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
Care
Comment
Mental Health
4 min read

Suicide prevention cannot be done in isolation

Community response is needed, not just remote call-handling

Rachael is an author and theology of mental health specialist. 

 

 

Three posters with suicide prevention messages.
Samaritans adverts.

Suicide is a tragedy that leaves devastation in its wake for individuals, families and communities - but it remains shrouded in stigma. Whilst those who die by suicide are grieved and mourned amongst their communities, those who experience suicidal thoughts or who survive suicide attempts are often dismissed as ‘attention-seeking’ or ‘dramatic’.  

The truth is, our response as a society to suicide is one which often ignores those who are most vulnerable until it is too late. According to the UK Office for National Statistics, the number of people dying by suicide has risen steadily since 2021, and whilst some of this can be attributed to the way in which deaths are recorded, it also represents a real and urgent need to change the narrative around suicide and the suicidal.  

As the need has risen, we have also seen that services seeking to support those struggling with rising costs and rising demand.  

Just 64 per cent of urgent cases and 72 per cent of routine cases were receiving treatment within the recommended time frames and the proportion of NHS funding being allocated to mental health falling between 2018 and 2023 highlights that the parity of esteem for mental health promised back in 2010 seems to grow further away. 

Against this backdrop, for over seventy years, the Samaritans have been synonymous with suicide prevention, working where the health service has struggled to be. It’s sometimes been referred to as the fourth emergency service and has been providing spaces, mainly staffed by volunteers, in person, on the phone and online for people to express their despair in confidence.  

And yet earlier this year, it was announced that over the next decade, at least 100 of its branches would be closing, moving to larger regional working and piloting remote call-handling.  

Whilst this might be an understandable move considering the economic landscape for the Samaritans, it risks not only a backlash from the volunteers upon which Samaritans relies but also reducing the community support that locally resourced hubs provide.  

Suicide prevention cannot be done in isolation; it has to be done in and with community.  

Even the most well-trained and seasoned volunteer might find particular calls distressing, and the idea that they would have to face these remotely, without other volunteers to support them, is concerning.  

I think this needs to be a wake-up call, not just for the sector - but society as a whole. Because when it comes to suicide, we need to work together to see an end to the stigma and a change in the way people are supported. 

Suicide prevention cannot be left up to charities, we all have a role to play. 

It matters how we engage with one another, because suicide can affect anyone. There are undoubtedly groups within society who are at a higher risk (for example, young people and men in their middle age).  

Still, nobody is immune to hopelessness, and even the smallest acts of kindness and care can help to prevent suicide.  

In the Bible story of the Good Samaritan, from which Samaritans take its name, Jesus tell the story of a man brutally robbed and left for dead on the roadside. A priest and a Levite avoid the man and the help he so clearly needs, but a Samaritan (thought of as an enemy to Jesus’ audience) was the one to not only care for his physical wounds, but also pay for him to recuperate at an inn.  

We need to have our eyes open to the suffering around us, but also a willingness to help. It probably won’t be by giving someone a lift on a donkey as it is in the story(!) but it will almost certainly involve asking the people we meet how they are and not only waiting for the answer, but following it up to enable people to share.  

It might require us to challenge the language used around suicide; moving from the stigmatising “committing suicide” with its roots in the criminalisation of suicide which was present before 1962 to “died by suicide”, and shifting from terms like “failed suicide attempt” to “survived suicide attempt” so that those who must rebuild their lives after an attempt are met with compassion and not condemnation.  

Above all, we need to be able to see beyond labels such as “attention seeking” or “treatment resistant” to reach the person whose hope has run dry, and allow our hope to be borrowed by those most in need, both through our language and our actions.

Support Seen & Unseen

Since Spring 2023, our readers have enjoyed over 1,500 articles. All for free. 
This is made possible through the generosity of our amazing community of supporters.

If you enjoy Seen & Unseen, would you consider making a gift towards our work?
 
Do so by joining Behind The Seen. Alongside other benefits, you’ll receive an extra fortnightly email from me sharing my reading and reflections on the ideas that are shaping our times.

Graham Tomlin
Editor-in-Chief