August 22, 2022 - 5:00pm
British politics has many charming uncodified institutions, from Black Rod’s door-knocking to the many polite fictions which pepper the constitution. A less charming one is the Assisted Dying Bill, which has been introduced, in one form or another, seven times over the last nine years. Its supporters, who seek to legalise euthanasia, are convinced that they are destined for victory — and they seem to have public opinion on their side.
Now they have added to their ranks Matt Hancock, the disgraced former Health Secretary, who supports it “as a freedom-loving Conservative”, as if he were discussing cutting up some regulatory red-tape. He compares it to the decriminalisation of homosexuality and the legalisation of gay marriage: merely the latest progressive struggle which is bound to succeed, for the arc of history is long, and bends toward justice.
On the very same day as Hancock’s declaration, it was reported in Canada that an injured veteran was casually asked if he wanted euthanasia when he was simply trying to obtain healthcare, without him ever having expressed an interest in ending his life. The week prior, the Associated Press reported cases where Canadian patients chose to die due to inadequate income support, and where disabled people who refused euthanasia were called “selfish” and accused of being a drain on resources, in one case by a hospital’s director of ethics.
Such reports have been legion ever since Canada legalised euthanasia in 2016, after its Supreme Court struck down the legal prohibition on assisted suicide because it infringed a constitutional right to life. Since then, many have chosen to die because, in the words of one who applied for it, they “simply cannot afford to keep on living”. Poverty itself is not a valid ground for euthanasia, but almost any chronic condition — including hearing loss in at least one case — can be. From 2023, mental illness will be a qualifying ground as well.
No doubt euthanasia’s proponents will dismiss Canada’s experience as an aberration and argue that it is possible to regulate away the moral hazards associated with the practice. The same argument was made by Canada’s judges, who brazenly dismissed the experience from the Netherlands, where children as young as 12 can now choose to die, and where a doctor was acquitted of murder even after admitting to euthanising an elderly woman despite her persistent protestations that she did not want to die.
But we do not even need to leave these islands to see what legalised euthanasia would look like in the UK. At the height of the the Covid pandemic, the very National Health Service which Hancock oversaw issued ‘Do Not Resuscitate’ orders for disabled patients — including ones with learning disabilities — who did not want, or in some cases did not know about them, while care homes reported that NHS representatives had ordered them to issue blanket DNR orders for all of their elderly inmates.
And one only has to consider the experience of the now-memory holed Liverpool Care Pathway, under which patients were starved to death in the name of “end-of-life care”, to realise the immense potential for abuse of legalised euthanasia within the NHS. Healthcare is ruinously expensive; euthanasia is cheap and value-for-money. No healthcare administrator, however well-intentioned, can ignore utilitarian considerations entirely, but the legalisation of euthanasia will make the moral hazard irresistible.
The incontrovertible truth is that, at a time of ageing populations and strained government budgets, it is absolutely impossible to establish a euthanasia regime that will not be abused, as has happened in every country which has legalised it.
Even if one has no inherent moral objections to a tightly regulated, limited scheme of euthanasia for those in unbearable pain at the end of their lives, such a scheme cannot and will not exist under present conditions. The slippery slope is real — do we really want to follow Matt Hancock down to the bottom of it?
Yuan Yi Zhu is an assistant professor at Leiden University and a research fellow of Harris Manchester College, Oxford.
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SubscribeAssisted dying policies are beset by moral hazards – true. But refusal of assisted dying policies are beset by (other) moral hazards too.
We euthanise our pets to end their suffering believing it is cruel to prolong it. The moral hazard in denying assisted dying to suffering people is exposed – cruelty.
Succinctly and beautifully put
I don’t think comparing grandma to a pet dog is particularly appropriate, but I see what you’re trying to say.
I have actually been involved in a “give him enough morphine to not suffer” case though, and I can tell you that (at least in America) doctors have always followed the “no-cruelty” position. We have an entire industry (hospice) devoted to exactly that: making sure that dying people aren’t in pain. You must have something similar in the UK.
