Column
Assisted dying
Care
Comment
4 min read

Proposed euthanasia safeguards insult our NHS

We must defend a collective sense of care and generosity.

George is a visiting fellow at the London School of Economics and an Anglican priest.

A gable end mural depicts a nurse in scrubs and a mask turning and looking towards the viewer.
A mural of an NHS nurse during COVID, Manchester.
Mural Republic

It was, I believe, the late political satirist Simon Hoggart who coined the Law of the Ridiculous Reverse, which held that, if the opposite of a statement is plainly absurd, then it was not worth making in the first place.  

This law comes to mind when Labour MP Kim Leadbeater promises that her Assisted Dying Bill will have the “strictest safeguards in the world”, one of which is that those patients who have ordered their fatal dose “would be allowed to change their mind at any time.”   

Where, exactly, has it ever been suggested that an individual, having asked for an assisted death, would not be allowed to change their mind? I’m just wondering which legislator or medical professional has proposed that once a lethal draught has been prescribed then there is no turning back.  

I’m struggling to picture the circumstance in which a terminally ill patient is pinned down and killed, the last words that they hear being: “I’m sorry Mrs Simpkins, but everyone’s gone to a lot of trouble. You asked for it and you’re jolly well going to get it.” 

This is important because, apparently, being able to change your mind about asking for help to kill yourself is one of the strictest safeguards in the world. I hope Ms Leadbeater will forgive me for pointing out that this doesn’t really stack up. 

 And what’s serious about it is that it’s also a massive straw man argument. The clear and rather devious implication is that one of the arguments being made against the introduction of an assisted suicide law is that patients won’t be able to change their minds about it, which I think we can all accept simply isn’t a fact at all. It’s absurd – a Ridiculous Reverse. 

So I’ll defend the NHS with a religious fervour. To my mind, healthcare is a holy mission. We meddle in law with the Hippocratic Oath at our very deep peril. 

It’s also hugely contemptuous of the medical profession in general and rude to the NHS in particular. That’s because there’s a snide impression behind Leadbeater’s comment there may be hundreds of budding Harold Shipman out there, but her powerful safeguards are going to protect us from them. 

We’re in danger of becoming inured to this kind of insult from politicians directed at the NHS. And it’s worth exploring why they might think we need to be protected from unscrupulous doctors and nurses. In this case, one possible reason is that the NHS isn’t being particularly helpful in giving the euthanasia enthusiasts what they want. 

Doctors and their staff have plenty of ethical objections to assisted suicide. But leave those aside for a moment. At the practical level, the NHS has made it clear that it doesn’t have the infrastructure to operate a policy of assisted deaths safely. And it can’t afford to set one up. So a government that introduces assisted suicide is going to have to organise and regulate its own assisted death agency. 

“Oh,” the assisted dying lobbyists seem to exclaim, “we’d presumed you’d do as you’re told.” Just hand out the hemlock. Take your instructions from the legislature. 

But the NHS is better than that. And it’s that kind of high principle that so infuriates feckless politicians. It was the late Nigel Lawson who said, somewhat ruefully, that the NHS “is the closest thing the English have to a religion”. The right wing of politics regularly tells us it’s time to renounce that religion. 

To worship the NHS as a religion would, literally, be idolatrous. But it’s not so to acknowledge its religious qualities. Just look at the word – the Latin religio means something like “good faith”, the essence of who we are, what makes us good. 

The NHS, in its post-war incarnation, has been central to who we are as a people and what defines us. It’s something to do with our collective sense of care and generosity to one another. Its members, like our national Church, make up a single body. 

This is not to co-opt the NHS as the medical wing of the Church. It’s no part of the NHS’s brief to proselytize – rather the reverse; Christian medical staff have been in deep disciplinary trouble for evangelising. It is a profoundly secular organisation. 

So the NHS emphatically isn’t in the business of propagating the gospel. But that’s not to say that we can’t be in the same business. Many priests have stories of their most affirming work being in the company of people of other faiths or of none. 

The NHS’s proud heritage is to offer treatment free to anyone at the point of access. Put another way, it will seek to heal anyone who comes to it. I make no apology for saying that sounds familiar. 

So I’ll defend the NHS with a religious fervour. To my mind, healthcare is a holy mission. We meddle in law with the Hippocratic Oath at our very deep peril. 

And when NHS professionals tell us where we can stick our assisted suicides, I respectfully suggest we give it our solemn attention, rather than patronisingly offering a Law of the Ridiculous Reverse.

Essay
Comment
Politics
10 min read

England needs a written constitution that defends against populism

A new resolution acknowledges what forges a sense of right and wrong.
A wide angle picture shows a king and queen on thrones before many people in ceremonial clothes.
The Opening of Parliament.
Roger Harris/House of Lords, CC BY 3.0, via Wikimedia Commons.

New Year is often a time for reckoning and resolutions. Nations, no less than individual persons, would benefit from such an annual reckoning with themselves.  

