matters stand, we have those who want to legislate for the right to free speech and those who campaign to restrict it. Nothing can come of that. 

By regulating ourselves, the risk is run of sounding conservatively nostalgic for a golden age of civility that never really existed, or rather that was imposed by social authority. It’s the sort of proposed solution you hear when someone says it’s really a question of good manners. It’s true that freedom of speech largely worked in a period of deference, but deference was probably not a good price to pay for it.  

What can be said is that, like any freedom, freedom of speech comes with congruent responsibilities. We hold a responsibility not to cause violence with what we say, even or especially if that means turning the other cheek. In ecclesiological management terms, this would make freedom of speech a pastoral rather than systemic provision. We serve each other; we don’t require the state to serve us.  

Linehan’s post was fine up until it’s final phrase. But it’s peer pressure, not the law, that should have prevented him from using it. Taking the violence out of speech should be an educated, peaceful instinct. And that remains a social duty, not a governance one.

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