The Slippery Slope of Euthanasia

Principles are funny things. When they apply to others, we tend to regard them as hard and fast rules, never to be broken; when to ourselves, more as rules of thumb, to be followed up to the point at which they conflict with our other desires. Rare is he who always does what he says he should. This is well-understood – Sir Keir Starmer attracted attention and criticism during the election campaign when he stated that he would not use private health care for a relative if needed. The oddity he displayed was not so much the principle itself, but the fact that he claimed (truthfully or not) that he would follow it in circumstances in which most people would imagine themselves letting it fall by the wayside.

I say this because I am aware that I may not, in the future, act in a way wholly consonant with the argument I am about to outline. Principles are principles, not rules, and principles have exceptions which, we often find it easy to believe, should apply to us and those close to us. That I believe what I believe is no guarantee that, were push to come to shove, I would follow that belief. This may make me a hypocrite, or it may merely make me human, I leave it up to you to decide.

Assisted Dying is back on the political menu, Lord Falconer having introduced a Private Members’ Bill on the topic in the House of Lords. It appears to have the support of the government, Keir Starmer having committed to providing parliamentary time for its discussion, the lack of which being the primary reason that most such proposals die. The Bill has prominent supporters such as Esther Rantzen who, already terminally ill, sees it as a way to get the type of death she desires.

With an unpleasant and apparently unavoidable future, it is easy to see why Dame Esther and her relatives wish to find a way of avoiding it. There is nothing wrong with that. We all wish the world to be organised in such a way so as to satisfy our desires. But, while the general arc of history has, over the past centuries, bent towards freedom (justice is another matter…), it has not bent towards complete freedom. Rights are granted to the population, not the individual so before we do so, we consider the risks involved in their usage by all. Lewis Hamilton has to stick to 70mph because allowing him to go at 100mph implies allowing a spotty 17-year-old out to impress his mates to do the same. And nobody wants that.

Britain has not been quick to legalise assisted dying, and we can look at other jurisdictions to see how they have dealt with it. Doing so, however, it is hard to avoid a sense of mission creep. Canada started by allowing medical assistance in dying (MAID) only to those with terminal illness. But a court in 2019, extended eligibility to those with a “reasonably foreseeable death” (which surely means everyone at every stage of life) and usage has surged, rising 30% in 2022 (the last year for which data is available), to account for 4.1% of deaths. New Zealand is similar, with calls to expand the conditions eligible coming just two years after the initial legalisation.

Those who propose the law in the UK are adamant that it will be tightly drawn and restricted to a small number of conditions. But so did people in Canada, Holland, New Zealand, and every jurisdiction in which it is legal. And in many of those countries, it has not stayed as tightly drawn as it started. There is no reason to believe that Britain will be any different, no matter the intentions of its law-makers – clever people have an odd blind-spot about the cleverness of others when it comes to bending the rules they create.

Indeed, the logic of assisted dying is that the legislation should not be tightly drawn. For, it is odd, if the purpose is to relieve suffering, to restrict it those in the last few months of their lives. Many people can suffer grievously for many years. Their suffering should be as worthy of consideration and amelioration as that of others, lest we create a “condition-lottery” (two-tier euthanasia?) which gives favourable treatment to those with certain diseases. Canada is to join the Netherlands in allowing euthanasia for psychiatric illness (the roll-out is currently delayed for logistical, not ethical reasons), since mental suffering must be treated in the same way as physical.

As euthanasia becomes normalised, it becomes normal, no longer an exception, but an accepted and, to an extent, expected treatment for certain conditions. If person A with condition x chooses it, it is reasonable to assume that person B with the same condition or one causing similar suffering will do the same. In Canada, it was offered to a disabled veteran (all she wanted was a new ramp for her wheelchair) and it was given to a man suffering no more than hearing loss.

The former individual was able to resist the pressure, the latter unfortunately not. And the pressure can be substantial as those who need care need people to give it to them and can easily feel a burden, whether that care is provided by their family or by the state. In such cases, assisted dying can easily become a course an individual feels they should pursue even when it is not one they wish to pursue or, with a degree of understanding from others, need to pursue.

It was notable that, when he discussed his proposed ban on smoking, the Prime Minister characterised the habit as a “huge burden on the NHS, …a burden on the tax-payer” suggesting that individuals should have an eye on the public purse and their impact on it when they make their lifestyle choices. Such thinking, of course, putting people at the service of the health system rather than the system at the service of the people (“Ask not what the NHS can do for you, but what you can do for the NHS…”) would encourage people with longer term, expensive conditions to choose assisted dying rather than treatment. Just as it would have been to Canada’s financial benefit for the veteran to choose euthanasia, so, with a publicly funded health system, will it be to Britain’s should assisted dying become legal. As the opprobrium heaped on “benefit scroungers” shows, the British public is quite happy to stigmatise those felt to place an unnecessary burden on others.

The difference between left and right is often characterised as being between different visions of humanity. To the former, we are perfectible, to the latter, “out of the crooked timber of humanity, no straight thing was ever made.” Dame Esther wishes to legalise assisted dying because she wants to use it herself and does not believe it will be misused by others; it is a policy with benefits but no costs. To my mind it has both – it will help some but there is nothing in other countries’ experience, our own country’s incentives or human nature to suggest that it will not be used on those who could and, would in their heart of hearts prefer to, lead flourishing lives. Dame Esther’s freedom will come at the cost of theirs. Like speed limits, these risks of misuse by some are sufficient to justify banning the use by any.

There is, as the bard said, a tide in the affairs of men. It seems clear that assisted dying is a matter of when, not if, in Britain. And it seems likely it will happen under Labour, a party whose former leader warned voters “not to fall ill [and] not to grow old” under the Conservatives, ironically introducing a policy overwhelmingly used and misused on just those groups. Time to check your medical insurance.

Stewart Slater works in Finance. He invites you to join him at his website.

This piece was first published in Country Squire Magazine, and is reproduced by kind permission.

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