The Context In Which Choices Take Place

Niall Gooch writes:

If you’ve travelled on the London Underground recently, you have probably seen the posters supporting Kim Leadbeater’s Terminally Ill Adults (End Of Life) Bill, which will be debated in Parliament on Friday. They are very slick and professional, as you would expect from an extremely well-funded group such as Dignity in Dying. The posters are especially prominent at Westminster tube station, which is heavily used by MPs and peers and their staff (you can enter the Palace of Westminster complex directly from the station).

The posters feature mostly young and healthy people stressing how much they want to have choice at the end of life, alluding in some cases to terrible experiences undergone by relatives. The problem, of course, is that these are mere catchphrases. “Choice at the end of life” and “my dying wish is my family won’t see me suffer and I won’t have to” are among the most anodyne motherhood-and-apple-pie slogans imaginable. Parliamentarians should not be deceived by mere clichés about choice, which deliberately obfuscate the matter at hand, muddling people about the options currently available. It is hardly surprising that, according to new polling, almost two thirds of British voters support assisted dying.

The intention is clearly to make people who do not know much about end-of-life care — a large majority of the population — assume that without assisted suicide, we are all at high risk of an unpleasant death, pointlessly prolonged by dogmatic vitalist medical professionals. But this is not the case. British palliative care is some of the best in the world, and patients already have the right to refuse medical interventions. It is a well-established principle of good medical ethics that doctors can, in some circumstances, discontinue or not initiate treatments which are futile and burdensome. In the case of unresponsive patients, doctors can and do make reasonable decisions with families about how best to proceed. Contrary to the myth-making of Dignity in Dying, British hospital wards are not full of patients being miserably kept alive against their will by hard-hearted medical professionals.

“Choice” is a slippery concept in itself. In 2022, Canadian clothing retailer Simons released a schmaltzy pro-euthanasia TV advert featuring Jennyfer Hatch, a woman in her late-thirties who had chosen to die under Canada’s Medical Assistance in Dying (MAiD) programme. But the advert was quickly withdrawn when it became known that Hatch had been unable to find appropriate healthcare for her Ehlers-Danlos Syndrome. “I feel like I’m falling through the cracks so if I’m not able to access healthcare am I then able to access death care?” she had stated.

This story has been replicated hundreds of times not only under the Canadian MAiD regime, but in the Netherlands and Belgium too. People with depression or chronic illness, people with severe disabilities who cannot access support, people who are “tired of life”: all have ended up having their lives ended. Ostensibly, they have chosen to do so, but the very availability of death as an option changes the game, because it forms our expectations and assumptions about how people should behave in particular situations.

A disability rights campaigner once explained it to me this way: if the default is that no one can be intentionally killed, even with their consent, then no one has to defend their decision to go on living. But if assisted suicide becomes an option, then those who feel themselves to be a burden constantly have to justify their continued existence. It is also true that with constant cost pressures on the NHS and social care, the availability of assisted suicide must inevitably affect the calculations of those who decide on resource allocation. After all, good end-of-life care is expensive.

We can only hope that in the meagre five hours available to debate this enormously consequential bill, MPs will look beyond glib mantras and think very carefully about the context in which choices take place.