Assisted Dying: Doctors are right, this euthanasia bill could go so dreadfully wrong

Any society that will put up with that sort of thing – it’s clearly regarded as natural in the film – won’t have a problem with secretive corporations turning out ready-meals predicated on cannibalism.

As it happens, almost all the assumptions of Soylent Green (and Harry Harrison’s novel Make Room! Make Room!, on which it’s based) were wrong: it turns out that a global population of seven billion wasn’t unsustainable, but produced a world richer, healthier, mostly more free and with lower levels of poverty and access to abundant, much cheaper food than when Harrison wrote the book.

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But one area where it may have been right is about the dulling moral effects of state-sanctioned euthanasia; the doctors who have written to the Health Secretary, Humza Yousaf, to warn against the Lib Dem MSP Liam McArthur’s bill to legalise assisted deaths, articulate widely-held concerns, even among those sympathetic to those who are terminally ill and wish to end their lives.

And many of us are: almost everyone who has watched a loved one suffering, knowing that death is imminent, will understand the impulse to have the whole business over and done with, for their sake.

But there are numerous reasons why there is, and always has been, resistance to actively legalising euthanasia. The argument based on the sanctity of human life is an absolutist one, but because of that, and though I am myself inclined towards it, it’s not very useful when debating the legal position. Like abortion or the death penalty, those who take that position oppose euthanasia in any circumstances (though some have plausible reasons why they don’t regard all those issues as identical).

In practice, however, the prevailing attitude of our society is closer to that of Arthur Hugh Clough’s “Thou shalt not kill, but needst not strive / Officiously to keep alive” – which was written as a satire of weaselly moral equivocation, rather than a précis of Hippocrates. Very few people argue that doctors who, having discussed the dangers, prescribe lethal quantities of analgesics for those at the end of their lives should be hauled before the courts – and they practically never are, even though such drugs are often the proximate cause of death.

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That’s obviously not an entirely satisfactory legal position, but it’s a pragmatic one, because there are compelling practical objections to the alternatives. One is that there are no medical certainties about death, except that we all eventually die. People who have been given terminal diagnoses have survived for decades, often living very fulfilling lives (Stephen Hawking is an obvious case); patients have awoken from years in coma. These are, of course, exceptions, but one could make a similar argument about the death penalty being applied to one innocent person, and plenty of people do.

A related question is the degree to which someone terminally ill, or in serious pain, is capable of agency: to assume they are would usually be preferable to having the issue decided by others, but we do make such interventions all the time to prevent those who are mentally distressed from making decisions of that kind. By contrast, the recent, scandalous cases of DNR notices being applied to disabled patients in Covid wards, without the consent or in some cases even the knowledge of them or their families, is a compelling demonstration that medical professionals don’t always get such calls right.

That may be a forceful argument for regarding euthanasia as a special case, because when a practice is legitimised, it becomes regarded as normal, rather than exceptional – especially by those, such as medical and legal professionals, routinely involved in the decisions around it.

Anyone who doubts this need only look at abortion. This has nothing to do with whether you think abortion is a woman’s inalienable right, or is always wrong: only the stated aims of the legislation, compared with current practice.

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When legalisation was introduced by David Steel in 1967, almost everyone who argued for it said that it would be rare, subject to strict conditions, and was mainly desirable to prevent the deaths of the 50 or so women who died each year during illegal procedures. No one anticipated that, after the law has been amended seven or eight times, more than 200,000 terminations would be conducted annually in the UK.

There are plenty of people, especially those who don’t regard life as beginning at conception, who don’t have an issue with this, and lots who think women’s abortion rights should be strengthened. But the point is that what was previously an ethical hot potato is now commonplace, certainly for doctors.

There is currently an interesting case before the High Court, not about abortion itself, but about the different rules on term limits that apply to diagnoses of Down’s Syndrome. The competing rights of the disabled, but unborn, and those of a woman to control her own body may currently be a concern mainly for those who oppose abortion. But even for those who view abortion as a right, the case of established persons is obviously different.

If disability, incapacity or suffering are sufficient justification for ending a life, those in that position will be presented with it as an option; there is a significant danger that declining the option will come to be seen as the irrational decision.

Framing the question as a legitimate one, however compassionate it may seem, risks suggesting that those who insist on living, despite pain or a quality of life others judge unbearable, are making the wrong choice. It’s then a short step to that choice being seen as evidence that they’re not fit to make the choice.

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