This essay, on the complexities of the assisted dying debate, was my Observer column this week. It was published on 24 October 2021, under the headline “Claiming a monopoly on truth and decency is no way to win the assisted dying debate”.
A man is standing on the parapet of a bridge. He is about to jump. What should you do? Most people would agree that the moral act would be to talk to him to try to persuade him not to. Most people would also agree that giving him a push because “that’s what he wanted” would be committing murder.
Your grandmother is dying. She is in great pain, has only a few days to live and wants you to end her life now. It’s unlikely that most people could bring themselves to do that. But most would probably understand if you did accede to her wishes, however tormented you felt. And even more were a doctor to give her sufficient painkillers to allow her to die in peace.
The debate about assisted dying is one in which there are no simple answers; a debate in which we need to acknowledge that truth and moral decency lie on both sides and in which context is particularly important in judging what is right and wrong. On Friday, the House of Lords debated Baroness Meacher’s Assisted Dying Bill, which would allow terminally ill adults assistance to end their life. It’s unlikely to become law, but the debate will undoubtedly continue.
The Lords debate was respectful, often moving. Much of the wider discussion on the issue, however, is mired in bad faith assumptions: on the one side, the idea that opposition to assisted dying is driven primarily by religious obscurantism and on the other that supporters are tantamount to murderers and “not to be trusted”. Those are not good places from which to start a hugely significant yet highly sensitive public debate.
I am broadly in favour of decriminalising, in a limited fashion, acts of assisted dying but I also understand the force of the arguments from opponents and partly agree with them. This is a terrain to be carefully negotiated.
The first, critical argument is about the sanctity of life. This is more than a religious argument. Most of us, religious or irreligious, place special meaning on human life, recognising that we are not merely machines or slabs of meat, but persons, moral agents to whom we accord dignity and respect by virtue of being human.
Few, however, view the sanctity of life in absolute terms. Many who oppose assisted dying support the death penalty. Most would defend the taking of a life in self-defence or accept killing other humans in a war they think is just or necessary. Again, context matters.
The philosopher Ronald Dworkin observed that we value life through three lenses: subjectively (treasuring the inner life of the individual); intrinsically (insisting that a human life is valuable in and of itself); and instrumentally (gauging people through their usefulness for society and other individuals). Opponents of assisted dying rightly stress the intrinsic value of life and worry that in expanding the legal capacity to end life we may be drawn to viewing human worth in more instrumental ways. One of the ironies, though, is that in stressing the intrinsic, we may implicitly downgrade the subjective aspect of being human. We can end up giving priority to the state of being alive – of breathing or being conscious – over an individual’s moral sense of what life means to them. Yet it is that capacity for subjective evaluation that truly makes us human. It allows individuals to reason and reflect, to contemplate the worth of one’s life and the nature of one’s death. To deny someone the right to end their life with a sense of dignity is to diminish that capacity. That may be necessary to protect a wider sense of the common good, but we should be aware of the consequences of doing so.
A second key argument is that of the “slippery slope” – the belief that one step towards any form of assisted dying would irrevocably lead to a world in which we accepted the culling of the old and the infirm.
There are few spheres of life in which slippery slope arguments have not been deployed. In the late 1960s, a Times leader warned that the new technique of IVF could lead to a race between nations, each “breeding a race of intellectual giants”. Any attempt to decriminalise marijuana becomes a downward path to smack being sold in the corner shop. And, for many, gay marriage is “a slippery slope to polygamy and bestiality”.
It’s a metaphor whose power derives from imagining social developments as though they were natural and inevitable, just as a ball rolls down a slope under gravity. What shapes human laws and conduct, however, are not invisible natural forces but political debate. There is nothing inevitable about social change and taking one step does not mean a slide all the way to the bottom.
Many critics point to developments in the Netherlands as an example of a slippery slope. In 2002, assisted dying was legalised for people with incurable illnesses facing “unbearable suffering”. Over the past decade, there has been a debate over extending the law to all those over 75 who feel they have “completed” their life. This, indeed, would be a calamitous move. The problem, though, is not the mythical slippery slope, but that critics have not yet convinced proponents that their proposals are dangerous and wrong. This, as much as any other contentious issues, from Brexit to immigration, should be worked out through public debate, not fear-mongering about slippery slopes.
Linked to slippery slope arguments are fears that assisted dying laws will devalue the lives of old or disabled people. Many might feel they are a burden on their families or on society and so feel a pressure to die. These are important issues and a primary reason the proposed expansion of the law in the Netherlands is so troubling. Society should view the elderly and the vulnerable as people to whom we have obligations, not as inconveniences weighing us down.
The real issue, though, is less the law than wider social attitudes towards elderly and disabled people. During the Covid pandemic, there have been abuses of “Do Not Resuscitate” orders, apparently given to care home residents and those with learning difficulties without regard for their wishes or welfare. The stories are shocking, but few would argue that the solution lies in getting rid of DNR notices. The same logic should shape the assisted dying debate, too.
There are many other questions – from the need for improved palliative care to the relationship between individual choice and the common good – with which to wrestle in this debate. Too often, though, these get entangled in a common refusal to see the significance of the argument from the other side. Compassion and moral righteousness don’t belong in bunkers.