Assisted Dying: Cheaper When Dead

State-assisted dying. I used to be all for it.

How compassionate and empathetic to allow sick people to choose to die, I once thought. A true marker of an advanced, caring, society.

Then I started paying attention.

I watched austerity economics pushed by governments, billionaires and their thinktanks wreak havoc on healthcare systems. I read studies about the hundreds of thousands of people killed by public spending cuts, specifically cuts to health and social care. I watched disabled friends despair as systems of support were deliberately ripped away from them. I experienced a disabling pandemic. I watched friends become disabled by a virus they were told wouldn’t be a biggie if they were young and fit, especially after being vaccinated. I watched as they were then abandoned by the governments who told them they’d be fine. I watched governments demonise sick people. I watched as they told them their illness was a lifestyle choice, or anxiety. It was all in their head. I watched them try and force these sick people back to work. I read what disability organisations had to say about the so-called ‘right to die.’ I read about how assisted dying was being applied in Canada, the Netherlands, Switzerland, Oregon. I read about the long-history of euthanasia. I read about the Nazi predilection for eugenics disguised as compassion. I read accounts of disabled people demeaned and dismissed by doctors and nurses for decades. I listened to people explain how this grotesquely imbalanced power relationship can so easily and quickly turn abusive and dangerous. Even deadly.

And I changed my mind.

The UK is the latest western country to move forward with laws to legalise doctor-assisted suicide.

The current law would allow people with six months to live to choose death, after being examined by two physicians and the decision reviewed by a judge.

Seems reasonable? The small print says that the second doctor is appointed by the first, opening up the system to clear abuse. Legal experts say the judicial review component is unworkable. Physicians say a timeframe on expected life left is often arbitrary, never able to be determined with accuracy.

But the clamour for a change in the law must be overwhelming, right?

Not exactly.

EVERY SINGLE organisation in the UK led by disabled people is against the bill. And not one physician, social or palliative care group has spoken up in defence of the proposed law.

The campaign in the UK has been pushed entirely by one organisation - Dignity in Dying - a right to die lobby group funded by a right-wing British billionaire family.

The group has spent millions in recent years pushing its message, including decking out entire London underground stations with assisted dying adverts. In the week leading up to the first vote on the law in Britain’s parliament, the group was the number one buyer of Facebook ads in the country.

It’s unclear exactly what the motivations of this group are. But it does show us one thing: money buys laws.

Because, to repeat, every single organisation that the British government should be listening to on the dangers of state suicide is being ignored.

And the dangers are numerous and insidious. We only have to look at what has happened in Canada, the Netherlands and Oregon.

I don’t really like the thin end of the wedge argument because you can use it to argue against any policy, good or bad. But when it comes to euthanasia, everywhere it has been legalised the first iteration of the law actually has been the thin end of the wedge, the slippery slope.

In Canada, after euthanasia was legalised for the terminally ill in 2016, eligibility was expanded to people with chronic but not life-threatening illnesses. This has since seen people with non-terminal illnesses signed off for death and killed by a doctor. People with terminal illnesses in Canada, but with potentially many years left to live, have chosen death because the state refused to help them with anything else.

In 2022 Sathya Dhara Kovac, a Canadian with the progressive nervous system disease ALS - amyotrophic lateral sclerosis - chose euthanasia aged just 44, not primarily because of her disease but because the state refused to pay for the extra home care help she needed to continue living in her own apartment with her beloved dog. In her obituary she was explicit about this. She wrote: ‘ultimately it was not a genetic disease that took me out, it was a system.’

Can we ever be sure about the ethical position of those doctors who put their hands up to administer death? In Canada, physicians have joked about coercing the family of patients into proceeding with assisted death. Others, outrageously, have talked about the moment of death ushering in “an urgent need for sex.”

In The Netherlands, people in their twenties with autism and personality disorder have been able to legally kill themselves under a law that started out strictly for the terminally ill with months to live. Theo Boer, a professor of healthcare ethics and originally a vocal advocate for assisted dying, spent nine years on the government committee reviewing euthanasia. The experience profoundly changed his mind. Boer said he ‘saw the Dutch euthanasia practice evolve from death being a last resort to death being a default option.’

In Oregon, patients with anorexia have been offered assisted suicide. A twenty-five year analysis of Oregon’s assisted dying laws found that very few people who legally kill themselves are ever offered counselling and half of those who ask a doctor to kill them do so ‘because they feel like a burden.’ Under these conditions, is assisted dying really a result of a state-led compassion and success, or state-led indifference and failure?

Of course, there are individual stories of painful suffering that make the case for euthanasia. Powerful stories. But in democracies, legal frameworks that govern the conduct of entire professions, that determine questions of life and death, are not supposed to respond to individuals and billionaire lobby groups. They are supposed to work for everyone and respond to the majority.

In my opinion we should be extremely suspicious about the motivations of those countries moving ahead with euthanasia. Because these countries and their governments do not have track records suggesting benevolence and grace as the driving forces for healthcare and disability policies.

Let’s take the UK.

The wait for wheelchair accessible social housing in Britain is FORTY SEVEN years. The wait for a simple wheelchair itself can be years, even for children. It’s a simple fucking wheelchair! Absolutely scandalous.

But hardly a surprise.

In 2016 a special UN committee investigated the British government for its conduct under the UN convention on the rights of disabled persons and found it guilty of “grave and systemic” violations against disabled people. The British government repeatedly dodged hearings intended to hold it to account and improve its failings. In 2019, a separate UN report by the rapporteur on extreme poverty and human rights found that British government policy had led to the “systematic immiseration of a significant part of the British population.” The NHS has been torn apart and sold off by governments of the centre-left and right for 30 years. Waiting times for emergency departments, for cancer treatments, for home help, have skyrocketed. In Britain, under 65s deemed healthy are not eligible for covid or flu vaccines.

Yet all of a sudden, when it comes to assisted dying, we’re supposed to believe there has been an outbreak of compassion at the highest levels of elite British society? We’re supposed to think a country systematically abusing and mistreating disabled people is going to find a perfect moral compass when deciding who to kill? We’re supposed to believe a healthcare profession that consistently engages in abusive and deadly behaviour but too often sits above the law, will correct all its flaws overnight and administer death with precise judgement and control?

Truly enlightened societies would give everyone the legal right to assisted living before assisted dying. True care and compassion would see governments offer disabled and chronically sick people all the help and support they need and ask for, no questions asked, with minimal paperwork required. They would fund healthcare and palliative care systems accordingly.

They would trust people.

Money would be no object.

The grim truth is that it’s easier, quicker and, crucially, cheaper to offer people a state suicide before doing any of that.

Assisted dying might be easy to agree with in individual cases on the grounds of empathy and compassion, but I find it impossible to agree with it when the arbiter is the brutal and compassionless austerity state.

States should earn the right to encode assisted dying into the fabric of our societies through their actions and behaviours. It should be the final bar after all the others have been successfully cleared. Past behaviour should reassure us about the future competent administration of something so important as living or dying.

As it is, assisted dying laws appear a reward for egregious failure. It fundamentally bastardises the relationship between patient and care provider. No doctor should ever be able to ask someone “have you thought about killing yourself?”

Under the guise of compassion, systems which often show a complete disregard for the life, health and happiness of sick people are being given the right to legally kill those people.

That can’t be right.