If in life we must always strive to find some Aristotelian ‘golden mean’, between recklessness and timidity so it is in the life of states and nations. Many countries have been brought into ruin by the excess of misdirected appetites and wrongly-ordered desires: demagogues inflaming the people; oligarchs seeking to turn the res publica – the ‘public thing’ – into their own personal fiefdom. Revolutions, corruption and public lassitude are the wages of such sins. Ultimately, it ends in the death of the state itself: the collapse of all legitimate authority into warring gangs, while refugees flee, if they can, to the borders. 

Many countries, conversely, go through their lives in cowed timidity, until they end up in an old age of regret, having never achieved their full potential. These nations do not necessarily collapse, but slowly decline – unable to reform themselves, locked in a vision of their past that was better than their present or any imaginable future.  

 England is at risk of both these dangers. On the one hand, a reckless reactionary populism, which has long laid dormant, but has been unleashed since 2016. It threatens to abandon all prudence and overthrow all restraint, to attack the civil service and the courts, to reject Human Rights, to corrode civic discourse, and to set aside all procedural propriety, until we end up sodden in the gutter of despotism. On the one hand, a persistent constitutional conservatism stands in the way of the necessary, long overdue, reforms which would breathe life and vitality back into an old, tired, country, and would give our institutions the strength to resist such destructive forces.  

Nations, like people, can experience decisive moments of what might be termed repentance. When they wake up in the gutter – their capital city bombed, their army disbanded, their people starving – they can turn from the paths which took them to that place, and find a newness of life, a new hope, embodied in a new constitutional order. This is what Germany, Italy and Japan did after 1945. They can also experience a kind of conversion, away from false principles to truer ones, as much of Central Europe did after the fall of the Berlin Wall.  

I am using theological language here to describe merely civic and political attitudes, which is always a dangerous thing to do. It would be a misreading of my intent if one were to conclude that I conflate a well-ordered polity with the Heavenly City. Nevertheless, a well-constituted polity, in which freedom and justice, peace and the common good, are not only treasured but actually – to some practical extent – achieved, is an inestimable blessing. We should strive to obtain it.  

A well-constituted polity is based upon the principle of ‘public government’. The state is a public entity, belonging to the public, in which public office is a public trust to be used for public ends, and where citizens in public life must be faithful stewards of the public good, for which they are responsible to the public. 

Democracy is our shorthand term for this arrangement, although it is a rather clumsy one. Democracy, properly understood, is not unlimited majority rule, nor the unconstrained rule of the person elected by the majority. It is, rather, a complex political system that combines representative and responsible government with civil liberties and the rule of law.  

Populism is a caricature of democracy. Populists attempt to undermine the barriers that restrain abuses of power. Their attempts to weaken the judiciary and civil service, sideline those who disagree with them, infringe fundamental rights, centralise power, and restrict public dissent, must therefore be seen as attacks on democracy. They put arbitrary power into the hands of particular persons. 

England’s position is not that of Germany in 1945. It might, in some ways, be analogous to that of Central Europe in the 1990s. Much of England today looks like I remember my first visit there then: the same grey faces, the same cheap clothes, the same visible effects of bad housing, bad food, and lack of opportunity. If anything, England is worse off, because at least those countries had hope of better days ahead. No one yet has imagined an English future better than its past.  

England has been let down by a failed ideology – that of neoliberal capitalism, which, as Dr Abby Innes points out, is every bit as rigid and doctrinaire as the official Marxist ideology of the former Communist states. England has been let down, too, by decades of corrupt, incompetent, short-sighted and careless government. The symptoms of misgovernment can be seen in England’s economic record, its social problems, its crumbling infrastructure and over-stretched public services.  Outside the Customs Union and the Single Market, England is isolated from its European neighbours.  The country is not living up to its potential.  

This should spur us to consider the weakness of English democracy. As currently established, the state often fails to serve the common good. The English do not live in a well-constituted polity with ‘public government’ as its foundation, but in a fiefdom-state that has been cut, privatised, deregulated into near oblivion.  

If it were only a matter of specific individuals, or of one party, the problem could easily be fixed. But the country has not only been let down by this government or that government, by this party or that Prime Minister. It is the system of government, the constitutional order as a whole, that has failed us. 

Restoring England’s hope for the future, its prosperity, and its quality of life, must begin, then, with the improvement of English democracy, and that with a refoundation of its constitution. This is hard to hear, because, as Mr Podsnap put it in Charles’ Dickens 1864 novel Our Mutual Friend, ‘We Englishmen are very proud of our constitution, Sir. It was bestowed upon us by Providence. No other country is so favoured as this country.' It is hard to admit that something is broken, when once it was so highly prized – indeed, so intrinsically bound up in England’s sense of national identity. 

The Westminster Model of democracy is not without its virtues. Its origins can be traced far back into English history. Yet it did not develop into maturity in England alone. Bagehot was carried around the world, read under palm and pine, and drilled into the ruling classes from Vancouver to Colombo. The Westminster Model owes much to Magna Carta and Simon de Montfort’s ‘Model Parliament’ of 1295, but it owes just as much to the developments of the Victorian age: (nearly) universal suffrage, political parties, manifestos, and the establishment of a permanent, professional and non-partisan civil service.  

