Four years ago, the Assisted Dying Bill was overwhelmingly defeated in parliament. The euthanasia debate hasn’t disappeared, however. One recent poll showed that 90 per cent of the UK’s population now support assisted dying for the terminally ill. So is a relaxation of the law inevitable? Would it represent progress? Or is it very dangerous? Our literary editor Sam Leith joined our associate editor Douglas Murray to discuss.
Sam: I find myself, possibly in accordance with my position as one of The Spectator’s hand-wringing liberals, in favour of assisted dying but I want to be clear on the narrowness of that position. The Assisted Dying Bill would not have allowed us to euthanise the incapable. Nor did it support assisted suicide for people not suffering from a terminal illness. Those discussions are part of a separate argument. The Bill essentially said that two doctors and a high court judge must agree that a person has less than six months to live and is of sound mind. At that point, assisted dying becomes an option. I think that is a very humane, reasonable position.
The fundamental reason why I am in favour is a pretty solid, almost conservative position. Most of the foundations of our common law and the freedoms we enjoy are to do with the idea that your body is your own. It follows that it shouldn’t be the business of the state to tell you what you can and can’t do with it. If you are in a position where you, for good and intelligible reasons, want to control the circumstances of your death, you should be entitled to. I would feel it was a bloody cheek if I wanted to die and the state told me it was their business, not mine.
Douglas: Let me start by disagreeing with the idea that your body is your own. You may have a considerable amount of autonomy over your body, but it’s not just yours to give or take. Everybody around you, everybody you love, has some involvement in what you decide to do with it. Our decisions will always have an effect on those closest to us — and the effects will ripple out towards the rest of society. In the case of assisted dying for terminal illness, nobody knows what the wider effects will be.
Let me also state my first principles: there are several reasons why I have very strong feelings about this. The first is that I think it’s an issue which is being described as a ‘right’ when that’s highly debatable. Secondly, there are very few issues which are anything like this one that we discuss. When I last wrote about this for The Spectator in 2015, I had a conversation with Lord Falconer, one of the main proponents of euthanasia. He said he couldn’t believe that I talked about the matter in such grandiose terms, as if one ought to talk about euthanasia in the same way that you talk about proposals for VAT alterations.
There is only one issue I can think of that is of remotely similar seriousness: abortion. It’s a useful comparison for the following reason. When abortion laws were changed in the UK and every other country in the West, we were told why they were going to change, which was because of the horror of backstreet abortionists. Today, we find ourselves in a position where without much pushback other than from some Catholics, abortion is basically a means of contraception. It’s an amazing amount of change in a short space of time. I see very few reasons why the same rapid shift wouldn’t happen with euthanasia.
Sam: We are talking about a law on the statute book rather than a direction of travel. The abortion case is different. Oddly enough, I am much more sympathetic to the case against abortion because between conception and birth, another body enters into the discussion. In the case of euthanasia, the debate is about one individual.
Douglas: The window between conception and abortion is not that different to the difference between the diagnosis of a terminal illness and euthanasia.
Sam: I would say it is rather different. What we are talking about is making an absolute distinction in law about when a person with a terminal illness can choose to die. Now it may be that if we sign this into law, people will begin pushing for more…
Douglas: Oh without a doubt. There is a very slippery slope when it comes to euthanasia. Some years ago, I went to speak with euthanasia practitioners in Belgium and the Netherlands, where it is legal. I was amazed by the slippage that had happened. Their debate started off with all of the things you have said — my own body, at the very end of my life, with a terminal condition. Euthanasia was legalised and the campaign has moved on. It is now focused on allowing children to do it, allowing it for the mentally ill, and for people who are ‘tired of life’.
These countries are not very different from ours in historic attitudes and religious inheritances. So they should be a salutary case study at least. One of the most interesting things about the euthanasia movement in the Netherlands and in Belgium is at every stage, there’s always a next step.
Sam: But if there is always a next step, if you can always draw a continuum between one reasonable position and an unreasonable position far down the road, does that mean that at no point should you take a reasonable position? That the only form of bulwark against that is a sort of absolutism?
Douglas: But I don’t concede that it is a reasonable position to start with. There is nothing innate about the British people that means we won’t go for the next step, just like in Holland and Belgium. And, as I say, there always is a next step. Physical illness is always then conflated with mental illness — and we live in a country where the government is now committed to the idea that physical ailments and mental ailments are to be put on level pegging. The moment you say ‘We treat mental illness as seriously as we do physical illness’, you concede that there are terminal physical illnesses and terminal mental illnesses.
One example of where this can lead is the case of Nathan Verhelst. Verhelst was born a girl. He grew up very unhappy and attempted to change sex in the late 2000s, but the operations weren’t successful and left terrible scarring. Two years after surgery, the Belgian state euthanised Nathan Verhelst at the age of 44. My point is the moment you start down this path, you have no idea where it will lead. Lord Falconer may believe that it will stop at step one but the evidence suggests otherwise. It is very hard to put down an incredibly clear moral line to stop step two, three, four and so on, all the way to the pill you take if you’ve become ‘tired of life’.
