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
Ethics
Politics
War & peace
5 min read

We must invest in defence, fast - it’s the only moral thing to do

The responsible use of force today precludes pacifism

Emerson Csorba works in deep tech, following experience in geopolitics and energy.

Amid a bombed alley, a victim is helped to walk by a rescue worker
Aftermath of a Russian drone attack, Odesa, Ukraine.
Dsns.gov.ua, CC BY 4.0, via Wikimedia Commons.

In May 2016, I was hiking the Southwest Coast Path in a group, trudging through dense forest between Lyme Regis and Weymouth, when a distinctly unsettling event occurred. As we moved along a narrow trail, a buzzing sound began—we assumed we had disturbed a bee’s nest. We quickened my pace, but the buzzing continued. Eventually, we emerged from the woods and looked up. The sound had not come from bees, but from a drone that had been following us.

I will never forget that sound; the eerie sense of something pursuing you, but unseen. In a recent BBC special on the war in Ukraine, a journalist documents the now-pervasive use of drones, the journalist and Ukrainian soldiers hiding under the cover of forest as a Russian drone scans the area, before escaping to their car in which an AI voice says ‘Detection: multiple drones, multiple pilots, high signal strength’ as they journey overground. This is the new era of covert warfare, where the enemy strikes without being easily identified. You hear the hum, but the source is elusive.

In the coming years, this kind of psychological warfare will make its way into Western cities. Terrorist attacks will shift from in-person confrontations—like the Novichok poisonings in Salisbury—towards remote, anonymous assaults: drones drifting from overseas into coastal cities to target civilians, or swarms carrying out mass attacks in dense downtown cores. The aim will be psychological trauma at scale. Civilians will grow hesitant to leave home, hyper-sensitive to the buzz of anonymous drones in their own areas. Iran recently declared that no US, British, or French base is safe from retaliation in the emerging Israel–Iran war. It is not difficult to imagine Western cities soon being viewed as legitimate targets.

We are entering a time of intensified conflict, with national security becoming the dominant framework for policymaking. The watchword of UK government policy is ‘security,’ and—writing now from Montréal—the recent Canadian election was framed around which party and leader could best protect Canadians from external threat. In this context, even domains once governed by cooperation are transformed into zero-sum contests, because national security framing by its nature shifts focus from reciprocity to limitation of the other. 

Free trade, for example - fundamentally the mutually beneficial exchange of goods and services as part of the creation of value - becomes, in a security-focused world, a question of containment. Trade, in a security-focused world, is turned on its head, free trade becoming trade wars. Fairness (in which the pie is grown and shared across multiple people) is replaced by interest, whether the interest of countries or communities and individuals within them seeking to protect themselves. As US–China competition escalates, we can expect human relations—among both states and citizens—to become even more zero-sum. 

In such an environment, do morals still matter? When the enemy grows more ruthless and more innovative in an era of national security, must we match them in kind? Or is it still possible to uphold principles while defending ourselves?

Restraint and humility are still critical virtues—but must not be mistaken for weakness.

In a recent Times column, Juliet Samuel suggested that gestures of non-aggression—such as Finland’s 2015 destruction of its one million landmine stockpile—now appear dangerously naïve. Ukraine, for its part, has rightly disregarded the Ottawa and Oslo (banning cluster munitions) conventions. Its survival depends on ingenuity, rapid technological development (for instance through the work of funds such as D3), and collaboration with its allies to prototype and deploy advanced systems.

Reinhold Niebuhr, in Moral Man and Immoral Society, contends that to be moral, one must possess the capacity for force—‘power must be challenged by power.’ That power, however, must be exercised with responsibility, humility, and moral purpose. Nigel Biggar, my former doctoral supervisor and a key figure in the Niebuhr tradition of Christian realism, argues in In Defence of War that war can be justified on balance when it meets the criteria of jus ad bellum: just cause, legitimate authority, right intention, proportionality, and reasonable prospect of success. 

War, in this reading, can express a ‘kind harshness’—a form of judgment exercised in defence of victims. Like Niebuhr, Biggar grounds his argument in Augustinian realism: the world is fundamentally good, yet broken. Because evil persists, the moral use of force becomes necessary to uphold what is right. I believe this to be true, and directly applicable to the national security-focused world in which we find ourselves. 

What does this mean then for Western countries as national security reasserts itself as the central organising principle of governance?

It means significant and urgent investment in defence and deep technology, including for instance emerging capabilities like cognitive warfare and neuroadaptive systems (wearables that enhance soldiers’ performance in live combat), counter-drone systems for urban, rural, and maritime environments, and next-generation electronic warfare and geospatial intelligence.

If drone attacks intensify at sea—such as those carried out by the Houthis to disrupt global shipping routes—counter-drone systems will be vital to ensure safe passage. In a world of manipulated narratives and disinformation, geospatial intelligence will serve as a source of truth, helping establish what is actually happening on the ground. And as agentic AI grows increasingly capable of manipulating users—through sycophancy, persuasion, and other techniques—oversight technologies like Yoshua Bengio’s new LawZero project will be essential for maintaining objectivity and integrity.

The responsible use of force today precludes pacifism, averting violence altogether. It means maintaining—and advancing—the capability for overwhelming force, so it is ready if needed. Morality in an era of national security demands investment in defence technologies at speed, to stay several steps ahead of adversaries. A ‘whole-of-society’ approach, as recommended in the recent UK Strategic Defence Review, means preparing citizens with such a mindset. Restraint and humility are still critical virtues—but must not be mistaken for weakness. Western nations must be prepared to act swiftly, decisively, and with the deterrent power that peace requires.

This is the world we are entering: one in which governments and civilians alike must be ready for unexpected threats. The hum of a drone overhead is more than a sound—it is instead a warning, reminding not only Ukrainians but those currently in peaceful situations, to prepare ourselves for potential conflicts to come. The appropriate response is not retreat, but the responsible and moral exercise of power: a necessary duty if we are to preserve peace, freedom, and justice in a world increasingly intent on contesting them.

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