Assisted Suicide – Much More Than ‘Assisted Dying’

Stephen Balogh, December 2024

This is an updated version of an opinion piece published by FET in January 2023 in light of the Second Reading of the Terminally Ill Adults (End of Life) Bill on 29 November 2024.

As many of you will know only too well, our politicians voted at the Second Reading on 29th November to advance the Terminally Ill Adults (End of Life) Bill to the Committee Stage, in which a specially assembled public bill committee will go through the bill line-by-line, scrutinising each clause and proposing amendments. 

The earliest the subsequent Report Stage could take place is in late April, so the Committee Stage is expected to take between now and then. We now know the composition of the committee, which comprises 14 who voted for the bill and 9 who voted against. Two of the members are government ministers, Health Minister Stephen Kinnock and Justice Minister Sarah Sackman. 

At the Second Reading vote, which was more strongly in favour than expected (330 for vs 275 against, a majority of 55), it appeared that all might be lost. All now depends on the extent to which those who expressed satisfaction with the Bill as it stood remain equally confident at the end of the process of scrutiny and in the face of amendments made, and the extent to which those who only cautiously supported it in the hope of strengthening safeguards are sufficiently reassured. Whilst 55 seems an overriding majority, it would take “only” 28 of those who previously voted in support to turn against the bill at the third reading to overturn that majority, and several have already expressed fresh misgivings. Still, it is quite a mountain to climb. 

The remainder of this article, considering the impact on the family, is more or less unchanged from when it was first published two years ago because I believe the arguments it proposes are still entirely relevant – in fact further corroborated by more recent experience especially from Canada. One point I would strongly note is what I refer to as “repurposed institutional involvement” in the first paragraph. It is striking that so much of the debate prior to the vote centred on the fitness for purpose or otherwise of the NHS, in two interconnected ways. Firstly, the extent to which the NHS is competent in its current core objective in treating and curing illness. If, as by so many measures both absolute and comparative it is falling short of this objective, how could it be seen to be competent, both administratively and medically, to take on the task of killing? Secondly, about the matter of safeguards. Whatever might have been deemed suitable safeguards in Canada at the time legislation was enacted, it is clear that incentives have largely overridden the effectiveness of checks and balances. Ethics have been cast aside, with financial and expediency considerations coming to the fore and tilting the institutional balance towards assisted suicide. It is simply not credible to imagine the UK would have the backbone not to succumb in the same way.

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We have to face up to the dichotomy arising in so many aspects of the rapid social change countries especially in the West are experiencing, including the UK: total autonomy of the individual regardless of consequential effects (and increasingly with active, repurposed institutional involvement) versus selective limitations on individual freedom of action in recognition of their consequences on the individual, on others around them and on society as a whole. 

Those who bear the impacts and consequences of an end of life are almost always family members. In every culture, including our own, there have been time-honoured rituals and acts that assist with those experiencing loss, with common recognition that a life slipped away naturally is materially different in effect to a life deliberately ended. Would a prospective sea change towards institutionally enabled, autonomous choices about the time and manner of one’s death affect families and family relationships positively or negatively? After all, it touches the very deepest nature of an individual’s presence in the world and their part in it. 

As for so many big issues facing society, much of the difference in view centres on the “slippery slope” argument. On the one hand, is there even a slippery slope here? On the other hand, what is at the bottom of such a slope and is it so bad that we must scrabble around to stay at the top? Of course, some argue it is entirely level ground, inviting discussion about a balanced and somehow stable mid-point that society can learn to live with. 

Perhaps this is what is behind the dual “assisted dying/assisted suicide” label used in the title of the Commons Inquiry: two distinct terms indicating fundamentally different acts separated only by a slash mark. Is it attempting to imply a near equivalence between the two terms such that they can be conflated, or is it maintaining an uneasy and somewhat ambiguous demarcation? Hard to tell, on the face of it. Both are currently illegal in the UK. 

In this opinion piece I offer just a couple of thoughts on family impacts, based on my own experience, in what is a vast and complex subject. 