However, there a moral chasm between “make sure he doesn’t suffer no matter how much morphine you give him” and “he’s ready to go, give him a lethal injection.” The first is compassion; the second is murder. The Catholic Church has great work on the ethics of choices like this. It’s the difference between a evil which occurs as a byproduct of an attempt to do good, and an intentional act of evil. The Church says there is moral culpability for the latter but not the former. You don’t have to be Catholic (I am not) to recognize the value of such a distinction. Ruling that it’s OK to intentionally take another human being’s life is a dangerous road, as many countries that have legalized such behavior have already found.
I don’t think that here we are talking about compulsory euthanasia. What is needed is a system so those who want to exit, and have the mental capacity to make that decision themselves, are given the rights to do so and access to the means.
The Netherlands, Canada, Washington State in the US, etc.—none of these laws were enacted as the Compulsory Euthanasia Act. They are presented as Choice in end-of-life care. They slip outside of the guardrails, though, almost immediately.
Indeed, but of course our pets have no say or right in the matter, and can be dispatched at our whim for pretty much any reason at all.
I have a strong suspicion that every single one of the ‘principled’ opponents of euthanasia, if they found themselves to be in unbearable* and incurable pain, would drop their objections like the hottest potato.
Of course, the most stringent safeguards possible should be put into place. It should never, for instance, be the decision of just one medical professional, or of a non-medical professional. In addition, the penalties for anyone found to have abused their authority in such matters should be as severe as they might be for a manslaughter charge, including corporate manslaughter in the case of an institution.
In the end, it’s a question of simple humanity. If the patient requests it, their next of kin assents and two independent medical professionals agree (or if the patient is unable to make a rational decision, perhaps three professionals), then the act of mercy will be profound.
Further, the possibility of a next of kin being charged with manslaughter or even murder where they themselves can’t bear to witness the unbearable will provide further mercy.
Matt Hancock’s failings are irrelevant to this discussion, and using them as a means of seeking to bolster the case against euthanasia shows a lack of judgment.
Not at all, Yuan summarised the pro case well: it’s cheap and gets rid of pain. Only downside is that some extra people also get to die but if you’re happy with that, thems the breaks I guess.
Don’t be flippant, it’s too important a subject.
And if the next of kin are only to keen to “help” someone on their way? What of that?
Then they require two medical professionals to independently agree. Of course, if one takes the view that the profession being ripe for corruption over-rides the desperate pain or increasing gasps for breath of a dying patient, then fine. Just make sure you don’t find yourself in that position, i’m 100% certain you’d change your opinion.
British abortion law theoretically requires a doctor’s agreement to abort a foetus, but in practice that’s a complete dead letter. I don’t expect similar euthanasia safeguards to be any more effective.
“Gasps for breath of a dying patient…!” Too much posturing already. Changing your mind is not an option when the needle is in, however much persuasion was required. And who can presume to take a life that has not naturally come to its end? The one who gave it.
Well yes, but in real life I’ve only witnessed the opposite – family members pushing for their ‘loved ones’ to be kept alive. Why? Only they know, but it really looked like various strands of selfishness and psychological immaturity.
You are forgetting that suicide is perfetly possible even without legaliased euthanasia. If I am in unbearable pain I can choose kill myself. If my wife is, I can choose to help her die – and take the risks involved. People are not asking for the possibility of killing themselves – they have that already. They are asking for suicide to be encouraged as a good way to go, for society to support and validate their decision, for a man in a white coat to stand by and tell them they are doing the right thing, and for the right to go out in a great party with all their friends standing by. Those are not human rights, and they are not worth the number of additional deaths that legalised euthanasia will bring with it.
As for the ‘most stringent safeguards’, we know they will be useless. for comparison, under UK law abortion is only allowed if the physical or mental health of the mother is in danger, and two doctors need to certify this. Not long go, a pro-abortion organisation was found to have a store of pre-signed doctors’ forms where the name of the patient could be added afterwards. Certainly doctors signed the forms without ever talking to the patient, let alone evaluating her health.An anti-abortion group brought this to the attention of the police – it is obviously, blatantly illegal, after all. No one investigated, no one was prosecuted, and no one cared. All the surviving participants were happy with the outcome, and no one welcomed outsiders sticking their nose in. The police simply could not be bothered, whatever the law says.
