A New Paradigm For Assisted Dying
The UK bill is a win for decency and dignity—while offering robust safeguards to avoid the mistakes of other countries.
Liberal democracies are rights-based societies. Citizens have a right to equal protection under the law, to safety, and to a wide range of public services. We have the right to freedom of conscience, expression, and assembly. We have the right to choose our leaders through free and fair elections. The idea of rights is foundational to governance and society across the democratic world.
But there’s one right that many democratic societies refuse to grant, and it may be the most consequential of them all—the right to die.
It’s a strange incongruence that so many rights-focused democratic societies force terminally ill people to remain in a state of immense and indefinite suffering against their will. A bill in the UK, the Terminally Ill Adults (End of Life) Bill, was recently introduced to address this vast and cruel contradiction. On Friday, the House of Commons voted in favor of the bill, which must go through several more legislative stages before becoming law. But the vote is a historic moment that sets a course for a freer and more humane future for terminally ill Britons.
The End of Life bill is highly restrictive. Beyond the baseline conditions—that applicants are adults of sound mind who have not been coerced or pressured in any way, and who have a “clear, settled and informed wish to end their own life”—the bill contains many robust safeguards. For example, a person must be terminally ill to be eligible for lawful assistance in their death. This means they must have an “inevitably progressive illness, disease or medical condition which cannot be reversed by treatment,” and their death can “reasonably be expected within 6 months.”
Meanwhile, the process of approving a request for assisted dying in the bill is intensive, and it contains numerous guardrails and checks. A terminally ill person must voluntarily make an initial declaration that is witnessed by a doctor and another person, at which point they will have a 7-day period to reflect on the decision. A second doctor must independently evaluate the request to determine whether the eligibility criteria are met. The request is then sent to the High Court for approval. If the court decides that all the requirements are met, the applicant must issue a second declaration after another 14-day reflection period (which is shortened to 48 hours if their death is imminent). At this point, the terminally ill person would be prescribed a life-ending “approved substance,” which would have to be self-administered.
There have been plenty of bad faith arguments against the End of Life Bill, such as the idea that non-life-threatening conditions like diabetes could fall under the criterion “cannot be reversed by treatment”—ignoring the bill’s stipulation that these conditions must be imminently terminal—or the ugly and false argument that the bill treats some people as “productive” and others as “disposable.” But most critics of the bill raise important points that will need to be a central focus as the legislation works its way toward becoming law (although many have been addressed already).
For example, some disability advocates argue that the government should focus on improving health services such as palliative care before authorizing assisted dying. It will always be possible to argue that the healthcare system as a whole is imperfect; but this shouldn’t be used as an excuse to permanently delay the establishment of a legal framework around assisted dying. The bill requires doctors to discuss services like “palliative, hospice or other care,” as well as “any treatment available and the likely effect of it” with patients considering assisted dying. There are many circumstances when patients already opt for palliative or hospice care as a form of end-of-life care, which means stopping treatments (such as radiation or chemotherapy for cancer patients) in favor of a better quality of life. In these cases, it can plausibly be argued that the patients would live longer if they kept receiving the more strenuous treatments. But they’re free to make this choice.
Another argument is that the bill might put the UK on a “slippery slope,” and that eligibility requirements will be relaxed over time to include people who shouldn’t be given the option of taking their own lives. Canada is often cited as the prime example of this slide. When Canada first legalized assisted dying in 2016, it was only for people with terminal illnesses. The law was expanded in 2021 to cover those who have a “serious and incurable illness, disease or disability,” and the person’s death no longer needs to be “reasonably foreseeable.” The most disturbing aspect of the Canadian law is that it might soon allow people whose only condition is mental illness to take their own lives.
Other versions of the slippery slope argument point to the continent. The Netherlands and Belgium legalized assisted dying over 20 years ago, and both countries consider mental health issues sufficient for eligibility. Euthanasia for minors is also legal in each country. Children must be at least 12 years old to request euthanasia with parental consent in the Netherlands, and for 16 to 18-year-olds, parents merely need to be “involved in the decision-making process.” There’s no age limit in Belgium, though the child must always have the written consent of parents. Assisted dying in Switzerland has been legal since 1942. A terminal diagnosis is unnecessary and applicants can have a mental illness (though they need to be deemed capable of making their own decisions).
Given the wide range of laws around assisted dying, it’s understandable that opponents of the UK bill are concerned that the safeguards will erode over time. This is particularly true given the different outcomes from country to country—while assisted dying accounted for 1.5 percent of all deaths in Switzerland in 2018, it accounts for 4.1 percent of all deaths in Canada.
Other international comparisons are more favorable. In the United States, assisted dying has been legal in Oregon since 1997, and it only accounts for 0.8 percent of total deaths in the state. Oregon’s Death with Dignity Act is a clear precursor to the UK bill—it was enacted nearly two and a half decades ago, and eligibility is still limited to applicants with terminal diagnoses that will “lead to death within six months.” Other safeguards have remained in place as well, such as approval from multiple doctors, requirements to inform patients of “feasible alternatives” such as “comfort care, hospice care, and pain control,” and multiple requests from the applicant spread out over time.
More fundamentally, while the experiences of other countries and states are instructive, the most relevant issue is what is actually contained in the End of Life bill. The UK Parliament has advanced legislation that allows Britons with terminal illnesses to end their lives on their own terms, while providing what are among the most robust safeguards for any such law in the world. Terminally ill people are today forced by law to continue living with unbearable pain, which is an extremely steep price to pay to avoid the negative consequences envisioned by opponents of the bill, many of which are hypothetical.
