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. 

Essay
America
Comment
Leading
Politics
6 min read

Democracy, hypocrisy and us

A deep dive into the pitfalls of political vision and our response to them.

Josh is a curate in London, and is completing a PhD in theology.

Donald Trump holds his arms out to his side while speaking.
Trump addresses a faith leader event.
x/realdonaldtrump.

Coverage of the Republican candidate for Vice-President, J.D. Vance can't help but return again and again to his Christian intellectual influences. Whether it's an interview with Rod Dreher or an analysis of Patrick Deneen and other 'New Right' thinkers, many US political journalists are having to give their readers a crash course in some of the most controversial ideas in contemporary theology. One recent Politico article stands out because it didn't just introduce an unsuspecting audience of political obsessives to an obscure theologian, it also told them (us) about contradictory ways one might read said obscure theologian. And yet these contradictions force us to confront a difficulty facing anyone engaged in democratic debate.  

In the article , Ian Ward sought to explore the impact of Rene Girard's scapegoat mechanism on Vance. In doing so, Ward underlines the importance of Girard's ideas in the intellectual circles around J.D. Vance and his mentor, Peter Thiel.  

Girard, a French academic who died in 2015, is remembered foremost for his analysis of the relation between desire and conflict. Girard proposes that desire is ‘memetic, that is to say, it mimics; I want what I see that others want. This naturally leads to conflict, a conflict that can only be resolved by a scapegoat. Identifying a scapegoat, an out-group, is a force powerful enough to create a sense of solidarity between those would otherwise be in conflict over shared desires. 

The Politico take considered how Vance's reading of Girard might relate to Vance's defence of his running mate's false suggestion that Haitian immigrants are eating their neighbour's pets in Springfield, Ohio. It went as far to suggest that—rather than a rejection of Girard's analysis— Vance could be understood to be applying a pragmatic reading of Girard. Ward writes:  

Though Girard never said so outright, some of his interpreters have argued that Girard’s idea of the Christian ethic — which in theory offers an alternative to ritualistic violence as a basis for social cohesion — cannot in practice serve as the basis for a large, complex and modern society. 

Scapegoating is inevitable, deploy it to your advantage. We cannot know how exactly this or any reading of Rene Girard factors into his political tactics. What we can know is that Vance's public fascination with big ideas opens him up to a charge upon which a healthy democracy depends: hypocrisy.  

In contrast, there is often a surprising transparency to Trump's appeals to self-interest, Addressing a audience in July, Trump declared:  

Christians, get out and vote, just this time. You won't have to do it anymore. Four more years, you know what, it will be fixed, it will be fine, you won't have to vote anymore, my beautiful Christians. 

As much as Vance and others try to change this, there is little ideological content, no substance behind ‘Make America Great Again’ insofar as Trump tells it. It is politics at its most transactional and what Trump offer his supporters, beautiful or otherwise, is so often a scapegoat. Trump tends to be pretty open about this and, as ugly as this kind of politics is, there is a strange kind of honesty to it. But Vance is different. He has big ideas. And however weird you may think these ideas are, and however much tension there seems to be between his love of Rene Girard and his scapegoating of Haitian immigrants, democracy is better for that tension. Constructive democratic debate, in some sense, depends on hypocrisy. Without it, democracy would be nothing more than a negotiation around mere self-interest.  

A politician with an ideological vision is one that can be held accountable. Keir Starmer's recent decision to pay back £6,000 worth of gifts is a case in point. Had he not sought to set himself as a contrast to the Boris Johnson of Partygate, the criticism of his accepting clothes and tickets would not have had the same bite. 

Stumbling into politics haunted by a sense that things could be better will make us hypocrites on impact.

The first generations of Christians encountered a similar problem. The law they believed that they had received from God showed them a vision for the good life just as it revealed all the ways they fell short. As the early church leader Paul wrote: “through the Law comes the knowledge of sin.” We might add that through political ideology or aspiration comes the knowledge of political hypocrisy.  

Had Vance never publicly explored Girard's theory, if he were only an opportunist more like Trump, we would have one less means by which to hold him to account. Every politician will be found lacking when judged by their public ideological aspirations. And the more ideological aspirations, the greater the charge of hypocrisy. Hypocrisy will always be found wherever we find people debating and aspiring to ideas more perfect than they are.  I'm not defending any individual hypocrisy; the residents of Springfield, Ohio and newcomers across the US deserve so much better. Hypocrisy is always disappointing, but it is less disappointing than the alternatives: either a naked pursuit of self-interest or a naïve expectation of ideological purity. 

The question for each of us in a democracy is how we live with hypocrisy, expecting it while still expecting more from those who wish to serve us in public office. And a moment's introspection reveals that it is a charge that confronts each of us also: the shaming gap between my aspirations for my life and the reality. To ask how we live with these hypocritical politicians is really to ask how we live with ourselves? 

With that we return to Girard. He claimed that Jesus Christ willingly became a transparently innocent scapegoat and in doing so undermined the mechanism. In the Politico article, Vance is quoted as follows:  

In Christ, we see our efforts to shift blame and our own inadequacies onto a victim for what they are: a moral failing, projected violently upon someone else. Christ is the scapegoat who reveals our imperfections, and forces us to look at our own flaws rather than blame our society’s chosen victims. 

The exacting logic of the crucifixion prevents us from scapegoating even the scapegoating politicians. 

But Jesus’ death is more than an embodied social critique. In coming to us and dying in the person of Jesus, God showed his love for imperfect people struggling under the weight of perfect ideas. He came to give the home and safety we all desire, offered freely to hypocrites.  The point of Christ's death is not, at least in the first instance, to inspire me to treat others better. It is God's unconditioned offer to the broken and hypocritical, as the broken and hypocritical, not as he'd rather we be. 

Paul puts it like this: "God demonstrates his own love for us in this: While we were still sinners, Christ died for us." Yes, God's grace is too dramatic, too strong not to provoke us and empower us to change, but his love comes to us before any change. It comes to us as we are, nursing our pitchforks and that self-righteous sense that it's all really someone else's fault.  

Stumbling into politics haunted by a sense that things could be better will make us hypocrites on impact. We must not excuse this hypocrisy; we should hold ourselves and our leaders to account. And yet we can do so gratefully haunted and gratefully held by a God who came for hypocrites.