Euthanasia will be no different.
Rasmus, in both cases, abortion and assisted dying, the laws were widely ignored because the police and MPs knew that the majority of the population had other views and were intent on acting on them.
Aren’t the laws supposed to reflect the majority’s views? Polls in Australia showed a large majority for Voluntary Assisted Dying (otherwise the MPs wouldn’t have done it).
That is as may be – but it is a different question. And anyway, how many countries have banned the death penalty, even if popular opinion favours it? But the point here is that all those safeguards that people talk about are going to be worthless in practice. If you are in favour of assisted suicide by all means say so, but face up to the consequences and stop hiding behind the fiction of ‘stringent safeguards’.
In recent times, when the euthanasia debate was much in the news, a woman wrote to the Times to say that she would feel honour bound to opt for “assisted dying” if she became a financial burden to her family. This comment became well publicised and took the debate in the opposite direction to the one she intended. The prospect of normalising euthanasia when elderly people feel or become a burden gave many of us some qualms. The frequently used comparison between putting a dog down and ending a human life is not always a comfortable one either. We can talk blithely about “the most stringent safeguards” and every Parliament that legalises euthanasia tries to achieve this. In practice, the evidence indicates this is hard to achieve. “Double effect” pain relief is legal and palliative specialists provide wonderful end of life care in our hospices. Perhaps they should have a louder voice in this debate.
<i>I have a strong suspicion that every single one of the ‘principled’ opponents of euthanasia, if they found themselves to be in unbearable* and incurable pain, would drop their objections like the hottest potato.</i>
Even if that’s true, so what? If I had the opportunity to steal a million quid in such a way that I knew I’d never be caught, I think there’s a strong chance I’d give into temptation and steal it. Does that mean I should start campaigning for theft to be decriminalised?
Steve, I have actually dealt with the “unbearable pain” issue in my own family, and its a red herring. Hospice exists precisely to help manage end-of-life pain so that people near death can have the best day possible TODAY. Atul Gawande, an Indian oncologist, wrote a book called Being Mortal that is an excellent read on this subject. In my own case, we gave instructions for my grandfather to be given whatever level of morphine was necessary for him to not hurt. No doctor had a problem with that, and this was LONG before “assisted suicide” laws become common in America.
I’m sure there are a few cases that don’t fit this model, but the vast majority do. And based on the scope creep that has occurred in other countries (“what is unbearable?; “what is ‘pain?”; “what about mental pain?”, etc…) legalization of lethal injection strikes me as road replete with enough dangers that I’m unwilling to start down it.
After You Mr Hancock! Where you lead we will follow <snigger>
Euthanasia is being promoted by the governing class as the Final Solution to the problem of unfunded retirement/health care entitlements. First sold as “mercy” and “freedom” then it will be sold through moral censure. Then it will just be mandated. And what had been a class of human beings will be converted by the fascist alchemy into “life unworthy of life”.
It’s many years since I read of elderly Dutch citizens carrying cards declining to be admitted to hospital in an emergency.
Didn’t we just bankrupt the West and destroy millions of children’s education to make sure Granny got those last months of life locked down alone in her room?
The purpose of bankrupting the West and destroying children’s education was to determine the extent of population compliance with the demands of the puppet-masters. The nod to ‘Granny’ was an after-the-fact pretense to gain wider acquiescence to the absurd measures imposed on all of us to ensure maximal profits to the pharmaceutical manufacturers, submissions to the god ‘science’, and abject cowering to our ‘betters’. But even so, the hubris of presuming to take an innocent life based on some supposedly justifyingly criteria is an arrogation of pretended omniscience. It isn’t just a moral hazard, it is a moral failure.
Exactly. After witnessing the profoundly negligent handling of Covid – and of care for youth with gender dysphoria – the idea that it can simply be better regulated is laughable. It is clear that the vast majority of health professionals would rather maim their patients than challenge the status quo and risk their income and social stature.
