Legislators ought to be looking to boost palliative care systems, not encouraging premature deaths

In a pastoral letter that will be read out parishes across his diocese this weekend, Bishop Richard Moth of the Diocese of Arundel & Brighton will be encouraging Catholics to write to their MP to voice their opposition to the government’s Terminally Ill Adults (End of Life) Bill.

Tabled by Labour’s Kim Leadbeater, MP for Spen Valley, West Riding of Yorkshire, the Bill is due to have its second reading in the Commons on Friday 29th November, and Bishop Moth, who is Chair for the Department of Social Justice at the Catholic Bishops’ Conference of England and Wales, quite rightly makes the point that “The outcome of the debate is by no means certain, and every letter makes a difference.”

Discerning the public attitude to euthanasia isn’t as easy as some politicians and campaigners may think, and in fact the whole manner and timing of this particular attempt to introduce such a bill smacks heavily of political gameplay. After all, it’s looking increasingly like the newly elected Labour party had little intention of honouring many of the key promises that people voted for, so the ensuing maelstrom of U-turns, recriminations and regrets was sorely in need of a decoy to distract public ire away from the fiscal upheavals.

The introduction of the Terminally Ill Adults (End of Life) Bill so early into a new parliament may have seemed to Sir Kier Starmer an extremely useful and outfield initiative, and it has certainly served its purpose to distract the public narrative away from the growing unrest and discontent that was at one point threatening to undermine the social order. However, framing the legislation in a culturally-populist context – that it would serve to grant retired TV personality Esther Rantzen her dying wish – was not only a complete and typically ‘elderly’ misreading of popular culture, but it dragged an otherwise profoundly serious ethical issue into the realm of tabloid sensationalism.

Back in March Mr Starmer declared profoundly: “I’m personally in favour of changing the law … I think we need to make time. We will make the commitment. Esther, I can give you that commitment right now.”

Well, sadly for Mrs Rantzen at least, it looks highly unlikely that Mr Starmer is going to be able to keep his promise, because whatever a small coterie of Labour neo-liberals may think, there is little consensus among politicians on this issue, and even less within the general public. The concern of our bishops, and indeed numerous groups from across a broad range of social and moral positions, is that in the current legislative environment it only takes a very small number of politicians and a minority of voters to drive through legislation that impacts heavily on the rest of us.

In such an environment, there is an understandable concern that an unwanted bill may be driven through by just a small number of supporters, but equally there’s a very reasonable expectation that if a sufficient contra-narrative can be activated, enough legislators may move to reject such a proposition. It is for this reason that our Catholic bishops in particular are keen to encourage us all to write to our MPs. To some this may seem like a well-worn and ofttimes ineffective path, but in the case of the Terminally Ill Adults (End of Life) Bill it could have a profound impact. Why? Because MPs are going to be given a free vote on this bill which means they don’t have to tow the party line, and the evidence is that there are deeply differing opinions on this issue amongst all parties.

One of the most common myths surrounding support for such legislation is that the left wing of politics is more likely to favour assisted dying as it’s a more person and caring oriented outlook, in contrast to uncompassionate, reactionary Tories who would happily condemn the suffering to an undignified death. Conversely there’s an equally fallacious view that the right wing of politics will respect the person, whilst the extreme left would seek to reduce the population to useful commodities.

Looking back at the fate of recent attempts to introduce ‘assisted dying’ bills into parliament we can see that both support and opposition hold no party allegiance or prominence – an amendment to the Health and Care Bill introduced in 2021 by the Conservative peer Lord Forsyth that would have forced the government to consider an assisted suicide bill was unsuccessful, as were earlier attempts in both the Lords and the Commons – one under a Labour government in 1997, another under a Conservative one in 2015.

The 2015 Assisted Dying Bill was thrown out by an impressive 330 votes to 118, and was interesting in that despite a Conservative majority giving it a head of steam, the defeat was down to the 92 Labour MPs who voted with the government (as opposed to just 73 who supported it). It’s also worth mentioning that one of the most vocal opponents of the bill was Jeremy Corbyn, who warned that “This Bill would put the most vulnerable people at risk.

“I don’t believe we should be talking about assisted dying until our social care and health care systems have been improved sufficiently with a focus on the sick and elderly,” he said.

Mr Corbyn’s arguments may have been focussing on the familiar left wing ‘broken NHS’ narrative, but his remarks go to the very heart of concerns about any assisted dying bill. In the numerous surveys of public opinion that have been carried out on this issue there’s a clear pattern – because contemporary British society likes to see itself in terms of espousing mutual respect and tolerance, and concern for the vulnerable, initial responses tend to reveal a general tolerance for the right of an individual to decide their own destiny and it is from this top level data that campaigners like to argue that Britons are in favour – and even demanding – access to assisted suicide.

