Esther Rantzen hailed Scotland's new leglislation as 'historic' (ViacomCBS)

April 3, 2024   5 mins

What counts as a “dignified death”? On Monday, we got an intimation of what one looks like for Guardian readers, as journalist Renate van der Zee wrote about her elderly mother’s “completely calm, almost cheerful” legal demise at the hands of a visiting doctor in the Netherlands in 2022. After a speech to her three daughters about “how it was important to take care of the Earth wisely, to recycle as much as possible and to look after one another”, Jannèt drank the potion handed to her, and 15 minutes later reportedly met a peaceful and painless death.

In stark contrast to this beatific moment, the 90-year-old’s life before her exit had been “long and tormented”, according to her daughter. Factors that led to her decision to end things included “deafness, incontinence and many other conditions”, as well as a “lack of mental resilience” to cope with the suffering. One wonders what the deceased would have felt about such frank disclosures. While dignity in death supposedly now requires control over the precise timing of your demise, a discreet silence from relatives about the embarrassing details beforehand seems to have become optional.

Campaigners for assisted dying seek to eliminate messiness of various physical and emotional kinds, and their language is adjusted accordingly. At times, it can sound as if one is being offered a particularly relaxing spa treatment. With a pleasing ring of supportiveness, you are now being “assisted” in achieving something, rather than killed by a doctor or killing yourself. In van der Zee’s piece, the lethally toxic sedative given to “the patient” was merely a “drink”, and its administration a “procedure”, after which her mother “fell asleep”. Also in the past week, Scottish politicians sponsoring a new bill legalising voluntary euthanasia have stated that, once legalised, resulting deaths will be recorded as “natural” rather than as a result of suicide, with the suggestion that this will reduce the “stigma” around assisted dying. In other words, moral qualms will be framed as bigotry. (Then again, perhaps bureaucrats are just looking for a respectable cover story for Scotland’s ever-decreasing life expectancy rates.)

And alongside the sanitised language, there’s a tendency to place large amounts of trust in the future judgements of relevant unidentified authority figures, even in the face of blatant legal and medical failures of the recent past. Many activists seem convinced that any UK pro-assisted dying law will contain enough safeguards to avoid people being bumped off for the wrong reasons. And perhaps they are right, as far as the first iteration of any such law goes; but they are bound to be wrong about later extensions of it. Changes in social norms tend to roll down slopes rather than hurtle off cliffs; but either way we can all easily end up at the bottom.

Canadians, for instance, used to reject assisted dying, but now significant numbers would agree to expand the existing programme in order to include as respective qualifying reasons, “inability to receive medical treatment” (51% of respondents), and “homelessness” (28%). In the Netherlands, euthanasia is permitted on the basis of “hopeless and unbearable suffering” rather than fatal illness and is sometimes allowed for psychiatric illness alone. Given the degree of concept creep endemic to modern society, as we collectively grow yet more anxious and neurotic, who knows what mundane aspects of modern life will end up counting as “hopeless and unbearable” too?

I am using the future tense here deliberately, for it seems clear that such legislation will pass in the whole of the UK sooner or later. Its arrival has been heralded for a while now, not least by the safe, agent-approved involvement of TV personalities like Dame Esther Rantzen — herself now in the grip of Stage 4 lung cancer and apparently keener than ever on personal choice in this area. (Presumably she has forgotten saying that unvaccinated Covid sufferers should be left to expire on their own, wholly untreated by the NHS.) Other celebrities have been doing their bit by offering personal anecdotes of heart-rending suffering too, including some from beyond the grave.

The main tool their opponents tend to wield in response to such campaigning is a list of potential adverse consequences to society generally, should legalisation happen: for instance, that it might lead to martyr-ish types being guilt-tripped into taking up the option against their own best interests; or that its real appeal to economists is the cost-efficient dispatching of those who disproportionately drain health and social care resources. Indeed, the latter was actually positively embraced by Matthew Parris in his Times column last week. But really, either way, how can such abstractions compete, faced with the visceral power of a story about Dame Prue Leith’s brother’s agonising death from bone cancer? It is not that we care so much about what happens to celebrities and their families, but rather that, in a vacuum of personal experience where most of us have yet to see a dead body, their stories can act as psychic proxy for what we imagine or fear might happen to us.

“Their stories can act as psychic proxy for what we imagine or fear might happen to us.”

Since Parris’s article, some Christian commentators have argued that his chilling reasoning about the social utility of assisted dying has starkly exemplified how the value of individual human life can become negotiable in a post-God world, as we move instead to prioritise the good of the collective in utilitarian fashion. Yet the example of the many Canadians now willing, in principle, to see a painless death available for those poor and homeless people who convincingly say they want one, reveals that the good of the collective is far from the minds of many in contemplating such matters. In fact, society’s trajectory away from God and towards legalised euthanasia is less direct, and also less altruistic, than both Parris and his critics seem to think. It is not that an increasingly secular outlook directly causes us to prioritise collective benefit over the individual, but rather that it paralyses many of us intellectually, and means that a selfish mental focus upon alleviating future personal suffering is the only cause we can really get behind.

Or to put it another way: the real reason why the activists’ rhetoric eventually will prevail is that, without prior commitment to some deeply felt theological or philosophical principle about the intrinsic value of human life, all that is left for most of us are vague intuitions and orphaned remnants of moral reasoning inherited from a formerly Christian outlook. And these are no match against the powerful lure of a vision of preventing personal physical suffering in future, or the suffering of loved ones, via the offering of a serene and painless death.

This is what gives the edge to emotive anecdotes like those offered by van der Zee and Rantzen. Sure, to most of us, on the face of it there seems something wrong with doctors killing off the old and the sick even if they are mentally competent to assess the situation and fully acquiescent; but what is it, exactly? Lacking a convincing reference to God or some other organising value system, many will struggle to articulate the problem. They will naturally wonder: wouldn’t any harms caused be offset by the massive reduction in hideous, meaningless suffering? Back and forth the non-committal reasoning will go, leaving the argumentative field open to those with more immediate and self-interested emotional reactions to take the win.

As a matter of fact, though I myself cannot manage it, a full-throated and enthusiastic endorsement of utilitarianism and of the cumulative value of the collective over that of the individual might well knock the arguments of both Parris and Rantzen on the head. For, once introduced at scale and firmly embedded into existing social systems, the constant presence of the psychological possibility of assisted dying might easily wreak more quantifiable havoc than it prevents, in exactly the ways anticipated by critics: guilt-tripping those who feel like burdens into premature endings; tempting the already depressed towards easy oblivion, and so on. But to make this case convincingly would require a positive belief in something; and for many of us, real ardour for the principle of utility is just as hard to conjure up as a sincere belief in a Christian God. Those who want to see the back of assisted-dying laws had probably better start praying harder, though I wouldn’t hold out any hope.

Kathleen Stock is an UnHerd columnist and a co-director of The Lesbian Project.