Originally published at Project-Syndicate | Dec 6th, 2024
The United Kingdom appears poised to join the growing list of countries that allow terminally ill patients to receive medical assistance in dying. Given the weakness of opponents’ arguments, and years of experience with similar legislation elsewhere, the UK’s move is well justified.
MELBOURNE – Last month, members of the UK House of Commons were allowed to vote according to their conscience on a private member’s bill to permit some patients to receive medical assistance in dying. In 2015, a similar proposal failed, gaining only 118 votes, with 330 against. This time, however, the bill, moved by Labour MP Kim Leadbeater, was supported by 330 members and opposed by only 275.
The bill allows patients who are 18 or over and have received a medical diagnosis of a terminal illness with no more than six months to live to request medical assistance in dying. The request must be approved by two doctors and a judge. A doctor may then prescribe a lethal drug that patients may take. The legislation must still go through parliamentary committees and the House of Lords, and may be amended, but some form of assisted dying will likely become lawful in England and Wales.
John Stuart Mill, a member of the House of Commons in the 1860s, would have been pleased. Medical aid in dying comes squarely under the principle he defended in On Liberty: “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.”
Doctors in the Netherlands have been able to practice voluntary euthanasia openly since the 1980s, and Austria, Belgium, Canada, Colombia, Ecuador, Germany, Luxembourg, New Zealand, Spain, and Switzerland now permit medical assistance in dying, while a law permitting it in Portugal is not yet in force.
In the United States, Oregon legalized medical assistance in dying in 1997. It has, to date, been followed by nine states, including California, as well as by Washington, DC. All six Australian states now allow medically assisted dying, too.
In the 1970s, when I first advocated legalizing voluntary euthanasia, the most troubling opposition came from those who argued that legalization would be a slippery slope. We would start, they predicted, by honoring the considered requests of terminally ill people, but once we had weakened the prohibition on taking innocent human life, we would proceed to kill people who are an economic burden or members of racial or ethnic minorities considered inferior to the majority.
Predictably, in the United Kingdom, the Archbishop of Canterbury, Justin Welby, attempted to use this argument. But today, in contrast to the 1970s, there is plenty of evidence against it. Leadbeater responded to the archbishop by pointing to the experience of Oregon, which now has 27 years of legal medically assisted dying without a slippery slope in sight.
In the UK, opponents of legalization referred to the danger that, once doctors could legally provide assistance in dying, terminally ill patients would feel pressured to request it. Liz Carr, an actor and disability-rights campaigner, said that some people might think: “My family is having to look after me, I’m incontinent, I don’t want to use all the money I have saved over the years on care, it would be better for those who love me not to see me like this, I will do the honorable thing.”
Carr is right: some people might think that. But why is that an objection to legalizing assistance in dying? Doesn’t a person who has been told that she has fewer than six months to live have the right to decide whether she prefers her savings to be spent on her care or to be available to her family after she dies? If, perhaps after using some of her savings for her own care, she judges that this is not money well spent, isn’t she in the best position to decide?
Another argument I have heard many times over the past 40 years is that instead of legalizing assisted dying, governments should spend more on palliative care so that terminally ill patients can die a natural death without suffering. In the recent UK debate, that argument came from an unusual source: Wes Streeting, Secretary of State for Health and Social Care in the Labour government. Streeting voted against the bill after saying that he did not believe the palliative care system is good enough to support assisted dying.
If Streeting wants to reduce the number of people who will use the new legislation, it is within the power of his government to ensure that the UK has the best palliative care that the current state of science and available funding can provide. Until that happens, though, why would he wish to prevent terminally ill patients from obtaining assistance in dying when they are dying in pain and discomfort because of the inadequacy of the health-care system his department administers?
In any case, statistics from Oregon show that only a minority of those using the state’s Death with Dignity Act do so because of inadequate pain control. Loss of autonomy and the inability to engage in activities that make life enjoyable are the most commonly cited reasons, and palliative care cannot change those aspects of illness. Fortunately, terminally ill residents of England and Wales (Scotland’s parliament is considering a similar bill) will most likely soon be able to make their own decisions on when their life is no longer worth living.
Peter Singer: Founder of the nonprofit organization The Life You Can Save, is Emeritus Professor of Bioethics at Princeton University. His books include Consider the Turkey, Animal Liberation, Practical Ethics, The Ethics of What We Eat (with Jim Mason), Rethinking Life and Death, The Point of View of the Universe, co-authored with Katarzyna de Lazari-Radek, The Most Good You Can Do, Famine, Affluence, and Morality, One World Now, Ethics in the Real World, Why Vegan?, and Utilitarianism: A Very Short Introduction, also with Katarzyna de Lazari-Radek. In April 2021, W.W. Norton published his new edition of Apuleius’s The Golden Ass. In 2013, he was named the world’s third “most influential contemporary thinker” by the Gottlieb Duttweiler Institute. He is a co-author (with Shih Chao-Hwei) of The Buddhist and the Ethicist (Shambhala Publications, 2023).
