Assisted dying: are humanists allowed to dissent?

By David Warden

In this article, David writes that the relief of intolerable suffering is a noble cause but merely focusing on “autonomy” and “rights” is not giving us the full picture of this complex moral issue.

David is Editor of Humanistically Speaking and Chairman of Dorset Humanists.

“Must I await the cruelty either of disease or of man, when I can depart in the midst of torture and shake off my troubles? Life keeps none of us against our will. Live if it suits you; if not, you can go back to where you came from.” Seneca, Epistles 70.14-15

“Living is slavery if the freedom to die is lacking.” Montaigne, A Custom of the Isle of Cea (1580)

“Of all people, you might expect humanists to have protecting human life at the core of their ideological DNA. Instead, they are queuing up to plunge in the needle of death. The humanists talk blithely about ‘safeguards’, as if any legal system can protect an elderly and highly suggestible person from subtle forms of micro-manipulations... This is the brave new world the humanists have been arguing for.” Giles Fraser, UnHerd

Elsewhere in this issue, we highlight humanist views in support of assisted dying. In this article, I would like to give permission to humanists to raise objections to, dissent from, or merely express doubt about humanist orthodoxy on this matter. This risks attracting the ire of those who may believe that humanists should present a united front against religious opposition. But, as a lifelong dissenter from all manner of orthodox opinions, I believe that integrity and freedom of conscience take primacy over party loyalty.

The case for autonomy and choice

In common with many people, I find myself in a moral dilemma about assisted dying. The Bill currently going through the UK Parliament, the Terminally Ill Adults (End of Life) Bill, introduced by Labour MP Kim Leadbeater, aims to permit terminally ill adults in England and Wales to seek medical assistance to end their lives under strict safeguards. This would create an exception to the criminal offence of encouraging or assisting the suicide or attempted suicide of another person which, under Section 2 of the Suicide Act 1961, can lead to imprisonment for up to 14 years.

I can readily think of cases where this exception might have been welcome. The previous chair of Dorset Humanists, Jane Bannister, died from lung cancer in 2013. The cancer was certain to kill her in a matter of months and I understand that lung cancer is very painful. Jane was probably a supporter of assisted dying and I can imagine that she and her close family might have wished to shorten her dying process. My husband’s nephew died earlier this year from bowel cancer. Death was certain and perhaps he might have taken advantage of assistance to cut short the dying process. I do not know whether in either of these cases their suffering was unbearable, or whether bodily pain outweighed any sweetness of life which remained for them and their loved ones, but assisted suicide would have given them autonomy and choice about the manner and timing of their death.

One of our Dorset Humanists members, now well into her 90s, has been asking Dorset Humanists for some years to arrange her death. Obviously we were unable to help, but after a fall and a spell in hospital, she is now in a nursing home with increasing dementia. Another friend, well over 100, is in an expensive residential home which is compromising the likelihood of her being able to leave properties to her grandchildren. Some days she wants to die, but she seems to perk up after a bowl of tiramisu. Assisted suicide might be considered, by some, to be the utilitarian answer to extreme old age as well as terminal illness.

The humanist case in favour of assisted dying strongly promotes the principles of autonomy and freedom of choice. “My life, my death.” And there may be even more compelling cases than terminal cancer, such as conditions which are not necessarily life-shortening but which are chronic, unbearable, progressive, and untreatable. A living hell.

Does assisted dying normalise suicide, making it the moral option?

There is, however, a very strong taboo against suicide in our culture. People often do manage to take their own lives, often in very unpleasant ways, but as a society we try to dissuade people from taking this course of action. The existence of the Samaritans testifies to this. So perhaps the main concern I have about assisted dying is that it crosses a line. It begins the process of normalising suicide. It makes suicide an option in certain medical circumstances (terminal illness) and a patient can request a suicide drug from his or her doctor in order to self-administer. The main reason for such a request would be to reduce suffering and it allows the patient to take control of the situation. They might say “I've been given a few months to live, and it’s likely to be increasingly painful, so let’s get it over and done with before it gets any worse.” We probably don’t know how many patients would take advantage of such assistance. Maybe the majority would cling to life until the end. But some would take the life-ending drugs.

There has been much talk about possible coercion, and those in favour of the Bill have said that this is not possible because of the safeguards built into the Bill. I think something has been missing from this argument, which is that some people may come to feel that foreshortening the dying process would be the moral thing to do, perhaps in order to spare relatives the ghastliness of the whole process (my husband’s nephew looked like a concentration camp victim at the end) or to free up a hospital bed or to save thousands of pounds in nursing fees. There could be a subtle form of psychological pressure to “do the right thing” for the benefit of others. It raises the possibility that, while you as the patient might want to hang on to the end, your relatives might be making a different, perhaps unspoken, judgement. Over time, it could come to be seen as the rational and normal thing to do in such circumstances, with choosing to live seen as the irrational and selfish option. Introducing this dilemma in the last phase of someone’s life strikes me as a form of social coercion in itself. It foists choice onto everyone. Do these concerns override the positive benefit of assisted suicide, which is the autonomy to choose the manner and timing of one’s own death?