Sam: This raises an interesting question: what happens in a democratic society when public opinion shifts towards something it didn’t used to support? Right now, there is considerable public support for step one which is the step that is being debated at the moment. And it seems to me anti-democratic to say that we can’t go ahead with assisted dying because of the danger of what it might then lead to if public opinion shifts once it has been brought in.
I want to briefly refocus and make two points in response to what you’ve said. One of which is that you are absolutely right, others do have an interest in what we do with our bodies. The law enshrines the idea that we exist in relation to others, to our loved ones. One would assume that the same relationship would continue, so anyone taking a decision on assisted dying would take it in some form of consultation with their loved ones. They have the right to say to their family, you are going to be miserable but this is what I want for myself.
Douglas: Often the family don’t agree with the decision…
Sam: Yes, but the law at the moment allows me, with my sound body and theoretically sound mind, to empty my bank account, hop over to the other side of the world and abandon my wife. I can do all sorts of things that will harm, damage and upset my loved ones but the law recognises my right to do all that. In fact, it takes almost no view on the matter and I don’t see why that should change when I’m terminally ill. The law gives me the right to do with my own body what I like regardless of the impact on those around me.
My second point is that there is a pragmatic issue here, which is the same as in abortion reform. Those who want to die and can afford to — which obviously privileges, if that’s the word, certain groups — can travel abroad to Dignitas or wherever they like. It is much harder and more unpleasant for them to have to do this, and much more expensive and traumatising for relatives. If people are going to do it anyway, they should be allowed to do it here in a way that…
Douglas: Makes death easier to access.
Sam: Make death easier to access, exactly.
Douglas: What a beautiful slogan.
Sam: A consumer point.
Douglas: It’s not unwise to make these things harder than they need to be, rather than easier. I once spoke to a euthanasia doctor about his terminally ill patients. Many suffer from degenerative illnesses which mean that they cannot sign the form to die when they are at their worst. They sign it in advance which is not dissimilar to what’s being suggested here. I asked this doctor, how can you be sure further down the line that you are definitely killing —
or however one wants to euphemise that…
Sam: Euphemise, euthanise.
Douglas: …that you are killing them and they want to die? And he said, I can’t be sure. I asked, do you think you have ever euthanised somebody who didn’t actually want to die and he said yes, I’m certain of it. I’m sure we both know of elderly relatives and friends who are at the end of their lives. Quite often they will say ‘I don’t want to get to X stage’ and they are absolutely certain they will never get to X stage and if they ever got near X stage they would be flying off to Switzerland. But then they get to X stage and the stage beyond and they still want to live.
Sam: These are hard cases. There is a considerable philosophical discussion here, about how much your present self can bind your future self.
Douglas: Can you imagine lying in a bed, not wanting to die, but knowing that you will because you once signed a form, which the state is now enforcing? That’s the other thing about it, the sheer bureaucratic awfulness of it, the form filling, the euphemising that will go on, when we’re talking about whether or not people should die.
What’s more, end of life care tends to become very lax in countries which have legalised euthanasia. People involved with euthanasia often tell me how admirable and good British medicine is when it comes to the last stages of life. There is a presumption that doctors should continue to provide palliative care. Doctors can, without euthanising people, make judgments on how to alleviate pain…
Sam: You say alleviate pain, that sounds itself like a euphemism.
Douglas: Well they know how to tread exceptionally carefully within that terrain during the very final stages of life. But I’d rather be a country admired for offering good palliative care on the NHS than for very efficiently despatching its elderly based on a signature on a form.
Sam: Well it doesn’t sound to me that you are actually drawing that much of a distinction there…
Douglas: I’m saying it is already within the competency of doctors to make sure the pain which people rightly want to alleviate is alleviated at the most extreme end.
Sam: If doctors to a certain extent, on a nod and a wink, ‘ease the path’, I am not completely against that but I would much prefer to have a say. Where do you stand on the dignity of dying argument?
Douglas: I think we’d probably agree on that one. First of all, I think that the existing status quo already attempts to make sure that people maintain dignity to the extent they can. But the word ‘dignity’ can be interpreted in many ways.
Sam: As with sanctity. Some words are unhelpful because they are so subjective.
Douglas: I’m all for sanctity. You’re an atheist aren’t you?
Sam: I am.
Douglas: Like me. But if I can say so, we probably both have quite a significant moral challenge ourselves… which is how might you form an idea of the sanctity of the human soul or human life in a non-religious context. That seems to me a very important moral job of our time.
Sam: Assuming that we think that sanctity is an advantage?
Douglas: What else would it be?
Sam: I think you’d need to unpack what sanctity means. I would argue that for instance, and in this instance, if we are talking about the sanctity of life, why do we regard it as something that’s sacred, whatever that means? I would say it is because it belongs to the individual.
Douglas: I would disagree, I would say it is because it is something very deep we intuit about ourselves. We also know that in the absence of the concept, however you might define it, you unleash hell. Sanctity is one of the most important things in our civilisation. Do we regard people as in and of themselves sacred in some way or not?
