28.11.2024
Legalisation of assisted suicide is not progress, argues Paul Demarty, but rather gives capitalism free rein to throw the seriously ill in the trash-can
Parliament has been discussing what is called, according to the latest officially sanctioned euphemism, “assisted dying”. (When you think about that for five seconds, it sounds like one of those innuendoes people use to avoid being demonetised by YouTube - ‘unaliving yourself’, and so forth. So I will stick to the word, ‘euthanasia’, and the phrase, ‘physician-assisted suicide’, for that particular subtype.)
Though it was not in Labour’s manifesto, it has sailed to the top of the government’s agenda via a private member’s bill to be moved by Kim Leadbeater. There has been much earnest verbiage from the bill’s supporters, certainly; but also more cynical reasons leap to mind - for instance, that it is popular with the public, unlike the government, and thus a bankable ‘quick win’ if they can get it through the two houses in short order.
It is my own view - and I stress my own rather than that of the Weekly Worker or the Communist Party of Great Britain - that this policy should be opposed. There are many reasons to do so, but I will focus first of all on the strong likelihood that a ‘right to die’ with onerous legal safeguards will lead rapidly to a more ‘liberal’ regime, and from there to pressure on the very ill to take advantage of this new ‘right’. I will then discuss the questions of personal autonomy and dignity that largely motivate supporters of the bill and laws like it.
Canada
My first argument is, in the form I stated it above, open to the objection that it is a ‘slippery slope’ argument, and presents as inevitable a development without establishing the basis for that inevitability. (Or perhaps not even inevitability - just an unacceptable risk of such a development may be enough to reject legalisation, say.) Yet we in England and Wales have the advantage of having held out for so long, while other countries have leaped ahead. And, frankly, the evidence is that the risk is real.
In several countries, it is notable that the numbers seeking death under such laws have tended to grow and grow. Nor is it always a mere matter of statistics. The case of Canada’s ‘medical assistance in dying’ (‘Maid’) legislation is particularly disturbing. Initially restricted in 2016 to the terminally ill, the scope was expanded in 2021, removing that hard requirement and various safeguards for those whose death was, as the legislation states, “reasonably foreseeable”. The 2021 bill also included a clause extending Maid to people with severe treatment-resistant mental health disorders, but the enactment of that clause was delayed until 2023, then 2024, and now 2027. In the meantime, the government considered the possibility of reducing the age of consent for Maid as low as 12.
Annual ‘unalivings’ under this programme have correspondingly increased from 1,000 or so in the first year of operation to 13,000 in 2023. Individuals with long-term, incurable conditions have alleged, in increasing numbers, that doctors have suggested euthanasia to them. In one grim case, a 51-year-old woman with a disability that made her extremely sensitive to fumes from cigarettes and certain chemical cleaners had herself killed under Maid, after unsuccessfully attempting to find suitable housing in Toronto. If they do ever get around to throwing the mentally ill into the mix, there are a whole other set of issues - after all, a common symptom of severe, treatment-resistant mental disorders is suicidality …
Premier Justin Trudeau does not seem an unusually murderous ‘centre-left’ political leader (unlike Starmer, perhaps). And Canadians - who overwhelmingly support Maid, and supported its extension in 2021 - do not seem to be an unusually callous population among the various nations of the liberal west. Yet they do seem to have slipped down the slope. All those safeguards, all those assurances, turn out to be worthless. Why?
A few reasons suggest themselves - some more laudable than others. The restriction to the terminally ill is ultimately at odds with the reason people seek euthanasia in the first place, which is the alleviation of suffering and endless degradation. That is the emotional argument made by euthanasia’s advocates, and with good reason. Terminally ill people who are not, for the time being, crippled by their conditions are not at issue. So if it is appropriate to offer the dying the opportunity to escape their suffering, why not people who live lives of excruciating misery due to conditions that are not fatal in the short term? Indeed, could you not argue that the latter case is more morally urgent, since terminal illnesses are, by definition, time-limited? This, at least, is a rational extrapolation from the premise that it is morally licit to end suffering through suicide or euthanasia.
There are also structural reasons at work, however, which are not so attractive. To put it bluntly, long-term illness costs the taxpayer (or the insurer) money. Treatments must be paid for. Specialised accommodation must be procured, care workers employed. It is estimated that Maid saves the Canadian government hundreds of millions of dollars - not a huge number by state budget standards, but not tiny either. Meanwhile, in the neoliberal era, all these support systems are overstretched at best, and frequently flogged off to parasitic private providers. The NHS lurches from winter crisis to winter crisis. Social care gobbles up ever more of the meagre funds available to local councils.