Slippery slope or “progressive ratchet”?

Supporters of the Bill have argued that it is tightly drawn and it cannot lead to a slippery slope. I think what people have in mind by a slippery slope is that this Bill will be seen by activists as the first step and that there will inevitably be pressure to bring forward more “progressive” legislation in the future. At the Central London Humanists event, some people were quite open about this, saying that the Bill does not go far enough. So what might they have in mind for the future? Presumably, future legislation could permit assisted dying for other types of “unbearable suffering” which could open up an unlimited vista of possible applications. And this would be a logical extension of the current Bill. If the current Bill is designed to reduce suffering, then why not introduce further legislation to reduce suffering in many more cases other than terminal illness? This is how the progressive ratchet works.

My father was diagnosed with Parkinson’s disease when he was 40. At some point during my teenage years, he attempted suicide because his condition had become so distressing. His attempt failed, and he lived until he was 80. Three brain operations and drugs alleviated his symptoms to a considerable degree. His condition was chronic, progressive, sometimes unbearable, but treatable. There is no doubt that he suffered a great deal during those 40 years and suicide would have reduced the total amount of his suffering and, perhaps, increased the lifetime happiness of my mother. But it would also have cut short his life, and the many joys which were intermixed with the suffering, both for himself and his family, including grandchildren. I think of my dad as a hero who bore his suffering with great fortitude. I don’t want to valorise suffering for its own sake and the fact that I consider him a hero now is of no use to him after death. If he’d checked out early it would have been understandable. But it would have been the easier, less heroic option. More importantly, there is no doubt that he became a “burden” to my mother and many thousands of pounds were spent in residential fees in the last four years of his life. If assisted suicide had become normalised as a way to reduce suffering, and to increase overall happiness, there is no doubt in my mind that my father would have felt moral pressure to do the “selfless” thing for the benefit of others as well as for himself. If my mother had so much as hinted at the easy option, or even expressed outright a wish for my dad to die in a moment of despair or rage, how would she have dealt with her guilt after the event? Now although this is not envisaged in the current Bill, its logic opens a progressive pathway to this dystopian future.

Is the drug cocktail used for assisted suicide the same as for execution?

I posed this very blunt question to Dr Barry Newman during the Central London Humanists online event. He said he wasn’t an expert on execution methods, but he said that for assisted suicide the commonly-used substances are barbiturates. I understand that these act as powerful sedatives and cause deep unconsciousness, leading to death by suppressing the central nervous system. They are chosen for their ability to produce a peaceful death. An internet search informs me that, in executions, the focus is not so much on sedation followed by a peaceful death but on producing a quick death, which may involve pain or complications. OK, well the difference seems a bit marginal but I thought it was worth asking the question. Perhaps it’s irrelevant. But in both cases, the state is administering lethal drugs to kill the prisoner or patient.

Conclusion – is the status quo better than the alternative?

The debate over assisted dying (or assisted suicide) is, to some extent, a “wicked problem”. There is no perfect solution but perhaps only a choice between “the lesser of two evils”. The Stoics seemed to believe that living, and choosing not to live, should be a matter of choice and many modern-day humanists think the same way. It’s all about choice, autonomy, and human rights: “I have a right to die when I want, and the state is under an obligation to facilitate this with a convenient suicide pill”. Suicide becomes a service in the health care system. It seems to me, however, that the Terminally Ill Adults (End of Life) Bill would be a small step for the UK and giant leap into a new moral order. It almost seems like a new pact with Thanatos – the god of death. In Greek mythology, Thanatos is associated with a peaceful death and he is often portrayed as a winged youth carrying an inverted torch, symbolising a life extinguished. Assisted suicide is the utilitarian twin of abortion and it’s the logical next step for those who prioritise bodily autonomy and utilitarian happiness over what is sometimes referred to as the sanctity of life or the taboo against suicide. It’s almost the bureaucratisation of death. Make sure the right forms are filled in and the correct boxes ticked. Then off you go. Both of my parents were given “double-effect” morphine in their dying days. It was an acceptable form of assisted dying, administered by doctors for the relief of suffering. There are some awful cases of unbearable suffering – such as Tony Nicklinson who suffered a catastrophic stroke in 2005, resulting in locked-in syndrome – and assisted suicide has these cases in mind. We also need to bear in mind that our dilemma has arisen, in part, from advances in medical technology which can prolong life in cases where, in the past, nature might have taken the more merciful course. The relief of intolerable suffering is a noble cause but merely focusing on “autonomy” and “rights” is not giving us the full picture of this complex moral issue.

Further reading

Being Mortal: Medicine and What Matters in the End (2014) by Atul Gawande

“Assisted dying ignores what it means to be human” by Giles Fraser, UnHerd, November 25, 2024. Giles Fraser is an Anglican priest.

“Assisted dying bill would create the worst thought-out legal framework anywhere in the world” by Adam McCann, Associate Professor of Criminal Law and Criminal Justice, University of Reading