an idea whose time has come

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If people spent as much time thinking about how they might die as they do about, say, their retirement, many more nations would already have legalised assisted dying. Too many people with terminal illnesses are condemned to a lingering painful death, denied of dignity, in a faceless hospital ward. Doctors and nurses may conclude they should not be resuscitated, or recommend withholding fluids from the terminally ill. The only person denied a say is the one doing the dying.

A number of countries, such as Belgium, Canada, the Netherlands and a number of US and Australian states, have moved towards assisted dying, though the laws vary. Some nations permit doctors to administer lethal drugs, others to prescribe them for self-administration and some have simply created a legal defence for doctors. The eligibility rules also vary.

Until now Britain has stood against legalisation. Those currently seeking help to end their suffering in the UK must typically rush to a facility in Zurich before they lose the ability to travel. Many go alone for fear their relatives may face prosecution, although such cases are reasonably rare.

But this looks to be changing. Jersey, a British crown dependency outside the UK, may be the first to move. Scotland’s parliament is to debate a bill in the coming weeks. Most significantly, Keir Starmer, the Labour leader, has pledged a vote on the issue should he become prime minister, adding that he is in favour of a change in the law.

None of these guarantees a change. Parliamentarians will be free to vote with their conscience but there is a clear momentum towards reform. Opinion polls indicate substantial public support for legalisation. A survey by Ipsos last year showed that two in three Britons think it should be legal for a doctor to assist a patient aged 18 or older in ending their life, assuming certain conditions are met.

Yet there is also vociferous opposition. Some resist on religious grounds (though there is no reason why one person’s faith should be imposed on another). Others say the solution lies in more and better-funded palliative care. This should be on offer and might dissuade many from choosing to end their lives but it is not an argument against choice.

The most powerful argument against assisted dying is the fear that those who are sick, vulnerable or merely old feel pressured to end their lives and be less of a burden on their relatives. The Paralympian Tanni Grey-Thompson has spoken of her fear that the right to die would become a “duty to die”. 

This is an important and serious concern — though one should remember that forcing those desperate to die to stay alive is also a form of coercion. There is a clear middle-ground. Legislation would have to be restricted to those with a terminal illness and relatively short predicted time left to live (say six months). It would also need to be a sustained request to doctors, possibly without relatives present. It is probable that once people know they have this choice they would not seek to use it until very close to the end. 

This would mean precluding some terrible non-fatal degenerative diseases, major physical disability, dementia and any mental condition. Many will lament such limitation but creating safeguards and offering reassurance about legitimate fears is the price of progress. 

This is a difficult and emotional moral issue but one that now deserves serious and calm consideration. The UK would be wise to copy Jersey’s use of citizens’ juries to help politicians frame the debate. Any change will need to be carefully framed, transparent, tightly controlled and monitored. But it is time for politicians to catch up with their public and allow the terminally ill to choose a better death.


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