Remember, the people who ran the COVID response will also be running the euthanasia program. That should give you confidence.
It suddenly will get easier to get that impossible down payment on a house…..
‘you know, its been a long time since I had a good visit and talk with granny…..’
Re-read my point about unbearable pain. If you think your objections would stand for more than 30 seconds under those circumstances, involving either yourself or a loved one, you’re sadly mistaken.
We have Voluntary Assisted Dying in almost all of Australia – it will soon be all. Among the conditions to be able to access it is that you are likely to die from your illness in 6 months – you can’t get it just because you are 95 and tired of life.
In some ways it’s like abortion – safe and legal, or illegal and unsafe. Plenty of old/sick people try to commit suicide, as a way out of unbearable suffering, but mess it up and are left worse off. The ones that were successful will be found by someone who could be left with unpleasant memories.
Also, if it isn’t legal it happens anyway. When my mother (who I knew prayed every night to be able to die) was past being able to communicate I was asked if I wanted ‘terminal sedation’ for her. I hadn’t heard of it, so made a quick decision – Yes! – because I knew she would want it. They put her under anaesthetic until she died – 9 days later. Does that not happen in Britain? Because it leads to quick decisions – I didn’t ask my siblings. Thinking things through, preparing a ‘living will’, planning … seems to be a better way to go, otherwise you may be just leaving the decision to others.
My life, my body, my decision.
What is wanted a painless safeguarded way of arranging an exit without distressing nearest and dearest by having to find the body in the bath or in the garage
It’s not much to ask and it’s nothing to do with the moral hazard brigade.
If the author lives long enough to uncontrollably shit his adult nappies, he may choose to live like that, in those circumstances l wouldn’t, and l want my country, the UK, to give me the get out option of voluntary euthanasia. Your right to life should not impede my right to die.
You mean, your right to die when and how you choose.
Oh come on. There is now a whole industry based on keeping you alive. Alive means just that, that’s all. It’s like Dr Mengele is in charge. ‘Let’s see how long this nearly dead person can be actually prevented from dying.’ It’s gruesome and ugly. If you have watched folks in these ‘hospices’ being artificially kept in a state of limbo you will know what I mean. Palliative care is revolting and inhumane. The idea that an army of people want their relatives dead before their time is simply untrue.
The UK already operates a form of “euthanasia”. They call it DNR notices which the NHS talks people into signing or agreeing to.
In the cases of severely ill people (in pain, eg cancer patients), they just keep increasing the doses of morphine until the patient dies of overdose.
Cop out article. Everything worth writing about is complicated. Sticking your fingers in your ears, or lionising radical change…..no to both. Let’s slowly carefully work it out. Like we did with, oh i don’t know…cars, architecture, agriculture, paint, sewage systems….
As the author notes, we live in an era of ageing populations and strained health care budgets and so there will be greater pressure to view euthanasia as just another way of dealing with very old and sick patients. It’s an extremely important topic, imo, and complicated. It needs full length articles from competing view points. The author provides a summary of one side of the argument and, in my opinion, that’s not enough and potentially misleading.
Several No votes on this comment? Could it be time to rename the web to Herd?
Agreed – what seems also clear to me is that most folk have not thought thru the reality ‘that i/we will die” – and live on in fear and denial until the confused and nappies phase precludes any exit with integrity – and I think ‘exit with integrity’ is a good term for a grown up attitude to ‘exiting’. as I contemplate my own at some approaching nappies/confusion point , what are my options without the medical rigmarole that is the present scenario ?? A gas cooker in a small room ?, getting lost at sea with single malt whiskey ?, illegal drugs that I am not sure about or able to procure, probably overdose of sleeping pills for insomnia. I guess there are ways but should i have to take illegal responsibility for the method ?? I guess that is the way it is in our nanny states – plus the ridiculous legal risk for family members who would like to help……the DIY ethic pertains to most things in life if one wants to live in an independent self-directed manner amongst the sheep that most have become….
As a 67 year old, I am greatly looking forward to being an infirm elderly person in the society we are headed for.