Sam: We can agree human life is important.
Douglas: It’s not just important, it’s everything. We can’t sum it up as if it’s something we’d just rather have if we can. I can think of very few things that hit so fundamentally at the idea of human life being in some way sacred than doing everything possible within your technological and medical power to keep it going as long as you can. I can think of nothing more likely to erode that idea than allowing people, with the state’s blessing, to decide when they end their life.
The past century alone suggests to me that we should be unbelievably wary of even very minor shifts in our views on these matters. It’s not hard to do away with a concept like sanctity of human life, not hard at all. It has happened in country after country from every different political direction, it has happened for religious and non-religious reasons. It’s incredibly easy to do, incredibly easy to lose something like that and not know how to get it back.
Sam: It’s seems odd that an abstract concept of the sanctity of life is more important than the individual life itself. A person who is suffering is deemed less important than the preservation of a concept. Why?
Douglas: Predominantly because of the impact that it will have on everybody else in society.
Sam: In what way does my decision to end my life impact on everyone else in society? If I commit suicide, I am within my rights.
Douglas: Yes, well a very good example. When somebody commits suicide they destroy the lives of everybody around them, they create something absolutely unmendable in everybody’s life who loved them. My own view is that society should take a very negative view about suicide because of the effect it has on those around them. If the government decides that someone can end their life, it will still affect those around the person. The question is, how big is the ripple effect?
Sam: The ripple effect on society or on the individuals who surround them?
Douglas: On everybody…
Sam: I wouldn’t presume we should arbitrate for the ripple effect on the rest of society.
Douglas: Not arbitrate, just guess.
Sam: The people around you are going to be sad, but the decision wouldn’t be taken in a vacuum. Many people would argue that a person dying on their own terms might be considerably less traumatic than watching them suffer horribly for a very long period of time. By the time this legislation would be applicable, a person would already be in a place where things were pretty horrible for those around them. As for the ripple effect on the rest of society? I don’t quite know how you quantify that.
Douglas: There is something very profound that happens to a society that allows euthanasia. It changes people’s attitudes towards themselves. It reinforces the idea of individual autonomy and takes away something of the communal act of living. I would say it makes life more shallow.
Sam: These are very abstract, intangible and personal positions. One of my bugbears is that a lot of the time, the arguments against euthanasia are focused on the what ifs…
Douglas: That’s because we haven’t done it yet…
Sam: Yes. But these abstract ideas about sanctity and autonomy seem to me to run against or over the individual feelings of the people involved.
Douglas: But we have to talk hypothetically. And if you are talking about something as important as deciding when people are allowed to die, you are likely to be talking in fairly sweeping terms aren’t you? We have to talk in abstract terms, but let me try to put it in slightly more concrete terms. What’s one of the most significant statements of the religious inheritance that you and I and everyone else in this country has imbibed to some degree, whether or not we follow its claims? Choose life.
Sam: I think that’s Trainspotting, isn’t it?
Douglas: Choose life, that you and your descendants might live. It’s an unbelievably important inheritance. It doesn’t exist in every society in history, even as an aspiration let alone a command. It’s a very big thing to decide to caveat…
Sam: Why is that? It’s not a straightforward expression either. Choose life implies you can choose the opposite. Is it an invitation or an injunction or a command unto death? If we return to the actual argument under consideration, we are talking about choosing life or not choosing life when that choice has already been substantially taken away from us.
Douglas: By the events of nature.
Sam: Yes, we’re talking about allowing people to go in for assisted dying only when they are on the threshold of death anyway.
Douglas: Well that doesn’t counter what I just said which is that in every situation where you can choose life, it is a very profound, fundamental moral injunction. Neither you nor I nor anyone else can fully guess what happens when a society that has generally run on that injunction being significant decides there’s a parenthesis you can add to it: choose life (unless you are quite close to the end and then you can sign a form that the NHS will give you and then you can choose to die sooner). I would add that parenthesis with great care, if at all. I am of the inclination not at all.
The point I will now make is a very hard one for some people to accept so I flag it up with waivers. I find that a line from King Lear sums it up: ‘Men must endure their going hence, even as their coming hither.’ Why does this line always stand out? Because it instructs us that the whole thing is not remotely easy. Life requires endurance at the beginning, throughout and definitely at the end. That is an accurate — I’m not saying desirable — depiction of what life is: something to be endured.
Sam: But you could argue from the same premise that many of the ungodly innovations we’ve come up with over the years, — such as anaesthetic or antibiotics — are themselves a dangerous assault on this principle. One could also turn to Arthur Hugh Clough: ‘Thou shalt not kill; but needst not strive officiously to keep alive.’
Douglas: The idea that we should choose life helps a lot of people through very bad times. I would argue in both a religious and non-religious context that this view of life is fundamentally undermined by the practice of euthanasia. It shifts and alters our perception not just of life but of ourselves, what we’re doing, our purpose. It puts a radically different spin on everything.