Florian Huber’s Promise Me You’ll Shoot Yourself describes a wave of suicides that took place in the German town of Demmin between 30 April and 3 May 1945. The sheer scale of the deaths is almost unimaginable. As he writes:
People went to deaths in their droves: young men and women, staid married couples, people in the prime of life, the retired and the elderly. Many took their children with them: infants and toddlers, schoolchildren and adolescents.
These civilians killed themselves by any means available; hanging, shooting, poisoning, slit wrists. The town is on the intersection of three rivers, so self-drowning was common. Because the rivers are shallow and their currents weak, people filled rucksacks with rocks, sometimes tying small offspring to their chest before throwing themselves in.
Demmin wasn’t unique. Mass civilian suicides ravaged Germany in the immediate aftermath of the war. Tens of thousands of people took their own lives. A minimum estimate for Berlin alone numbers over 7000 deaths in a few weeks. Huber sees this “black wave of self-destruction” as an interlude whereby society’s “suicide taboo” was lifted in incredibly extreme circumstances.
Historians have asked how it came about that the Third Reich ended with thousands of people choosing both the timing and the manner of their own end. The number of suicides in the east of the country show that the terror of living under vengeful Russian occupation was an obvious factor. Yet there were also thousands in the west, suggesting other factors were at play. Having been intoxicated by a murderous and maniacally deluded regime, Huber concludes that defeat meant a “collective loss of meaning” to the extent of total “personal disintegration”.
From his writings in 1940, however, the Nazi-resisting theologian Dietrich Bonhoeffer shows that the regime lifted the “suicide taboo” before the mass suicides of 1945. He examines the suicidal tendencies inherent to Nazism in relation to euthanasia. Bonhoeffer decided self-chosen death should not be seen as a consequence of losing one’s sense of meaning, but as a final reassertion of demanding meaning on one’s own terms: “man’s attempt to give a final human meaning to a life which has become humanly meaningless.” Euthanasia means there is a disjuncture between the meaning people want to choose for themselves, and the meaning reality ever forces upon us — a meaning not always perspicuous to oneself, suggesting every moment of life matters, regardless of how we ourselves see it.
A 25 year Polish man saw the regime up-close in 1945, before travelling to Rome to study for the Catholic priesthood the following year. Fifty years later, in 1995, Karol Wojtyła, then Pope John Paul II, described the increasing demand for medically-administered suicide in developed countries as demonstrative of a newer “culture of death”. This moris cultura is created by “powerful cultural, economic and political currents”, he said, conspiring around an excessive focus on “efficiency”.
To see the meaning of life as something captured by what a person accomplishes, means the life prohibited by illness or infirmity from accomplishing very much at all appears meaningless. Such a person will probably present a significant burden of care and concern to their loved ones, restricting them from accomplishing as much as they desire as well. Borrowing from Bonhoeffer, again, to opt for medically-administered suicide then asserts a “final human meaning” — it decides to value that person’s prior achievements and free-up those around them to achieve whatever they want, unburdened.
John Paul II also claimed that euthanasia seems eminently reasonable for people used to taking “decisions into their own hands”. This connects with diagnoses of the contemporary world as characterized by poiesis. This means not seeing the world as having what Carl R. Trueman calls a “given order and a given meaning”, but rather seeing the world as one in which we’re expected to create our own meaning and purpose. This “expressive individualism” cannot abide the possibility that life has meaning beyond one’s own reckoning. Obstacles to expressing oneself then seem to deprive life of meaning itself.
Discussions of euthanasia never begin in such direct terms. Cultural tendencies require a lengthy gestation to break through to a moment where people begin, en masse, to consider it unquestionable that choosing the manner and timing of your own death is both eminently reasonable and morally desirable. Language plays a significant role. Those Germans who took their lives in 1945 committed what was called Selbstmord, literally “self-murder”. What we used to call “assisted suicide” is now the gentler and more seductive euphemism, “assisted dying”.
The new euphemism pretends that intravenously administering a lethal dose of deadly poison into the arm of an unwell person is merely a supportive gesture — generously assisting them along an otherwise inevitable trajectory which is already well underway.
In this it is quintessential Starmerism. It appears to surrender without reserve to an unchosen and inexorable inevitability. The same fatalism is applied to the economic “black-hole”, small boats, winter-fuel payments, and releasing prisoners early. But politics is always a choice — and the narrative about overwhelming and systemic inevitabilities is contradicted by the same government’s nimble and unexpected interventions: 24-hour courts, new smoking bans, scrapping the Freedom of Speech Bill, and Lords Reform. The Starmerite paradox is aptly shown by the decision to change a millennia’s old, steadily unbroken norm of human civilization by radically fast-tracking it through the legislative machine.
Another step in the playbook is to marshal the organs of the regime to wheel out human story after human story focusing only on the most inexplicably hard cases. Expect documentaries about tragic cases of locked-in syndrome, motor neurone disease, and early-onset dementia. Expect to be genuinely troubled by heartbreaking, tragic cases which would make anyone wonder if they’d opt for euthanasia in those circumstances, if it were their families having their lives turned upside down to care for what’s left of their mother or father.
Don’t expect such attention for the Belgian woman euthanized in her early 30s for suffering from depression. Nor the 34-year old Canadian man who was unemployed, blind in one eye and depressed, and only saved after his mother pleaded with the doctor responsible to reconsider. Nor the 16-year old girl with a brain tumour. And definitely don’t expect much reporting on the apparently modest tweaks to the laws in those countries that were originally presented as gentle and caring — such that only an unfeeling monster would pretend that a rubicon was being crossed, and from that point there would be no return.