There are other issues that need to be debated. Feelings of coercion or pressure to end one’s life will always be hazy—even if a terminally ill person has a supportive family and experiences no explicit pressure, that person may still fear becoming a burden to loved ones. There’s no way for any evaluation from doctors or judges to fully account for all the vicissitudes of human psychology and behavior. Advocates for the disabled in the UK are right that these concerns are even more acute when it comes to disabled people who may feel marginalized by the existing healthcare system, and who may already experience prejudice or feel guilt about how their situation has impacted those around them.
However, the thorny subjectivity of all the issues surrounding assisted dying cuts both ways. Terminally ill people who genuinely want to die with dignity feel a different kind of pressure—a form of pressure that can alienate them from loved ones and force them to suffer in silence. A recent New York Times article about the assisted dying debate in the UK highlights the case of Mark Pluciennik. He suffered from a neurological condition that left him “unable to move his legs, incontinent, [with] his eyesight failing, without any sense of taste or smell.” Pluciennik took his own life without telling his wife, Sarah Tarlow, to protect her from prosecution. Tarlow says “I still get upset and angry that he had to die on his own when I should have been there.” She protested in favor of assisted dying in front of Parliament: “I think it is cruel to make people die horrible, prolonged deaths against their will and that’s what the present situation currently does.”
Under current law in the UK, the family or friends of terminally ill people who help them end their own lives can face up to 14 years in prison. Family members who go abroad with their loved ones to a country like Switzerland where assisted dying is legal for foreigners can face prosecution upon their return. Critics of the End of Life bill should acknowledge that the current law already exerts horrific pressure on people who are facing the most difficult decision of their lives—pressure to make that decision all alone.
As you read these words, there are millions of people suffering a level of physical pain and mental anguish that most people could not possibly imagine. This should be the starting point for any discussion about whether people should have the right to end their own lives—humility about our complete lack of knowledge of what those lives are really like. The pain and isolation faced by terminally ill people is often compounded by innumerable daily indignities: the inability to bathe oneself or use the restroom, the inability to speak, the loss of motor function and senses, and so on to a horrifying extent.
But the lack of autonomy may be the biggest and cruelest indignity of all. Current UK law forces terminally ill people to suffer pointlessly under the insulting assumption that they don’t know what’s best for them—even if their mental faculties are fully intact and they have expressed their wishes clearly and repeatedly. Proponents of assisted dying should take heed of the risks surrounding a slippery slope and learn from the mistakes of other countries. But ultimately, the End of Life bill gives people the freedom to depart the world on their own terms, surrounded by those they love, and with the dignity they deserve. For that reason, it should be celebrated.
Matt Johnson is an essayist and the author of How Hitchens Can Save the Left: Rediscovering Fearless Liberalism in an Age of Counter-Enlightenment.
Follow Persuasion on Twitter, LinkedIn, and YouTube to keep up with our latest articles, podcasts, and events, as well as updates from excellent writers across our network.
And, to receive pieces like this in your inbox and support our work, subscribe below:
I'm old and I don't want to get put down!!! My objection isn't religious but selfish: I care about me, me, me. The question about assisted dying is if passed will it mean that more people get what they want or fewer. Are there more who want to want to get put down who will get what they want? Or more, like me who don't want to get put down who will be wheedled, pressured, or effectively forced by having support services cut who will not get what they want.
The elderly and infirm, and the chronically ill and disabled, are a burden financially and emotionally to caregivers and to their families. There's plenty of motivation to get them to get themselves euthanized. I'm cynical and a pessimist about human nature. If assisted dying people will be better able to practice self-deception, to imagine that by inducing inconvenient, expensive relatives to have themselves put down they're doing a good thing.
I want to survive as long as possible and I don't care how much of a financial or emotional burden I am on anyone. My life is all I've got, it's me, and I want as much me as possible. And I hope that during my final days I will be thoroughly doped up and high as a kite so that I don't know what is happening and don't care.
It’s pretty common that Canada is used in persuasion as an example of a country that has gone to far with its Medically Assisted in Dying (maid). However, why is it a mistake? Persuasion is a liberal magazine and believes in reasonable disagreement, even fairly unreasonable disagreement in politics. However, when Canadians as a democratic society broadly support MAID with a supermajority, we receive the patronising label of “mistake” rather than a liberal democratic society with slightly different value needs. When an American takes a principled libertarian position, I may strongly disagree. I certainly would fight to live in a different society. Yet, if a principled libertarian would rather all the ills of a libertarian society, including an increased chance of violent death, persuasion will greet that as a political preference with different values, something one can discuss and appreciate yet disagree in a liberal society.
MAID was brought about and expanded in Canada based on human rights lawsuits by citizens who were suffering and not able to go their own way. It has not been a top-down process.
The vast majority of patients using MAID, have terminal cancer. There is no conspiracy to depopulate our country of unproductive assets. Some with non-terminal illnesses suffer also want relief, but government has resisted doggedly for years. Our Liberal party may be a little woke, but it is also a small ‘c’ conservative centrist party. Now, you may not agree, but it is like gay marriage. You don’t have to get in a same sex marriage, you don’t even need to think them moral: you are free to do those things, but others are also free to enter such arrangements with legal protection.
Critics like to point out about slippery slopes, but slippery slopes are infantile argue. Nothing but a pure deontologies can worry about slippery slopes. Common law is grounded in reasonable judgement, and tends not to be to prescriptive. To check the executive and legislative powers, there is the judicial.
So please, explain why you disagree, but save us the patronising label of ‘mistake’ that you wouldn’t jump to put on someone who merely disagrees. Not only is it patronising, but indicating a laziness for not having engaged the issue. Perhaps you have considered it in a certain environment, but broaden your horizon of dialogue.