In my lifetime I have lost two close family members, both of them in what should have been their prime of life, the first to suicide and the second to cancer. Without going into detail here, the first tragically lost all sense of purpose and therefore any sense of her being, whilst the second was able to maintain clarity of purpose and manifest value to those around her right to the last. I am not comparing them with each other; no-one can truly know what is in the mind of someone in the moment before death and, in any case, all people and individual circumstances are unique. Both losses were of course tragedies for our family and in various ways we all live with the consequences to this day, even many years on. 

What strikes me is that neither event, in its day, was influenced institutionally. In other words, no institution acted to hasten them to their deaths or to set a tone or offer options that made it more likely. The cancer doctors and nurses exercised exemplary judgement in maximising quality of life for as long as humanly possible and reasonable. In neither case was there an institutional hint that life was no longer worth living, let alone provision of pathways to their termination. This is one of the things that would change, and change radically. 

If crisis of purpose is at the root of many people’s decision to take their own life and if it all too often shatters families in its wake, the obvious question is why it would be a good idea to pursue public policies which, where already enacted elsewhere, have if anything seen rises in the frequency of what is termed non-assisted suicide compared to territories that have not, with all the additional societal damage and fracture? Because that is what empirical research is clearly suggesting (see here for research by the Anscombe Bioethics Centre, for instance). Yes, far from stemming non-assisted suicide, in practice it seems to be accompanied by an increase. 

If our healthcare and related institutions, in which public trust has already been severely dented in recent years, are reoriented towards providing positive choices – sometimes even assisted – towards the manner and time of death, starting with those “hard cases” but inevitably radiating outwards towards generalised application, how might this over time alter society’s sense of the value of a person remaining alive, their purpose as a human being? 

It is not only the well-established concerns about the undermining of intergenerational family relations as older members dare to stick around selfishly as what might be termed “life blockers” (cf. “bed blockers”). Once legislation is in place, expansion of the remit seems inexorable. A December 2022 Reuters article reported on likely extension in Canada to include cases of “irremediable” mental illness at any age, even though robust criteria and safeguards are going to be hard to define, let alone enforce. In the aftermath of such reports and strong reaction to them, a temporary delay was announced by the Canadian government. But it looks as if the dam has already pretty much burst in that country, with the ready cataloguing of social and economic hardship cases by The Spectator, UnHerd and The New Atlantis amongst others (the latter two citing leaked internal evidence listing economic and social reasons for presentation for euthanasia from CAMAP, one of Canada’s burgeoning euthanasia industry agencies). 

This, I deeply fear, uncovers the second underlying driver: displacement of inherent purpose as a living human with a narrow, utilitarian social calculation of financial societal value, which would inevitably bleed into and disrupt family dynamics. Net cost too much to society or to the family? Hmm, here’s an easy solution you may wish to consider, and it neatly fits the most radical of individual expression, control over life itself. 

In light of these disturbing developments across the water (with reportedly similar developments in Belgium and the Netherlands), who in the UK would have confidence we could withstand a pull towards this state of affairs and that our institutions would not quickly become its cheerleaders? And for those who take comfort in the by-and-large sober tone of the debate in this country so far, be very wary. That tone is likely to change rapidly in line with other battlegrounds of social change, especially if and as proponents of liberalisation do gain ground. 

What’s the solution? Yes, a pushback against new liberalising public policy that contains unenforceable legal safeguards (“hard cases make bad law”). Yes, a readiness to engage with this debate and to recognise that assisted suicide is so much more than limited liberalisation of physician-enabled assisted death, even though the latter sets things skidding down the slippery slope regardless. 

However, even more is necessary: regalvanised efforts by us all to use our time, our care, our resources to imbue all those around us with an innate and worthwhile sense of purpose, within families and in society as a whole, until our time comes naturally. That is the real and essential counter-revolution.

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For more on assisted suicide / euthanasia, read the research paper by the Family Education Trust's Director, Peter D. Williams, False Autonomy and Hobson’s Choice: Why ‘Assisted Dying’ Harms the Family.

Stephen Balogh is the Chair of Trustees at FET.