The transformation of Empire to Commonwealth ended British rule, but not the British way of ruling. Westminster Model democracy had to be set down, of course, into a written, supreme-and-fundamental law, through which all the essentials were faithfully reproduced. If you want to discover the Westminster Model of democracy at its peak, read the constitutions of Belize or the Solomon Islands.

The rejection of written constitutions has been a prevailing English conservative principle since Burke. However, it leaves us defenceless against authoritarian reactionary populism. 

The irony is that those who are most comfortable with the imperial legacy are also those who are doing most to destroy public government at home. While fetishizing ‘The British Constitution’ and ‘Our Eight Hundred Years of Unbroken History’, the populist right rejects the principles and the values upon which that achievement rested. Just as they seek to create a pastiche of 1950s Britishness (absent of strong workers’ rights, strong unions, a generous welfare state, and publicly owned utilities and services), so likewise they seek to create a pastiche of the 1950s British Constitution, without the self-restraint, moderation, decorum, public service ethos, and high levels of social trust and cohesion, which made that system of complex unwritten rules work.  

The Blair-Brown reforms of 1997-2010 are a particular target of reactionary ire. The Human Rights Act mitigated, although it did not remove, the absolutism of Parliament. It gave the people who have little voice under a purely majoritarian system – ‘the weird, the wicked, the weak’ – a means by which to challenge the exercise of power. Devolution broke the prevailing English notion of British uniformity: it not only allowed Scotland and Wales to have a (muted) political voice and some (tightly constrained) freedom to craft their own policies, but also forced England into a reckoning with its own national identity. So far, this has played out mostly through the doubling-down on what the former Labour MP and scholar of English identity John Denham calls ‘Anglo-centric British nationalism’. The Tory – and Reform UK – constitutional agenda is obsessed with restoring the unlimited power of Parliament and of reinforcing the Anglo-centric British state. 

As we can see, from every NHS waiting list to every pothole in the road, the Anglo-British state is no longer working very well. It has all the vices of its past, and few of its virtues. A return to the pre-1997 status quo ante is impossible – it would be like trying to retake Hong Kong. Parliamentary absolutism tempered by the ‘good chaps’ theory is no longer a viable option. Either we must accept an untampered absolutism – which is the agenda of the reactionary populist right – or else we must deepen constitutional reform, and arrive at a new constitutional settlement which accepts that the British Imperial state, oriented to the needs of maritime imperial commerce, is over, and that an English nation-state, oriented to the common good of the ordinary people of England, is now needed.  

This entails a new, democratic, constitutional foundation. Small-c conservatives might baulk at this. The rejection of written constitutions has been a prevailing English conservative principle since Burke. However, it leaves us defenceless against authoritarian reactionary populism. Moderate, sensible, responsible conservatives should learn to think differently about written constitutions. Paradoxically, constitutionalism strengthens the state. By bounding and limiting state power, and providing a robust system of responsibility, accountability, and restraint, constitutional government actually enables the state to draw upon a deeper well of public legitimacy.  

What would English identity look like, if it were forged between the Channel and the Tweed, and not between the Nile and the Irrawaddy? What might an English constitution look like, and what values and principles might inform it?  

A constitution for England must recognise that England is a society of many faiths and none. It is, however, an acknowledgment that Christianity has forged and formed not only our institutions, but also our understandings of right and wrong. 

In addressing the last of these questions, the Christian tradition has much to add to the conversation.  

Christian theologians and political philosophers have spilled a lot of ink, in the past two millennia, on questions of good government, on the relationship between church and state, and what it means to be a Christian and a citizen of an earthly state.  

There seems to be an assumption – amongst both supporters and opponents of written constitutions – that a written constitution would have to be based on secular values. This stems, in part, from our ignorance of our own Westminster Model constitutional tradition. The constitutions of the United States and of France might be strictly secular, but the constitution of Antigua and Barbuda claims to be ‘founded upon principles that acknowledge the supremacy of God’, while that of Tuvalu explicitly refers to ‘respect for Christian principles’.  

This is not a bid for theocracy. A constitution for England must recognise that England is a society of many faiths and none. It is, however, an acknowledgment that Christianity has forged and formed not only our institutions, but also our understandings of right and wrong. To give all that up would produce an ethical vacuum in society, which will be filled only with ever more grotesque forms of exploitation.  

The cardinal ethical principle of constitutional democracy is a recognition of human dignity. At the origin and foundation of all institutions, and laws, and norms, we find ourselves having to cling to the fundamental command that Christians call the Golden Rule: ‘Do unto others as you would have others do unto you’. If we abandon that principle of human dignity, there is no solid ground on which to build a decent, well-ordered, democratic polity. Perhaps then we can build a new ‘Jerusalem’ in England’s grey and drizzly land. 

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