You might think that the health secretary Matt Hancock had already got more than enough on his plate to be bothered writing to Britain’s top statistician about a seemingly arcane piece of data. Covid and its knock-on effects plus social care are just two of the crises in his in-tray. Yet Mr Hancock has taken time out to write to Sir Ian Diamond, the National Statistician, asking whether he has any figures on the number of Britons who kill themselves after being diagnosed with a terminal illness. Why is he interested? The answer is that he apparently wants to pursue a subject that many believe goes to the heart of what kind of society we believe ourselves to be. Should we allow doctors to help people to die? Mr Hancock wants a new debate on the matter and thinks Sir Ian’s figures could inform it. So is it time to legalise assisted dying?
You could say that Mr Hancock is either courageous or foolhardy in poking his stick into this particular political nest. It excites fierce passions on both sides. Those who try to change the status quo have, so far at least, drawn opprobrium upon themselves and failed. The last attempt, back in 2015 by the former Labour Lord Chancellor, Lord Falconer, was soundly defeated in Parliament. It was not as though he wanted to follow the example of the Netherlands, which went as far as legalising euthanasia nearly twenty years ago. His proposal was very much more restrictive. He proposed that it become legal for someone suffering from a terminal illness and who was likely to die within six months to be able to chose to end their lives sooner and for any doctor who assisted them no longer to be liable for prosecution in doing so. But his bill was thrown out by 330 to 118, seemingly taking the issue off the political agenda if not for good, then for a long time to come.
Yet Mr Hancock now wants to put it back on the agenda. He is reported to have told a private meeting of the All Party Parliamentary Group on assisted dying that we needed a ‘new’ debate. And he is quoted as saying that the government ‘would consider collecting data on assisted dying if it was felt that that would improve and contribute to a sensitive debate in parliament on this subject’. Hence his letter to Sir Ian. It would seem that the health secretary believes that if we knew just how many people with terminal illnesses have to resort to suicide unassisted, MPs might change their minds about whether the compassionate thing to do would be to allow them to be helped.
At the moment it is a criminal offence to help anyone to commit suicide. A serious offence. It carries a maximum sentence of 14 years in prison. Until 1961 it was even illegal to try to commit suicide yourself but now, if you are terminally ill and want to end your life, it is perfectly legal to take yourself off to the Dignitas clinic in Switzerland where they may help you end your life. It is not legal even for someone else to help you go to Zurich if you’re beyond arranging it for yourself, though the prosecuting authorities have made clear they’re unlikely to charge a loving spouse who may have bought the air tickets. And it’s certainly not possible for someone in the latter stages of a terrible, incurable illness like motor neurone disease, to ask a doctor to help them die without running the risk that the doctor will be prosecuted.
It was this state of the law that Lord Falconer wanted to change and that Mr Hancock now wishes to revisit. New Zealand, Canada, several European countries and a handful of American states have already legalised some form of limited, assisted dying for terminally ill patients. The basic argument for doing so can be expressed in a single word: compassion. To be diagnosed with a terminal illness such as motor neurone disease is to be condemned to death through slow torture without the slightest hope of having the sentence commuted. Since we condemn and outlaw human-inflicted torture, the argument goes, we should take an equally strong stand against torture inflicted by nature. We should do all we can to prevent it.
Most proposals for legalising assisted dying involve two elements. First, that we should all have the right, when we are in sound mind, to draw up and sign legally-recognised documents asserting our wish, should we ever find ourselves suffering a terminal illness, to have any treatment ended and our lives brought to a close. And second, that anyone helping to carry out these wishes on our behalf should be immune from prosecution for having done so. Beyond these basics, details vary – such as about whether we need to renew (or have the chance to rescind) our earlier decision when we actually find ourselves suffering from a terminal illness; whether proxies, such as close relatives, should have the power to make such late decisions if we are no longer capable of doing so ourselves; whether two doctors or more should be required to testify our illness is terminal; whether judges should be involved. But the basics are simple: we should have the right to chose to die in such circumstances, and others (especially doctors) should be immune from prosecuting for helping us.
So what’s the objection to changing the law? There are broadly three grounds for maintaining the status quo. The most fundamental is the assertion that life is sacred and we should not condone in any form the taking of life. This case is usually most strongly put by those with deep religious beliefs against all forms of killing. To them, life is God-given and it is for God, not us, to take it away, a view summed up by Edgar in King Lear: ‘Men must endure/Their going hence, even as their coming hither’.
