When the right to die becomes a duty to die

Allowing assisted suicide will pressurise many suffering and disabled people to end their lives, argues Mary Ann Macdonald.

A bill to legalise assisted suicide in England and Wales has been formally introduced into Parliament, with members to vote on it this year.

Supporters of assisted suicide argue this offers more choice, dignity and compassion to the terminally ill. And though it is expected to be restricted to those in the last phases of their life, the experience of every single country where assisted suicide has been legalised shows that the criteria inevitably widens to include many disabled people over time. As a disabled person myself, this is a frightening prospect.

I wrote about assisted suicide in part here, but in this article I address the issue more directly to argue that its promises of more choice, protection of dignity and compassion are ultimately illusory.

More choice

Making assisted suicide legal would allow people to choose when they die, giving them autonomy over their future. Allowing for more choice appears great on the surface, but are all choices good?

We need to go beyond the assumption that personal choice has the last word because some personal choices can be very damaging towards others and towards society.

This is why we have the law, because some choices harm society (most obviously criminal ones) and we feel we need protection against them.

Once we acknowledge that some choices should not be allowed, we can properly analyse the choice of assisted suicide.

This bill seeks to legalise it for the terminally ill. Even if this always stays the case, the argument is dangerous because it ignores the fact that all choices are relational. There is never a choice which uniquely affects the individual. 

Forgetting this risks not acknowledging the reasons why people would choose to die. Particularly when we can see that many of these reasons are ones we can change, we could let, or make, people die for reasons we could address if we, as a society, prioritised them.

Like any other choice, many factors have led those making them to that conclusion. Some of those factors will be pain and suffering which can be hard to address, leading death to seem like the only credible option. But others, like lack of social care and security, are factors we can control and which can significantly help to ease suffering.

More than 100,000 people each year in the UK cannot get the palliative care they need to live comfortably.

Very well-intentioned family members and friends do care but, with the inadequacies in the social care system, this inevitably leads to the individual thinking that the upkeep of their life is a burden. We can look to Canada and the US to see that this plays a significant part in why people choose to die.

Canada’s latest health report on ‘Medical Assistance in Dying’, published in October 2023, evidences people’s reasons for requesting a medical end to their life in 2022. 

A common trend amongst the testimonies is a desire to end the suffering not only for themselves but also for the people who were looking after them. 35.3% reported a perception of being a burden on family, friends and caregivers. And one in five reported isolation or loneliness. 

The US state of Oregon’s ‘Dignity in Death’ 2023 report, cites that 43.3% of people were also concerned with being a burden.

Of course, even the best palliative care could never totally eradicate pain.

But legalising assisted suicide risks cost-effectiveness playing a part in treatment plans.

Assisted suicide will be an option available to consider. And it will be, from a purely monetary standpoint, the cheapest one. In a climate where palliative care is already not being prioritised, it is doubtful that the option of assisted suicide will be an occasional choice.

Assisted suicide is not just one option among many that people can freely choose if they want. It is an option that will dominate all others. With increasing economic and social failure, it is impossible to put safeguards in place that will protect people from feeling coerced to choose to die based on financial factors. 

Rather than allowing for more choice, it will appear to be the only choice in reality.

Protection of dignity

The argument of protecting dignity operates on a false notion of what actually constitutes human dignity. Advocates argue that the loss of faculties which often comes with terminal illness results in a loss of dignity that needs to be resolved. 

But, fundamentally, we are not defined by what we can and cannot do. The great feature of the human race is that, though united by our common humanity, we are all different. In deciding to shorten someone’s life because of their physical or mental limitations, we set a dangerous precedent whereby some are deemed less worthy simply because of their reduced capabilities.

Leading on from this, this view risks marginalising all disabled people. Aside from evidence from other countries which shows how euthanasia has negatively changed attitudes to disability in those places where it has been legalised, over fifty UK MPs are already campaigning for the criteria to include anyone who is ‘incurably suffering’. But the word ‘suffering’ could be defined in thousands of ways and could theoretically be argued to include anyone with a chronic disability.

To legalise assisted suicide while being aware of the insurmountable evidence from other countries who widened their criteria having legalised assisted suicide is to knowingly endanger the lives of disabled people in Britain. It is to say, “don’t worry, the pressure to end your lives does not relate to you just yet.” 

Making any form of vaguely defined ‘incurable suffering’ a possible motive to end one’s life is at the very least to raise the question: “Is your life worth living?” And someone, in a moment of darkness (which might well pass) could decide that is not.

This very option could lead to so many needless acts of suicide.

Assisted suicide builds on the fact that disabled people are already made to feel like a burden on state resources, and offers people a way out of that. No wonder many major disability rights charities have voiced concern over assisted suicide.

The boundary once blurred opens up the door for it to be blurred again and again. In 2015, assisted suicide was decisively rejected. Now it is being proposed again for the terminally ill. In another nine years, who can say that what was frowned upon in 2024 will no longer be?

Compassion

I find this debate often involves the demonising of the other, labelling supporters of assisted suicide as remorseless killers and its opponents as heartless ideologues. This gets us nowhere.

Many who support assisted suicide (often opting to call it assisted dying) are motivated by having witnessed their loved ones dying in a heart-wrenching way. We are compassionate beings. We see another’s pain and want to take it away.

I do not think most people have sinister intentions in arguing for assisted suicide. But nor do I see those arguing against it as actively wanting people to be in pain. The contention of this debate could be summed up as a disagreement as to what people think compassion looks like.

Advocates argue that honouring a person’s autonomy and relieving them from decline in health and their abilities in life is compassionate. But true compassion demands a deeper commitment.

Compassion is not just agreeing to someone’s desire to end their life.

A holistic and effective approach addresses the reasons behind that desire and ensures every possible support is offered to aid their quality of life. It is helping them see that they are valuable in themselves and to others also in this suffering. 

Making assisted suicide an option is wrong on all counts. It means it could appear on occasions to be the only option for those who worry they are a burden.

A compassionate society cannot be one that says a certain level of care is too much. We cannot say: we will help you but only up to this point. Instead of eliminating the sufferer, a caring stable society sees the worth in every life, even with pain or disability.

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