Promise Me You’ll Shoot Yourself ends with the 1959 hearing of Paul Kittel, who was charged with multiple manslaughter for his role in the post-war suicides. In 1945 he and his family all agreed to die, so he shot his wife and then his two sons, before turning the gun on himself. But the trigger just clicked. He was out of bullets. The jury were understandably lenient, deciding he was of unsound mind at the time it happened.
We can’t begin to imagine what the remaining years of Paul Kittel’s life had been like. The problem for us is that, once the euthanasia rubicon is crossed, it’s never long before even being of unsound mind presents the option of a medically-administered death. The irony is that, had Kittel lived in today’s culture of death, he may not have survived at all.
People are living longer lives than ever before. In Britain at the end of the 19th century, men and women died on average in their mid to late 40s. But thanks to the social and economic development of the past 150 years, the majority of people today live beyond 80.
This ought to be regarded as something to celebrate. A testament to the tremendous advances Britain has made since the Industrial Revolution. A tribute to myriad improvements in sanitation, diet and medical knowledge. Yet for far too many politicians, commentators and academics, the fact we’re living longer than ever is seen as a serious problem – even as a source of despair. Last week, two reports, one on the malfunctioning National Health Service (NHS) and another on the steadily rising public debt, attributed much of the blame for Britain’s woes to our population’s longevity.
Lord Darzi’s government-commissioned report on the state of the NHS claimed that the UK’s ‘ageing population is the most significant driver of increased healthcare needs’. Elsewhere, the Office for Budget Responsibility (OBR), the statutory watchdog on public spending, published its annual ‘fiscal risks and sustainability’ report. The OBR stated that Britain’s public debt was on an ‘unsustainable’ upward path partly because of the ageing population.
These claims about the damaging impact of demographic change turn the idea of progress on its head. Data showing that the NHS spends more on the elderly than on the young is hardly a cause for despair. Rather, all it means is that relatively fewer non-elderly people are falling ill or, worse, dying before they reach old age.
It is a well-established fact that health spending is much higher close to the end of life. In Britain, almost one-third of hospital spending is on people in the last three years of their life, at whatever age that befalls people. Thus, as people live longer – and die at older ages – these end-of-life costs will be postponed under older ages.
Therefore the share of health spending on the pre-elderly – that is, those under 70 – is declining precisely because of improved life expectancy. It is only because more and more people are living longer that the share of health spending on the elderly is rising. Yet this wholly positive achievement is now being interpreted as a negative cost for society.
Today’s doomsters will counter that modern health systems are struggling because elderly people may be living longer, but they’re doing so in poor health. But even this is a misleading presumption. Since 2000, both Britons’ life expectancy and what’s called their ‘healthy life expectancy’ have improved by the same number of years. Additional longevity does not, on average, result in a greater number of years in sickness or put extra strains on health budgets.
The OBR’s presentation of the rising fiscal burden of ageing is even more misleading. In its latest long-term fiscal analysis, it projects that total public spending will rise considerably over the next 50 years – from 44.5 per cent of GDP today to just over 60 per cent in 2074. Of that roughly 15 percentage-point rise, about half is due to the expected rise in interest costs of the rising public debt. The other seven or so percentage points are due to the expected rise in actual public spending on services and welfare, etc.
The OBR says the ‘main drivers of the increase in non-interest spending are ageing effects on state pensions and pensioner benefits, and the pressures on health spending from an ageing population’. Indeed, it holds ‘age-related spending’ responsible for fully two-thirds of the projected increase in non-interest public spending by 2074. The report commentary emphasises that a ‘key source of upward pressure on health spending comes from the projected further increase in life expectancy and overall ageing of the population in the UK over the coming 50 years’.
But if we dig a little deeper, we find that the OBR’s notion of ‘age-related’ spending is misleading. It refers to all spending on health, adult social care, education, state pensions and pensioner benefits, other welfare benefits and public-service pensions.
But only the spending on pensions and other pensioner benefits are surely specific to older people. These account for less than 30 per cent of so-called age-related spending today, and are forecast to make up a similar share of the projected increase in spending between now and 2074. Other categories are not old-age specific and do not reflect changes in the number of elderly people.
For instance, by far the biggest contributor to the OBR’s ‘age-related’ spending is health spending. But the growth in health spending in recent times has had little to do with the rising number and proportion of over-64s. As a share of GDP, health spending increased from 3.4 per cent of GDP in 1971 to 7.2 per cent in 2019 (pre-pandemic). That growth of 115 per cent was nearly three times greater than the increasing proportion of the population that was over 64 during the same timespan.
In fact, the OBR’s latest projections for the next half-century actually reveal the limited impact of ageing itself on public spending. Out of the projected 3.1 per cent increase per annum in health spending, demographic pressures account for only a fifth of that – which amounts to an increase on average of 0.6 per cent per annum.
The focus on demographic ageing in these two reports is not only misleading – it also does profound damage to our politics. Both Lord Darzi and the OBR are reinforcing the fatalistic sense that our problems are worsened by demographic factors that are largely outside our control.
After all, it is likely that Britain’s population, like those of other developed nations, will continue to age, a trend amplified by low fertility rates. Fewer babies being born further boosts the average age of any population. When ageing is presented as the leading cause of our social and economic problems, this undermines our ability to actually understand and overcome these challenges.
The NHS is certainly in crisis. Yet rather than blame people for getting ill or older, the aim should be to have a well-organised and well-funded health service. That also means we need to grow the UK’s wealth to enable extra public spending where it is genuinely needed. Likewise, the principal source of rising public-sector indebtedness is not people living longer, but the long-running decay in productivity growth.
We need to challenge this elite characterisation of people living longer as a problem. It is neither an obstacle to growth nor an unbearable strain on the public purse. This fatalism is wrong on every level.
