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My old friend Mark died last week, in his own home on the day of his choosing. Until an agonising terminal cancer was discovered at the tragically young age of 61, he had always been very fit: hiking and skiing. As the disease took hold, he had no doubts. An advance invitation to the farewell service came, spookily, while he was still alive. In the Netherlands, where he lived, he could control his ending.
In Britain, we condemn people to live. Diane Pretty, paralysed by motor neurone disease, was terrified of dying from choking or suffocation but was refused help despite taking her case all the way to the European Court of Human Rights. Tony Nicklinson, buried alive for seven years in a body crippled by locked-in syndrome, starved himself to death after his pleas for justice failed. Many people who write to me say that what they fear is not death, but dying.
With a vote to introduce assisted dying in the UK seemingly imminent, we need to acknowledge that there are worse things than death. I respect those whose religious faith makes them reject a mercy killing for themselves. But I do not see why they should deny the rest of us the choice. In any case, medical advances have surely subverted God’s timetable. After my father had endured weeks of decline in a bleak hospital ward, being jabbed every day with needles, he managed to croak, furiously: “What is keeping me alive?” The moment the doctors finally agreed to stop the antibiotics and fluids, his face was suffused with a relief that left me in no doubt it was the right decision.
Previous generations hoped to have a family doctor who knew them, who might hasten the end with a higher dose of morphine to dull the pain. This “doctrine of double effect” was a comfortable moral fudge until 2000, when the case of serial killer Dr Harold Shipman made doctors afraid of being prosecuted for unlawful killing. Now, legislation is the only option.
A common claim made against assisted dying is that we simply need better palliative care. But even the best hospices cannot always keep physical pain under control, or solve the psychological agony. A stronger argument, made by the Paralympian Tanni Grey-Thompson, is that a right to die could become a “duty to die”. Some disabled people do genuinely fear that they might be classified as a burden if laws were liberalised. But this is not borne out by the experience in many countries. And doing nothing is also coercive.
Opponents point to evidence that the number of people choosing an assisted death tends to increase in the years following legislation. But this isn’t so surprising, given growing awareness of new rules. In Oregon, where assisted death was legalised in 1997 for terminally ill, mentally competent adults, those that take the lethal drugs make up fewer than 1 per cent of deaths each year. More get the lethal prescription, but don’t use it; knowing they have a way out, some say, enables them to keep going. In Canada, there really does seem to be a slippery slope. Last year, more than 15,000 Canadians chose to be helped to end their lives, and the range of conditions covered by the legislation keeps expanding. But no country has to go that far, and few have. In Switzerland, where assisted suicide has been permitted since 1942, it is a criminal offence to help or incite suicide “from selfish motives”.
The debate is ramping up in the UK, with private members’ bills in the Scottish parliament and the House of Lords proposing to give terminally ill adults the choice of assisted death, if their suffering becomes too great. The Isle of Man has already legislated and Jersey’s States Assembly is drafting a law along similar lines, following the decision of a citizens’ jury. While a step forward, all of these are so narrowly drawn that they would exclude anyone who has an irreversible, progressive disease (such as multiple sclerosis) but is not terminally ill.
Sir Keir Starmer has pledged a free vote on the issue, saying he favours a change in the law. It won’t inevitably pass. While medical opinion has shifted, parliament remains at odds with public opinion. YouGov found 73 per cent of the public favoured doctor-assisted dying for the terminally ill in 2021, compared with 35 per cent of MPs. The mix has changed since then, but individual conscience doesn’t follow party lines.
Much of the debate is strangely skewed towards the voices of those who don’t want to die, or think they wouldn’t in some hypothetical future, rather than those who are begging for mercy now. Opponents of assisted dying express concern for the vulnerable, without acknowledging that some of the most vulnerable are those who are too physically handicapped to take their own lives.
Another aspect I find difficult is how the desire not to be a burden has been made to sound like a conspiracy of the deep state. The idea that the world is full of greedy relatives desperate to bump off Aunt Maud rather than pay her care home fees was debunked by the Covid-19 pandemic, in which families went to enormous lengths to protect their elderly. “By all means protect the vulnerable,” Nicklinson painstakingly wrote, forming each letter by blinking his eye at a computer. “Just don’t include me.”
Over the three decades of our friendship, Mark and I often talked about death. He was delighted to have moved to the Netherlands. He always said cheerily and emphatically that his last wish, if it came to it, would be to remain himself, and protect his loved ones from unnecessary distress. In a world where people suffer more prolonged deterioration and pain than earlier generations, politicians cannot simply keep defaulting to preserving life at all costs.