Strange times. One of the features of the pandemic has been the truly heroic efforts of healthcare workers to reach those in need, and provide them with the care necessary to see them through their crisis to recovery. At the height of the first lockdown, many of us stood on our doorsteps and clapped each week for a number of weeks to recognize and support these efforts. We locked down and stayed at home to prevent sickness and avoid deaths. We put the education of the young into deep-freeze to protect mainly the elderly and those vulnerable for reasons other than their age. But that was then, and this is now. Time has moved on and it’s interesting that it is in this context a very different attitude has been asserting itself.
There is now, and has been for some time, a vocal lobby in the UK advocating for a change in the law to allow the taking of life. The name of what is being advocated changes. It has been called all of euthanasia, assisted suicide, mercy killing, assisted dying, and other things beside. Somewhere I have no doubt PR specialists have been working to establish which term causes the least public anxiety and is likely to garner most public support. But the campaign is definitely up and running. Robert Shrimley’s column in the FT caught my eye back in August (“The time is ripe for citizens’ voices on assisted dying”, FT, 25/8/21; it’s behind the FT’s paywall unfortunately). A number of medical professional organisations have been changing their stance on “assisted dying” from opposition to “neutrality”. Then there was the proposal of Orkney MSP Liam McArthur for a bill to go through the Scottish parliament, which is currently out to public consultation. Most recently we had the debate on Baroness Meacher’s “assisted suicide” bill in the House of Lords.
This is not the first time there have been such debates of course, and the arguments made in the Lords were familiar enough. It is not likely to be the last time they are heard. The proponents are quick to claim they are promoting human dignity and autonomy – individual dignity and autonomy that is. It should be a matter of choice. We have choice in every other area of life, on what basis should it be denied in this one area? In this area though, talking about individual choice is misleading, One person’s right to choose to die, at least on the basis of most current proposals, is the imposition of an obligation to kill (or to assist in a killing) on someone else (usually a medical practitioner). And death, any death, like birth, does not just affect a single individual even in our particularly individualised culture. If someone wishes to die, there are a number of courses of action individuals can, and tragically do, take. That is not what this debate appears to be about. It is about state-sponsored, legislated and organized killing. This is why (as Lord Winston pointed out in the Lords debate), terminology matters; an "assisted" death, inevitably draws others in.
Opponents of the current proposals rehearsed their (equally familiar) arguments too. Practicalities were prominent, as was the “slippery slope” argument. This raises an interesting question. If, in a modern, liberal, democracy, assisted suicide/euthanasia is legalized, what happens? This, at least in theory, is now an answerable question as there are a number of such jurisdictions – the state of Oregon in the US, Quebec in Canada and Belgium and the Netherlands in Europe are examples. However, it turns out that how you interpret the data depends on which side of the argument you start. Proponents argue that in none of these places have things progressed to mass killing. Opponents point out that numbers have risen inexorably (Belgium: 2002, 24 cases – 2016/17, 4337; Netherlands: 2006, 1923 – 2017, 6585), and laws have been extended (eg in both Belgium and the Netherlands from only adults to children). Practice in terms of adhering to laws is variable and difficult to monitor and there could be even more slippage “under the radar”. The riposte is that these are practical matters that will have practical solutions. But such solutions are going to fall on an already overworked and overstretched healthcare system. Are resources and safeguards really going to be allocated to deathcare as opposed to other aspects of healthcare? Currently in the UK even our hospices, where high standards of palliative and end-of-life care are available, are not within the state healthcare system. They are largely supported by public donations and sponsorship. Surely the provision of proper end-of-life care should have priority over ending life “care”?
We live in culture where the beginning of life is just as contested. Individual rights and autonomy have been exalted, and the individual and societal cost has been high. In England and Wales 210,860 abortions were reported in 2020, the highest so far recorded (that averages out at over 20 per hour, every hour, over the year). The 1967 Act was introduced with all sorts of safeguards, but sent a signal that had a range of unintended consequences. I am not, as it happens, an absolutist on the abortion issue; an absolute ban would be unworkable and undesirable. And things like aggressive protesting outside centres providing abortions (let alone the violence that has occasionally erupted) cannot be condoned. But perhaps it can be agreed that the situation we currently have is not the sign of a healthy society. And, critically for the current debate, promises made during the original debate, and safeguards introduced to prevent "mission creep", both turned out to be rather hollow.
Legislating in such complex areas is tragically difficult and should never be undertaken with the breezy confidence exhibited by some of the supporters of Baroness Meacher’s bill. The law has to define, and by definition, it codifies. But some areas of life (and death) defy easy definition and codification. Leaving it to judgement and conscience may be messy, but it is a lot better than the alternatives.
