There are determined moves to make assisted suicide legal in both the UK and in Ireland. In advance of any legal decision, the Irish Medical Council has removed the ban on participating in the “deliberate killing” of patients from its medical guidelines.
In the UK, the Parliamentary Health and Social Care Committee has been taking evidence submitted to its inquiry into “Assisted Dying/Assisted Suicide” (the former term a relatively new euphemism for the latter). The Committee is due to publish its findings this year.
The television presenter Esther Rantzen has given a highly publicised BBC interview where she calls for a free vote on “assisted dying”: it is, she says, “important that the law catches up with what the country wants”.
Rantzen, who is currently undergoing treatment for lung cancer, disclosed that if her condition did not improve she was considering “assisted dying” – prompting Levelling Up Secretary Michael Gove to say that it would be “appropriate” for the Commons to debate the topic yet again, in spite of Parliament’s repeated rejection of assisted suicide and euthanasia.
The television presenter who fronted the BBC television series That’s Life! for 21 years joins a long line of public figures who have used their social influence to nudge, largely through emotional means, the consensus towards a legal right to self-termination. As the Catholic Herald reports, Kit Malthouse MP looks set to put down a 10-minute rule motion on the subject later this month.
Legalising assisted suicide and euthanasia is ordinarily argued for on two grounds, often in combination. The first is the primacy of autonomy and the second is that death is a benefit (e.g. to avoid suffering). Rantzen certainly gestured toward both rationale.
The Bios Centre, for which I work, argued in its submission to the aforementioned committee that once these grounds are accepted in principle, then:
“…the limits of either are open for expansion as restraint is eased. If autonomous choice is emphasised then it should not be surprising that the practice of euthanasia/assisted suicide expands to include suffering that is psychological rather than physical, or even existential as in ‘tired of life’ cases. If death is conceived as a benefit and a medical solution to suffering then it is not surprising that euthanasia naturally expands to include minors and infants and adults with mental incapacity, even those who made no previous request. It is very problematic to legislate for effective restraints on the expansion of lawful termination of life, since the ‘autonomy’ and ‘benefit’ justifications for the classic hard cases of euthanasia and assisted suicide are intrinsically vulnerable to such expansion.”
The evidence for this expansion is stark: our submission points to changing legislative arrangements and an ever-widening scope of justificatory reasons for assisted suicide and euthanasia in the Netherlands, Belgium and, more recently and alarmingly, Canada.
This is what has been termed the “empirical slippery slope” and confirms what many see as the “logical slippery slope”, which posits that if practice A (which may or may not be generally morally approved) is legally permitted there will be a natural expansion to the allowance of practice B, where B cannot be reasonably distinguished (or cannot be distinguished in practice) from A.
So, while someone may think that assisted suicide is not always morally wrong and could be morally acceptable in hard cases, they may still favour the prohibition of assisted suicide because they see that allowing assisted suicide in some cases will make it impossible to contain the practice given that similar cases, which cannot be reasonably or in practice distinguished from the first cases, will end up being included. This seems to be the position of, for example, former Supreme Court Justice Lord Sumption.
Those who campaign against euthanasia and assisted suicide have become used, over the years, to being accused of baseless scare-mongering. The accusers, however, have had to regroup in the face of repeated empirical confirmations of what they claimed would never happen. Recall how social conservatives were mocked in the 1960s for predicting, correctly, that legal endorsement of the Sexual Revolution would result in the hollowing out of marriage, mass abortion, abandoned children, etc.
Those who warned that changes in legislation in these areas created a slippery slope which had the effect of coarsening through habituation our social expectations of marriage were dismissed, including by those who saw each slide down the slope as a sign of further enlightenment. The data now in from the Sexual Revolution and the lives of those behind that data, however, tell a very different story.
Those who propose changing the law on “assisted dying” tend not to mention the alarming expansions seen in the countries mentioned above but tend to focus more on Oregon, US, which is held up as a shining example and a blueprint for proposed legislation for the UK.
Yet, as Bios put to the committee, in Oregon by 2020, the main four reasons cited by those who received assisted suicide were “less able to engage in activities making life enjoyable” (94.3 per cent); “losing autonomy” (93.1 per cent), “loss of dignity” (71.8 per cent) and “burden on family, friends/caregivers” (53.1 per cent). In contrast, “inadequate pain control, or concern about it” was cited by a lesser number (32.7 per cent).
A paper published late last year in the British Medical Journal, entitled “Oregon Death With Dignity Act access: 25 year analysis”, found that, according to Oregon Health Authority figures, “the number of assisted deaths in Oregon increased from 16 in 1998 to 278 in 2022. Over this time, patients’ health funding status changed from predominantly private (65 per cent) to predominantly government supported (79.5 per cent), and there was an increase in patients feeling a burden and describing financial concerns as reasons for choosing an assisted death”.
When we hear public figures refer to “autonomy” it is easy to forget that for many of those who choose to self-terminate, there will be extraordinary pressure from people or circumstances for them to do so – pressure which gradually becomes internalised such that the option of self-termination seems like both a release and a bestowing of a “benefit” on others.
Over this coming year, we will no doubt be told more about the wonders of Oregon and hear more emotive stories from public figures about their right to self-termination. But will we hear from those who have considered “assisted dying” only in desperation, because it seemed the only way out?
An Al-Jazeera documentary arrestingly titled “Do you want to die today?” has first-hand accounts of two Canadians in desperate social circumstances, one of whom had chronic physical as well as mental health problems, in addition to a recent cancer diagnosis. Rosina, who was given euthanasia with frightening speed, had struggled for a long time, as a friend testified, to receive pain medication and help with the cost of food and rent. But that is not all: as the friend recalled: “Rosina said what she wanted most was for someone to be there and just hold her hand.” In a video made shortly before she received the “procedure”, Rosina said openly that “I think if more people cared for me I might be able to handle the suffering”.
In contrast, still alive, because he “only” has mental health conditions (which, however, will be grounds for euthanasia in Canada from this year on), is 41-year-old Mitchell, who suffers from a gamut of psychiatric problems. He does not believe these problems can improve – although a doctor interviewed comments that most such conditions do improve and that their progress is unpredictable.
Mitchell has “absolutely no family contact”, can’t afford rent or groceries, is faced with homelessness, feels like he is “drowning”. He says he’s tried everything, and that while he wants euthanasia, and has wanted it for a long time, he also regards it as “coerced”. And he tells us: “I don’t want to go through the violence of killing myself really but this now seems like an option because that door is open and it feels like we are being led [author’s italics] into this door.”
There is no reason to believe that this will not happen in the UK should we choose this sort of legislative path. Support for this path is increasingly gaining momentum.
If our culture continues to over-emphasise autonomy (or a false conception of it) and under-emphasise true solidarity, it will be a suicidal choice in every sense of the term for our country.
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