Normally this case is not made explicitly, for reasons that I hope are obvious, but it was put in remarkably bald terms by the wet-Tory Times columnist, Matthew Parris, who wrote in March that “the argument against [euthanasia] is that pressure will grow on the terminally ill to hasten their own deaths - that’s not a bad thing”, After summarising the usual demographic problems - ageing population, declining birth rates, etc - he goes on:
It may sound brutal, but I don’t apologise for the reductivist tone in which this column treats human beings as units - in deficit or surplus to the collective. For a society as much as for an individual, self-preservation must shine a harsh beam on to the balance between input and output. To protect its future, a healthy society must adapt its norms, its cultural taboos and its moral codes.1
It is this perverse incentive that ensures the expansion of this policy. So long as assisted suicide is just illegal, the question cannot (legitimately) arise as to whether the ill and infirm are simply a burden. Once it is legal, for however restricted a population, the question is opened for everyone whether their life is ‘worth’ living, according to the kinds of calculus favoured by Parris, and whether the law should not be tweaked a little to allow us the ‘right’ to unburden society of our needs.
Kim Leadbeater, the MP who is advancing this legislation as a private member’s bill, insists that the safeguards in her bill are watertight, and that sign-off will be required from two doctors and a high court judge (though, oddly, this is not actually how the bill is worded). Coercing someone into euthanasia will be punishable by up to 14 years in prison. But much the same was true in Canada back in 2016. All these ‘safeguards’ are necessary, because we all know, fundamentally, that we live in a society that considers large numbers of people ‘useless mouths’, and resents the outlay of resources required to allow such people to live with a modicum of dignity. It is no surprise that disability rights campaigners typically oppose assisted suicide, as is indeed largely the case in Britain currently.
Autonomy
Most supporters of legal euthanasia and physician-assisted suicide, of course, would not talk about useless mouths or the “deficit or surplus to the collective” mentioned by Parris. Something like the direct opposite of such callousness is more commonly the case. Front of mind is the sheer extremity of suffering that sometimes attends mortal illness. We surely have the duty to take what measures are necessary to alleviate that suffering, and in certain cases the only means available is the deliberate ending of the patient’s life.
Related, but distinct, is the question of personal bodily autonomy. The decision to end one’s life must in the end be the responsibility of each individual. To argue otherwise is infantilising and paternalistic. Put these two arguments together, and you have the elements of the common slogan, ‘Dying with dignity’. Dignity is offended both by the degradation of extreme suffering and the denial of autonomy.
The trouble with this is that it is ultimately an argument from a specifically bourgeois conception of autonomy or freedom, which consists of the right to enter into contracts regardless of any substantive commitment to the good life. The freedom to die is, in fact, a freedom which could only make sense if no such link existed between freedom and fulfilment. Marxists have never considered this an adequate form of freedom. We oppose the ‘freedom’ to work 14 hours a day precisely for this reason. Freedom for the proletariat to pursue its positive ends is conditional on its ability to exercise collective self-discipline. In the same way, the ‘right to die’ itself infringes on the right of the severely disabled to have their needs met by society as a whole.
The argument on suffering has its own plausibility. (I must admit that my convictions on this issue wobbled a little earlier this year, when I had a bout of shingles, and got a small taste of what it really felt like to be in continuous, untreatable pain.) If our societies really had exhausted all other options - if we had universally available, high-quality palliative care, for example, and a strong supply of specially-adapted homes for people with permanent health conditions - then the question of euthanasia in extremis would be more plausible. This is plainly not the situation we face. Wes Streeting, who opposes Leadbeater’s bill, is right to point out that gearing up the NHS to kill people entails taking resources away from other work. But those resources are inadequate anyway.
As such, we counterpose the bourgeois conception of freedom with not only our own such conception, but also with the political economy of the working class - a commitment to production for need. That demands realism at precisely the point where bourgeois ideology retreats into fantasy - in its assumption that the ‘normal’ subject is a fully autonomous individual. On the contrary, radical dependence on others is not some weird, exceptional condition suffered only by the very unfortunate, but a universal feature of human life, at least in infancy and very commonly in old age or long-term sickness.
A sustainable idea of personal autonomy must in the end be open to the irreducible vulnerability of the human condition, and the limits it imposes on each of us as individuals. We seek a society that produces for need, among other reasons, because our needs are frighteningly mutable over time. Assisted suicide is directly counterposed to this - it is an admission that society considers the meeting of certain needs either beyond its capacity or not worth the bother.