We can’t afford a taboo on assisted dying

The late Michael Foot, that cerebral thinker, superb orator and calamitous Labour leader, once taught me a truth I’ve taken to heart. In any debate (Foot said) a good speech identifies the weaknesses in the other side’s case; but a great speech confronts its strengths.

As the Scottish parliament begins work on a bill to legalise assisted dying — a measure I’m sure is overdue — I could spend these thousand words on weaknesses in the objectors’ case. I could tackle the religious objections, which are irrelevant unless you believe in a divinity who has sanctified all human life, and absurd if you aren’t then a pacifist. I could tackle the argument that near-miraculous deathbed recoveries have occurred: yes indeed, but one Lazarus cannot justify a million torments. I could tackle the argument that unscrupulous relatives impatient for their inheritance may try to talk a sick person into ending it all. They may — but they’ll need to involve the certifying doctors in their plot. All these “what if” and “what about” arguments can be resisted, and in the fierce continuing debate, they will be. But count me out.

Anecdote, too, I won’t be drawn into. True stories will be enlisted on both sides. There will be tales of those who suffered to the last yet finally found God, or peace, or meaning. Or stories of loved ones for whom an assisted death was arranged, and who died blissfully happy and relieved. Anecdote can be telling, moving; but it shouldn’t clinch an argument.

• Assisted deaths in Scotland ‘won’t be recorded as suicide’

So I’ll try here to follow Michael Foot’s advice. Let’s acknowledge and confront the strongest argument against assisted dying. As (objectors say) the practice spreads, social and cultural pressure will grow on the terminally ill to hasten their own deaths so as “not to be a burden” on others or themselves.
I believe this will indeed come to pass. And I would welcome it.

I don’t dispute the objectors’ belief that once assisted dying becomes normalised we will become more apt to ask ourselves for how much longer we can justify the struggle. Is life still giving us more pleasure than pain? How much is all this costing relatives and the health service? How much of a burden are we placing on those who love us? How much of a burden are we placing upon ourselves? We will notice others asking themselves these questions and we’ll feel empowered by changing social norms to ask them ourselves. Discussion will become more open. It will become common practice to pose this question without embarrassment, and to weigh the answer up.

But it’s not as if these questions are new: they already haunt and have always haunted many afflicted by intolerable misery, indignity or suffering. That’s simply how people think: it’s natural. It’s right. If assisted dying becomes common and widely accepted, hundreds of thousands — perhaps millions — will consider choosing this road when the time comes; and in some cases, even ask themselves whether it would be selfish not to.

In short, a taboo will be lifted — and taboo is potent. What today is criminal could tomorrow become (as its proponents tend to insist) a sad but permitted option in a relatively small number of special and agonising circumstances; but within a decade or more be seen as a normal road for many to take, and considered socially responsible — and even, finally, urged upon people. Such (say objectors) is the wedge of which the Scottish proposal is just the thin end.

• How could assisted dying in Scotland work? The bill explained

Yes, but what’s wrong with the thick end? It will be a healthy development. In this century the future holds an almost cosmic struggle between, on the one hand, the old world with our ageing populations and inflexible economies, and, on the other, the raw and unbridled energies of an emerging, younger, nimbler and very different world, led by countries like China: all relatively new to prosperity and unencumbered by our western populations’ sense of entitlement.

We in Europe and North America (and, for instance, Japan, Australia and South Korea) are increasingly weighed down by low birth rates and high longevity. It’s more than a decade since in Japan sales of nappies for the elderly overtook sales of nappies for babies. One Japanese town is now recycling used incontinence pads into fuel for heating. Here in Britain it has become a common joke that our country has become a massive health service and attached care homes sector, with a state as a mere appendage, rather than the other way round.

A proportionately ever-smaller working population carries an ever-larger cohort of elderly and retired citizens, supported by state pensions and advances in medical science that sustain us into ever-longer retirements. When I was a child the average male lived to about 65, the age of male retirement. The average female lasted about ten years beyond her retirement age at 60. In 2020 the average male had lived on more than 20 years (the average female nearly 30) beyond retirement.

Good news? Often not for the final years of these extended retirements, often characterised by immobility, ill-health and dementia: and typically wildly expensive, cornering resources to fund our health and social care sectors. This imbalance helps explain governments’ desperate reliance on immigration — to the rage of electorates who won’t face the fundamental question: how are our economies going to pay for the ruinously expensive overhang that dare not speak its name: old age and infirmity?

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. This does not usually happen by decree but by a largely unconscious general creep. People begin changing their minds, often unaware of why.

I suspect — and believe I notice — that our culture is changing its mind about the worth of old age when coupled with crippling degeneration, incapacity, indignity and often suffering. If I’m right, our growing interest in assisted dying may reflect a largely unconscious realisation that we simply cannot afford extreme senescence or desperate infirmity for as many such individuals as our society is producing. “Your time is up” will never be an order, but — yes, the objectors are right — may one day be the kind of unspoken hint that everybody understands. And that’s a good thing.