Last Friday, the United Kingdom witnessed another defeat of an ‘Assisted Dying’ Bill, this time in the House of Commons. The cries of dismay from the ‘pro’ corner were predictable – this was a cruel denial of the right to self-determination, another classic case of religious people imposing their beliefs on others, and a sentence of serious suffering on those at the end of life. In wanting to propose a response to these accusations, I find myself in a tricky position: while I shudder at the way the media has used the case studies of real, suffering people to provoke morbid fascination with this debate, I am also reluctant to detach the existential argument from its context, since our socio-ethical positions do not come from nothing. Our choices do not exist in a vacuum.
But still – my response will reference no case studies. For every story of someone falsely diagnosed but then went on to several more years of health, or who died peacefully, with their family able to cherish those final months, there is another story of horrific suffering and decay and abandonment in a filthy hospital bed. Instead, consider the following question: why is it that we have got to the point where it seems preferable (or at least more realistic) that the latter group should end their lives, rather than working to grace them with the experience of the former?
The expression ‘assisted dying’ is a helpful entry point. An ideology of self-determination – or, as a ‘pro’ friend of mine put it, a belief in ‘sovereignty of the self’ – is a rather ironic basis for supporting something which, even in name, implies dependence on another. There are some things we just cannot do alone – and for the most vulnerable amongst us, this can include ending our lives. But assisted dying is a warped version of the sacred relationship of neighbour love – the extension of help is an end to your life, rather than the improvement of it. Regardless of one’s belief or not in a God-ordained moral system, our choices do not exist in a vacuum. They not only impact others around us, but also reflect our understanding of relational responsibility. When it comes to cases of people seeking medical options which would end their life, this goes both ways. Not only do we have a responsibility to care for those enduring terrible sickness or disability, but we must also learn to see the goodness in being dependent on another when we have nothing to offer them. This is a Good not only for ourselves, in that it mirrors our relationship to God, but also a Good for the person on whom we depend. It is good for humans to be ‘burdened’ by another human’s needs. In fact, it is precisely the kind of burden we should seek.
And this leads us to a second warped ‘Good’ made manifest in Assisted Dying legislation: the sacred act of self-sacrifice. If the guiding societal principle at hand is that your death would be of greater benefit to the people you love than your continued existence, it is little wonder that a driving motivator behind end-of-life wishes is to ‘unburden’ family members and friends. And perhaps that should disturb us most of all; that the very act we are called to embody as disciples of Christ might be prescribed to the weak so as not to inconvenience the strong.
Perhaps I am expressing a religious value as the basis for my argument here, but it is no more ideologically driven than a belief in ‘sovereignty of the self’. The irreligious and religious alike hold ‘sacred’ values, and both should be heard in the law-making forum. However, these ideological positions must come into conversation with practical consequences – consequences which can, in turn, shape ideological positions, perhaps with alarming outcomes. For example: while I am ideologically opposed to abortion, I know that, practically, it is very dangerous to make it entirely illegal, and so wouldn’t support that kind of legislation. Those who are ‘pro’ assisted dying must think carefully about a similar tension. Perhaps self-determination appeals, and has its logical end in being allowed to choose when to end your own life. But what is the practical result? What is at risk?
The case of ‘assisted dying’ is a rare instance in which slippery slope arguments are helpful – even essential. We have the example of countries where it has been made legal, and watched the rapid shift in the relationship between doctors and patients. The impact it has had in European countries is particularly alarming. It is no wonder, then, that the overwhelming majority of British doctors (see the BMA) are against its legalization. Nor is it surprising that major disability and mental health campaigners have spoken out against it: as someone who suffers from depression and related mental health difficulties, I know what it is like to feel that things are hopeless, that your life isn’t ‘worth’ living, and that people close to you find you a nuisance or don’t care for you – and I am young and physically healthy. The belief that humans who have just found out that they might not have long to live, or seem incurably depressed, or who are watching their family struggle to arrange care for them in their old age are able to make a sound, personal judgment about whether or not to end their lives is a rather naïve position to take. The need for a doctor to establish a ‘voluntary, clear, settled and informed wish’ to die sounds far more straightforward than it is. Human choices are messy, and are at best only ‘informed’ by their own perception of the past and present, with little to no knowledge of the future, short-term or long.
Of course, I write with a sigh of relief – assisted dying is still illegal in the United Kingdom. But this doesn’t mean that this piece isn’t also accompanied by a warning. Self-examination is required. If we are determined not to allow the most vulnerable amongst us carry the burden of the strong, and if our position against assisted dying is born out of a desire to prosper life rather than just prolong it, we have work to do. We need to protect our National Health Service, ensuring that one’s wealth is not a barrier to quality pain management and care. We need to make it easier for people without disposable income to care for elderly relatives at home. We need to invest in whole person care, not just numbing pain with drugs and leaving people alone in hospital beds. We need better understanding of and treatment for those struggling with mental illness. And we need to examine ourselves, and our attitude towards those who don’t appear to have things to ‘offer’ society. How are we measuring their worth? How are we measuring ours?