But, in a different form, it is also what underlies the opposition of many doctors to medically-assisted suicide. They argue that by taking the Hippocratic Oath – ‘first, do no harm’ – doctors commit themselves above all else to trying to keep their patients alive in all circumstances. Helping them to die is the antithesis of such a commitment.
These arguments about the sanctity of life do not go unchallenged however, even by doctors and clerics. Some religious leaders argue it is wrong to think of the sanctity of life in such absolute terms. We have no hesitation, they argue, in ending the suffering of animals by having them put down, yet animal life is ‘life’ just as much as our own is. Our focus should be not so much on the sanctity of life as on suffering. Why should we treat ourselves less ‘humanely’ than we treat animals? They say a doctor’s responsibility is not to preserve life in all circumstances even when that life is being lived in agony, but it is to preserve life when that life still entails some quality of life that can be enjoyed.
The second line of objection is that there is a danger that any relaxing of the total ban on any form of assisted dying may be abused. In particular, there is the fear that people suffering from terminal illness – or even people concerned that one day they may do so – will come under pressure to sign away their lives from unscrupulous relatives. Even if there is no actual pressure, it’s argued, some people may feel that they need to sign consents to having their own lives ended simply because they think they should ‘save their families’ from all the difficulties of an extended end-of-life. To which proponents of changing the law say: ‘Sure – maybe there are real dangers here. But the answer is to introduce as many safeguards as are thought necessary to deal with them rather than to give up on trying to alleviate suffering altogether.’
But perhaps the strongest objection is the third. This is a ‘slippery slope’. Once we allow even the most restricted form of assisted dying, there will soon be calls for further relaxation. Before we know where we are, the argument goes, we’ll have moved on from allowing the assisted dying only of the terminally ill to legalised euthanasia of anyone who wants to die.
One response is that, yes, there probably is a slippery slope - even if we might want to use a different phrase for it. But, rather than turn our backs on it, we should not run away in horror but to face up to the real moral difficulties that dealing with end-of-life suffering increasingly pose.
It’s perfectly obvious that if we were to legalise assisted suicide in a highly restricted way – say, by confining legalisation to those with motor neurone disease and embracing no one else – it would not be the end of the story. That’s because motor neurone disease is far from the only terminal illness that condemns its sufferers to an agonising death. Certain forms of dementia, for example, reduce their victims to a vegetative state in which no quality of life is discernible but in which the actual experience of suffering is unknowable to others. The fear of ending up in such a state would surely encourage many of us to want to be able to sign assisted-dying consents in advance, and so the pressure to extend the law to include it would inevitably grow.
And beyond that we can easily imagine pressure for assisted dying to be allowed even for those who do not have a terminal illness. More and more people are living into their nineties and beyond and see the quality of their lives shrinking remorselessly before them. Many of us have heard the cry from our very old relatives: ‘I’ve had enough. Give me a pill for God’s sake!’ We can even imagine a world in which the ‘marvels of modern medicine’ keep us all alive indefinitely. What will we do then?
In short, honest proponents of assisted dying concede that the ‘slippery slope’ objection is true but irrelevant. Unless we are prepared to tolerate ever-increasing suffering among our fellow human beings and refuse to do anything about it, the continuing criminalisation of assisted dying is unsustainable, slippery slope or not. We should not allow legitimate alarm about real moral problems to stop us acting now to relieve the suffering of the limited number of people for whom the proposed legalisation is currently intended. Maybe there will be pressure later for further relaxation, but let’s learn from a step-by-step decriminalisation what the problems may be and how to deal with them rather than run away in moral fright.
This would seem to be the thinking behind Mr Hancock’s wish for a ‘new’ debate. He knows that the medical profession is having second thoughts in its opposition and that public opinion is ahead of politicians here. He may also sense that despite the heavy defeat of the Falconer bill six years ago, politicians too are changing their minds. That certainly is the case with Andrew Mitchell, a Tory former cabinet minister now chairing the all-party group on assisted dying. ‘I was, as a student and as a young MP, adamantly opposed to assisted dying and over the years my view has changed completely,’ he has said. ‘Rather than moralising over generalised concerns, we must examine whether our current laws bear up under scrutiny, protect our citizens and respect their dignity. If they don’t, members of parliament cannot surely stand idly by and consign dying Brits to a miserable and undignified fate which our constituents would not choose for themselves.’
So is Mr Hancock right to renew the debate on legalising assisted dying or not? And if such a debate gets going, where do you stand?
Let us know.