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
Books
Comment
Film & TV
Morality
6 min read

Murder we wrote: how cosy crime and psycho-thrillers carve our minds

Our reactions have changed from heart-wringing cries to merely puzzle-solving

Theodore is author of the historical fiction series The Wanderer Chronicles.

Elderly amateur sleuth stand by their pinboard.
The Thursday Murder Club convenes.
Netflix.

We love murder. 

That seems to be the only reasonable conclusion when you look at the sales figures of Richard Osman’s record-busting murder mystery series, which opened with The Thursday Murder Club back in 2020. In UK sales alone, it sold over a million copies within the same year as its release, something no other book has ever done.  

This was more than a bestselling debut novel, this was a cultural event in UK publishing. And no doubt Netflix are hoping for something equally seismic when their film adaptation of The Thursday Murder Club goes live. 

The combination of light humour, a clutch of charismatic octogenarians, tea and cake, and the odd violent death or two to keep them entertained, seems to have struck the motherlode of British cultural appeal. I can only imagine the stellar cast they have assembled for the film adaptation, led by Helen Mirren and Pierce Brosnan, will take the series’ success to new heights. 

As an author currently puzzling my way through my own contemporary murder mystery, I can only look on at the phenomenon in wonder and sigh for what may yet be.  

But murder has always been a tricky one for me as a) an author, and b) a Christian. Do those two facts mean I have to be a “Christian author”? And if so, what kind of limits does that put around what I should be writing about? It may not sound like much of a conundrum to you, but honestly I have wrestled with this question for a long time. There is darkness in the world: how much darkness should I explore in my books? (So far, if you ever read any of my historical novels, you’ll see the answer is: quite a lot.) 

Maybe I’m taking it all too seriously and murder is mere light entertainment now. Death is to be enjoyed with a nice cup of tea; evil, with slice of Victoria sponge cake. 

But somehow, I don’t think so. 

Recently, I was helped in my moral quandary by another crime author, Andrew Klavan. In his book, The Kingdom of Cain, published last month, Klavan explores the question of evil and specifically murder in what he terms a ‘literature of darkness’. It is a fascinating, if unusual, book. His approach is to take three murders that actually happened, and demonstrate how each has influenced a long succession of murder novels (and movies) up to the present day.  

Through this exposition, we witness the changing attitudes to murder over the last century and a half and in particular how those changes seem strongly linked to the ebbing tide of Christian faith in the West. 

For example, Dostoyevsky’s great novel, Crime and Punishment, was published in 1866. The double-murder, central to the plot, is carried out by a young student named Raskolnikov. He is an intellectual who is seeking to prove that the moral boundary beyond which murder lies is nothing more than a mere concoction, a social construct (or worse, a religious one) which he, being of superior intelligence, can transcend and therefore ignore. The entire novel is the story of how his conscience will not allow him to get away with this. Near the end, he confesses his crime to the young prostitute, Sonya, who responds to his confession in fearful horror: 

“What have you done? What have you done to yourself?” 

The second question is key. 

Dostoyevsky based the plot of his novel on a real axe-murderer, a Frenchman called Pierre François Lacenaire, who went to the guillotine in 1836. Lacenaire became an international sensation when, in court, he aired many of his own pseudo-intellectual justifications for his actions – that the murders he committed were a strike against the injustice of the elites and the iniquitous power structures of the day. Rather than what they appeared to be: a grubby little double murder for the sake of a few francs. Lacenaire set the tune which many still whistle today, I’m sorry to say. 

But Dostoyevsky was prophetic. He foresaw long before Nietzsche and others who would follow, that the tide of Christian faith was going out in Western civilization. And so it continued to do through the back end of the twentieth century and into this one. 

Before that, the notion that murder is wrong because every human being is made in the image of God was a long-held axiom, going back arguably to the first chapters of Genesis. And in killing the image of God, any image of God, this may therefore be the closest we can come to killing God himself. Seen in that light, murder is sacrilege on an appalling scale.  

But there’s the rub. That light has dimmed. The secular philosophies of the nineteenth and twentieth centuries have turned down the dimmer-switch, so that it is no longer axiomatic that humans possess an inherent sacred value. Instead, in varying guises and to varying degrees, the conclusion has been that humans are nothing but self-conscious lumps of meat. We (the state, the law) may ascribe them some value. “We are all equal,” yes - but as George Orwell anticipated, “some are more equal than others.” (Is intersectionality, for example, anything but the manifestation of that prediction?) 

Maybe this explains how the horror of murder has diminished from Sonya’s heart-wringing cry, into something more akin to a crossword puzzle. Don’t get me wrong, I love a good Agatha Christie. But her murder mysteries don’t waste much time on the philosophical implications of, say, the local doctor bumping off the parish priest. 

And from there, the genre of the murder mystery has split into two strains. On the one hand, we get the psycho-thriller, in which the horror of the act of murder is of less interest than the dark psychological state of mind of the killer themselves. But if that’s too dark, don’t worry. We can do light, too! And so on to cosy crime blockbusters, in which, if a murder was committed, it was because the victim had it coming – so let’s all calm down and have another slice of cake. 

There is no space here in which to explore how, as a culture, our collective historical experience may have helped to steer us in this direction, as well as our changing philosophy. But there is no doubt where we have ended up. We see death cults all around us. We see legislation being passed in our Parliament which would have been unthinkable until very recently. We see social justice where before we saw crimes.  

Think about how often the arch-crimes of history have been perpetrated on the ground of viewing the “other” as less than human, and certainly less than sacred. Then ask yourself, why should we see any human as more than a lump of meat? At what point does the rubber hit the road? - as surely it will. 

What have we done? What have we done to ourselves? 

I do wonder where all this goes. And yet, if the spiritual bellwethers are to be believed, perhaps we have reached low tide at long last – certainly it has revealed some pretty ugly creatures lurking at the bottom of the rock pool. Many, myself included, must hope that the tide of faith is truly on the turn. Let’s see. Certainly, if this proves to be the case, it seems to follow that our attitude to murder will change with that on-rushing tide. And so with it, the literature of darkness. 

Beyond The Thursday Murder Club, there may yet be other great stories told of murder; they, like Crime & Punishment, will be far truer, and in a paradoxical sense, far more beautiful. After all, at the heart of the gospel, there lies a murder. If God himself can take such a dark event and turn it into light, then, at a far inferior level perhaps, as His image-bearers, so might we. 

Which reminds me… back to my draft.

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