How does it feel to provide “assisted dying” to people, in a place where this is legal? Some enjoy the experience, it would appear; indeed, some assisted dying providers enjoy it very much.
A recent <a href="https://pubmed.ncbi.nlm.nih.gov/39093520/#:~:text=The%20Canadian%20MAiD%20system%2C%20effectively,amid%20broad%20patient%20eligibility%20criteria."><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">article</mark></a> in the <em>HEC Forum</em> journal arrestingly titled “Canada’s Medical Assistance in Dying System can Enable Healthcare Serial Killing” described feelings of power, control and gratification – albeit perhaps mixed with compassion – on the part of those providing euthanasia. Assisted dying practitioners, it seems, can share some troubling features with less official serial killers.
That said, normal doctors are often reluctant to provide assisted dying and may react badly to the experience. One Dutch GP became introverted and hard to be around when cases came up, to the extent that his wife told him “I do not want you to do that anymore". The same <a href="https://pubmed.ncbi.nlm.nih.gov/31092632/"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">study</mark></a> of GPs showed that a majority were experiencing some kind of pressure: emotional blackmail and other pressure from patients, relatives and organisational structures.
Although willing to offer “some” assisted dying, they felt pressured to offer it too soon or in what they saw as potentially inappropriate cases. One describes the unpleasant experience of arriving on the day of the euthanasia and having the house door opened by the patient himself, who led the GP into the living room which was full of people “as if it was a birthday party.” Everyone held a glass of wine in their hand, while the GP got ready to end the patient’s life.
Dominant patients and relatives may put pressure on GPs who are uncertain where their limits are and feel control slipping away from them. In a society steeped in assisted dying, even those not currently in pain or close to death may see this measure as the expected, sensible thing to do. That applies to privileged patients for whom more alternatives are available as well as to the poor, homeless and desperate for whom options are scandalously reduced.
Recently, Lord Finkelstein <a href="https://www.thetimes.com/comment/columnists/article/times-up-for-status-quo-on-assisted-dying-pkjs8jfbs"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">blandly assured</mark></a> readers of <em>The Times</em> that a “reform” of our assisted dying laws would be a safer option than the legal status quo. He observed that, “If I were terminally ill, I would like the chance to control my own death and ensure it was as dignified and painless as possible. I would both want and need medical assistance to do this. I think this is a perfectly reasonable desire and that the law should not prevent me making such an arrangement.”
In standard liberal individualist style, Finkelstein moves swiftly from an individual’s “perfectly reasonable” desire to a desirable legal policy. If morality is seen as primarily about actual desires and some desires are characterised as “needs” we should seek to satisfy, then it seamlessly becomes a moral and legal imperative for the medical profession – indeed, for the entire NHS, implies Finkelstein – to facilitate these desires.
Despite a nod to undesired outcomes of “reform”, Finkelstein’s approach views politics as a simple technical activity – a mere deciding what people “want”, after which we seek the best means to achieve that end.
Assisted suicide becomes a political problem because individuals have the desire to die by “dignified” suicide – assumed to be a weighty “need”. The desire to avoid suffering at all costs in the name of an undefined “dignity” is unsurprisingly strong in a desire-based culture which has largely rejected traditional Christian ideas about the place of suffering in human life.
Combating suffering, not by treating pain but through the annihilation of the suffering subject himself, means that traditional worries about self-slaughter are put to one side where they cannot interfere with desire-satisfaction.
Liberal individualism is not the only way to think about politics. Human individuals are themselves the products of social co-operation rather than just the authors of it. Social structures and institutions formed in a Christian pre-liberal culture help educate desire and foster virtue and protect the vulnerable and elite alike. Those structures and institutions are not mere technical means to achieving individual desire-satisfaction but part of the very good in which we are called to participate as members bound to one another by a good beyond ourselves.
If assisted suicide is legalised, doctors will be expected to supply lethal drugs to those who request them – or at the very least, to refer to others who will do so. Supplying lethal drugs to the suicidal has been seen historically as against everything the medical profession stands for. What will be the effects on these heirs of a proud tradition uniting them to those who professed a solemn Oath against doing precisely that?
The venerable mantles of medicine and the law will be placed on a practice – socially endorsed suicide – which undermines the foundations of both. Thomas Aquinas was always clear that where the intention of the lawgiver tends toward true good – by which he meant the common good regulated according to divine justice – then through obedience to that law we are made good.
A law repugnant to that divine justice made by a lawgiver whose intentions do not tend to true good does not oblige in the same way. Laws such as the proposed assisted dying legislation will erode trust between patient and doctor and do serious harm to society, using the decent instincts of people to be “law-abiding” in ways which will tend to corrupt their character.
Those possessed of self-knowledge will not be sanguine about the effects of such laws on their minds and motives. Even those who claim that law has nothing to do with making people good and everything to do with social stability and external control may be concerned by the erosion of trust produced by assisted dying and its ability to spread in new and alarming ways.
How to respond, though, to Finkelstein’s argument that assisted dying is happening anyway in Britain and that it is “safer” to regulate it by statute? In fact, the current law – however gently enforced – does appear to be acting as a deterrent: there is a very low rate of lawbreaking, with relatives clearly deterred by the prospect of a police investigation.
On average, as Robert Preston comments in <a href="https://www.amazon.co.uk/Reality-Assisted-Dying-Understanding-Issues-ebook/dp/B0DDG1FX7D/ref=sr_1_1_sspa?crid=12VXL3W0HPENN&dib=eyJ2IjoiMSJ9.x-O_n9yseei_rZ4q-4pCSw.01ox_u6qw7OBTNp1Wrs6zU1CYt-b732Jl2yT_B_EGak&dib_tag=se&keywords=REality+of+assisted+dying&nsdOptOutParam=true&qid=1729771082&sprefix=reality+of+assisted+dying%2Caps%2C102&sr=8-1-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9hdGY&psc=1"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">The Reality of Assisted Dying</mark></a>, fewer than 20 cases of assisted suicide a year in England and Wales cross the desk of the Crown Prosecution Service. Fewer still are prosecuted, but the picture this presents is hardly that of floodgates already open. Is this really less “safe” than a situation where a suicide prescription is handed out with the blessing of the State and may be in the house for weeks and months before being “used” – whether voluntarily or under pressure from unknown agents?
Toward the end of his article, Lord Finkelstein reassures readers that the worries about Canada must be exaggerated: after all, is not support for the law at 84 per cent, according to a 2024 poll? Would support be so high, he asks, if “a change in the law was really so bold and dangerous, and lots of old people were being sent unwillingly to their deaths…?”
On this point, it may be worth remembering that last year, <a href="https://nationalpost.com/news/canada/canada-maid-assisted-suicide-homeless"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">almost a third</mark></a> of Canadians polled also supported offering assisted dying to people who are homeless or poor. Such terminations are already happening, reported in the international press.
If what you have is a hammer, everything looks like a nail. When we speak about educating desire, it is the desires of complacent observers, not just suffering and desperate individuals, that need the education of the law. That insight, integral to Christian tradition, is by no means confined to it.
<a href="https://catholicherald.co.uk/assisted-suicide-ideology-is-nazism-says-bishop-egan-as-he-urges-catholics-to-fight-bill/?swcfpc=1"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color"><strong><em>RELATED: Assisted suicide ideology is Nazism, says Bishop Egan as he urges Catholics to fight Bill</em></strong></mark></a>
<em>Photo: A medical practitioner on a general ward at The Queen Elizabeth Hospital in Birmingham, England, 16 March 2010. (Photo by Christopher Furlong/Getty Images.)</em>