However, at the deeper levels of enquiry the tick box responses become far more dispersed and unpredictable, and reveal both the complex realities and extreme dangers of legislating in this field in any manner other than respecting and preserving the sanctity and natural course of human life. To say that the human person has to run their course, including whatever death they have been brought to, is a profoundly simple and unambiguous ethical position – whether one believes in God or not. The alternative is to open up this finite rule to an ultimately uncontrollable and arbitrary range of interpretations and situations – from deciding what conditions qualify for the termination of life, to healthy individual’s right to choose death, and even ultimately to society mandating who will continue to live and who may be encouraged to die.

In such situations the backstop is always safeguards, safeguards and even more safeguards, but of itself this is to acknowledge that profound dangers have been unleashed. As just a couple of examples illustrate, Belgium became the first country to authorise euthanasia for children in 2014, and when Canada legalised medical assistance in dying in 2016, it took only months for some legislators to start pressing for the law to be extended to include those whose suffering was purely psychological.

On the issue of the protection of human life at the other extremity of our span, the position that life begins at the moment of conception is not just a religious belief, but a profoundly logical default that protects human life in the face of the absence of hard scientific evidence that it’s otherwise. As we have seen since abortion legislation has been introduced, the question of the exact hour and day when a foetus suddenly evolves from a random collection of cells to a human person has been reduced to a endlessly shifting series of medical assessments and probability conclusions.

In many respects the same danger applies to the assisted dying bill, as there is no universally agreed mechanism to determine when life ought to be terminated. More profoundly, as with abortion, the process of creating legislative parameters for this is to deliver lierally life and death decisions into the hands of the delegated representatives of the legislation, and such decisions are extremely difficult to reverse.

If one looks at some of the most recent surveys carried out on this issue, what leaps out is that people’s responses are conditioned deeply and fundamentally by the language of the questions – and nowhere is this more evident than in the fluctuations that can be caused by using phrases such as ‘painless death, ‘assisted dying, and ‘suicide’. It’s no surprise that public opinion is firmly in favour of people passing through a painless and dignified death, but is equally against people being able to take their own lives, assisted or otherwise.

It’s also no surprise that support for the premature termination of life drops off significantly as more information is provided. A UK ComRes/Care survey conducted in 2014 revealed initially that 74% of those polled were generally in favour of people being able to decide to end their own lives, but this plummeted to just 42% when people were made aware of the potential risk that some vulnerable people might feel pressurised into ending their lives to free their loved ones of a burden. Once again the solidarity with the plight of one’s neighbour seems to take precedence, that is until suspicions about the potential actions of the state and its representatives come into play. This fear is especially prescient in an age when the very existence of free, national public healthcare is under critical threat, and old certainties such as the judgement of God have been diminished and systematically secularised.

Sadly, far too little is also said about the role of palliative care in the final passage of earthly life and even the Catholic Church – which is a world-leading provider in this area – is often far too reticent about its contribution in this area. It could even be argued that if these services were far more widely known and publicised, the necessity for assisted suicide might be negated. After all, at the most basic level it is the fear of pain, incapacity and social burden that drives all impetus towards the avoidance of the inevitable. Palliative care not only removes these fears from the process, but it creates a new kind of dignity and acceptance that carries one towards a natural death, rather than a premature disposal.

As Bishop John Sherrington said at today’s press conference for the Catholic Bishops’ autumn plenary meeting: “This bill will cross a watershed in society – compassion means to suffer with, that means to accompany, to walk with a person who is sick, never give up on them or abandon them. To show through care that they are loved and valued. It’s that love and care that recognises the human dignity that is inately given by God. And it’s that dignity that all of our actions wish to protect. We therefore advocate for consistently funded and the strong availability of palliative care, because palliative care addresses the whole person, to address all the dimensions of suffering in a person.”

This latest bill that is making its way through parliament has a long way to go, and legislators seem no less divided than on previous occasions as to how they are going to respond. One thing we do know for certain is that the more information is available, the less likely people are to vote for this legislation. That’s why it is critically important that you not only write to your MP to ask them to vote against this bill, but you also tell them why you think it should be rejected. We have a health care system in place that despite the dismantling of successive governments is still the envy of the world, and the majority of its staff have a unique and profound commitment to the preservation of life at all stages. We also have a comprehensive and highly-experienced and focussed palliative care system – if as much effort, funding and parliamentary debate was put into developing these services rather than devising ever more effective ways to dispose of the sick, we would be a much better, healthier and morally sound country.

Joseph Kelly is a Catholic writer and theologian