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
Comment
Identity
Nationalism
5 min read

Which nation are you flying the flag for?

Flag raisings, Ed Sheeran, and my split national identity

Juila is a writer and social justice advocate. 

A Union Jack is draped over a railing, next to a red flag saying Jesus.
A flag demonstration, Portsmouth.
TikTok.

Flags are flying from lamp posts around England. It’s newsworthy here – and yet reports barely note that for those of us from Northern Ireland, we know something of this. A couple of weeks ago, the backlash was loud when Ed Sheeran declared himself ‘culturally Irish’, attributing greater significance to his family’s heritage than being born and raised in England. When it comes to signs of identity, things can quickly get personal. 

In my family – Northern Irish mother, English father, two daughters born in London but most of our childhood spent living just outside Belfast – we’ve been known to debate points to tot up our national identities over the dinner table. Does a place of birth outweigh the school years? When does formation finish – on turning 18 or do the months away at university count for anything? Does it matter how our mixed DNA actually expresses in our hair, our eyes, our stature?  

It’s a game and it’s our deeply felt reality. It’s the years spent with my schoolmates teaching me to correctly say ‘how now brown cow’ – and the arrival in England to find people couldn’t understand me saying my own name. It’s the stomach churn I still feel when I see flags flying, having grown up in a country where banners signal who is in – and therefore who is out. It touches on the questions of belonging and home.  

Irishness seems to travel well. The popularity of the island’s artists and art (from Paul Mescal to Derry Girls) are all signifiers of this cultural moment. But being Irish has always carried more cachet when I’ve been abroad, and I confess that when it has suited, I have led with my more ‘palatable’ half (or quarter or… the family maths is still up for debate). It’s convenient – but there’s also a discomfort in the enduring appeal of ‘Irishness’ outside of the island. It’s an ‘otherness’ that evokes intrigue and warmth, rather than fear. Difference that is more than acceptable, sometimes desirable. Distinct enough to be interesting but unthreatening for often being associated with white skin. 

Underneath the light-hearted arguments of our dinner table is a question of formation. Ed Sheeran attributes his sense of being Irish to the things that he feels have shaped him. It’s in being away from Belfast, living in England, that that I have seen more clearly the ways that Irishness has formed me. Watching Derry Girls with my English husband I freely laughed at what I assumed were universal jokes, only to have to hit pause and explain them. The show unearthed memories – not bad, just not often recalled – of Bill Clinton’s historic visit and the ‘across the barricades’ style gathering of primary schools from different sides of the community. 

Signs and symbols matter. I recently rewatched an episode of tv show, The West Wing, in which the US flag may – or may not – have been burned as part of a trick by magicians Penn and Teller. A media maelstrom follows. Whether or not the flag burned matters, as does the symbolism of this act taking place in the White House, itself an emblem of national identity and power. 

Reflecting on the news, I find myself thinking about the signs of a different kind of kingdom, one that transgresses national borders. In the Bible there's the story of one man who died once for all the world. And in dying, he brought forth his kingdom – one that crosses boundary lines to be truly global. The signs of this kingdom are not division or disconnection but peace and justice, joy and comfort, healing and presence. 

This is not about homogenisation. It’s not about the erosion of cultures, but about the beauty of all represented. As Harvey Kwiyani, a theologian from Malawi, puts it: “We are all welcome to God’s kingdom with our unique cultures. Being in the kingdom of God does not erase our cultural differences… The kingdom of God finds its fullest expression in intercultural mutuality. It is a multicultural kingdom.” The kingdom of God in all its richness – that’s a tempting proposition.  

It’s easy to see that we aren’t living in the fullness of this yet. But the world is not a static place. One metaphor used to describe the kingdom of God is yeast; living cultures filling the dough, making it rise. This is an image that is expansive, generous. The kingdom isn’t wholly realised yet, but we can see more and more of it. 

And like the yeast, we have a role to play in culture changing. As Graham Tomlin wrote following debates about ‘Englishness’, belonging to the kingdom of God means we have an identity not defined by where we live. Being part of this kingdom, we also become active participants in it. Formation is not just about us; we get to play an intentional role in the formation of a kinder world, in the coming of God’s kingdom. In the midst of fear and uncertainty, our ability to engage in such life-giving action offers a concrete hope.   

This is not a defensive position, but a brokering one. The kingdom is bigger than our individual lives, churches or communities; recognising this helps us to break out of a fortress mentality. So far, this century has been marked by fortification. As well as the raising of flags, there have also been walls. At the end of the second world war there were fewer than five border walls; there are now more than 70, most of them built in the last two decades. But the kingdom of God offers a view of home that is not about defence, not about perimeters, or even places. It’s a relationship with God, who made and sustains this world, who crosses the divide to meet each of us. In meeting him, we can partner together in seeing more of his kingdom on this earth.  

Anthropologist Andrew Shyrock defines sovereignty as “manifest in the ability to act as host”. Or to ground it in the day to day: to be able to offer a cup of tea. Perhaps some of the anger about Ed Sheeran’s claim is because of what it seems to either take or reject, pulling towards one nation while turning a back to another. Belonging to the kingdom of God invites us to think beyond what we can have to how we can intentionally serve. It has room to honour heritage and at the same time, it bends forward towards eternity. In the day to day, I find this a comfort: to see formation as not just about the past, but also the power of creative act after creative act in shaping the world that’s coming. 

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