My father died slowly. Fourteen years, from diagnosis to death. Cancer is like that, if you are lucky. Surgery, radiation treatment, and chemotherapy extended both his life and his death. Each interlude of near-normality between treatments had, like the isotopes in the radiation, a half-life. Each time it halved, death came closer to us all. Especially to my father, whose role in this family drama was to die as well as he could.
He pretended, at least to us, that he was not in pain or afraid, but he showed it in the extremities of delirium or anesthesia where personality dissolves. In these episodes, which usually occurred in the small hours in a crowded and dirty London hospital ward, the final impulse of his willpower was a refusal to cooperate with the doctors. We had to beg and bully him to accept the liquids or catheter that would steer him back toward the living. Each time he returned, a larger part of him stayed behind. The doctor preserves the patient by cutting bits out, but the disease eats away at the person you knew.
He was 56 years old, and I was 14, when he was diagnosed with non-Hodgkin’s lymphoma. The X-rays showed a large tumor in his left sinus. One surgeon warned that he might need part of his skull removed and that he might die within six months. He was lucky and lived another 14 years. He kept working, too. A freelance all his life, he went into hospital for the last time with an overnight bag containing a pair of pajamas and a script for the radio program he expected to record when he left. But death had his number. His half-lives had shrunk from six months, then three months, then six weeks, and then three weeks. “It wasn’t supposed to be like this,” he told me as he realized that it was.
Death is the land of cliché. The busy nurses grew kinder, the dashing doctors more elusive. The days and nights “blurred” in our “bedside vigil.” My father “slipped in and out of consciousness” as the morphine level rose and fell, unmoored between two shores. It was “his time,” a nurse whispered as his kidneys started to fail. Like “me time,” only more personal: We had arrived at the hospital through the same door, but we would be leaving alone, and he by the back door. This troubled him. He did not want to die. An atheist, he had nothing to look forward to. He fought up from the drugged depths, surfacing wide-eyed and helpless, fearful and babbling.
My mother asked my elder brother and me to do something. My elder brother ran away. I found a doctor and begged him to raise the dosage to a fatal level. The doctor said the law forbade this, but he could ensure my father felt no pain.
The nurses slipped a morphine pump into his hand. He crossed over from “palliative care” to “end-of-life care,” each squeeze a stroke of the oar. The will was stifled, and the panic abated. His breathing slowed, and its electronic echo stabilized like a signal heard across foggy waters. He looked beatific, as though granted a transcendent vision of the other side whose existence he had doubted. I made a mental note to take opiates in old age. And then he exhaled and was not.
My father died aged 70 in 1998. He made what was then called “a good death.” He was a living and dying exemplar of the social contract in postwar Western Europe. He paid his taxes, and though he died before claiming much of his state pension, the National Health Service never charged a penny for his treatment. He was not too much of a burden on the NHS, and the NHS kept its end of the bargain. He did not drain its resources by vegetating in the twilight for a decade or two, and it shunted him off the books with efficiency and compassion.
I still feel guilty about asking the doctor to finish him off. But he left us no instructions for those last days. We wanted to spare him his suffering but also to spare our own. This pain was penultimate among the burdens we had taken up out of love and duty, from night sweats and exhaustion to diapers and wheelchairs; the final pain is loss, but that is tempered by relief. I was 28 that year: His dying was half my life. It wasn’t supposed to be like this, but it never occurred to me to do it differently.
Should it be like this?
Death becomes us
On Nov. 29, a free vote of the House of Commons passed the Terminally Ill Adults (End of Life) Bill by 330 to 275 votes. The bill would give people in the last six months of their lives the legal right to ask for medical assistance in hastening their deaths. Its backers call this “assisted dying.” Its opponents call it “assisted suicide.”
The bill’s Labour proposer, Kim Leadbeater, argued that palliative and end-of-life care are not enough. Each year, hundreds of terminally ill Britons decide that life is no longer worth living. Current British law condemns them to what Leadbeater called a “horrible, harrowing death” and even makes criminals of their loved ones. Suicide is legal, but assisting suicide, for instance, by supplying the terminally ill with strong sedatives, can carry a 14-year sentence. Euthanasia, deliberately administering an overdose, is either murder or manslaughter.
The bill proposed that the state should assist in euthanizing any adult who is “expected to die within six months” and is capable of a “clear, rational and informed wish, free from coercion or pressure.” The would-be suicide must make two signed and witnessed declarations of intent and convince two independent doctors that they are “eligible.” A judge would then rule on the case. After a 14-day cooling-off period, a doctor would supply the means of death. The patient would decide when to take it.
In 2015, the Conservative-led Commons rejected a similar bill by 330 to 118 votes. Labour voted 92-73 against, and the Conservatives 210-27 against. This time, in a Labour-led Commons, Labour was 234-147 in favor. Support among the reduced Conservatives remained steady at 23, with the remaining 93 opposed. Prime Minister Keir Starmer, who voted in favor in 2015, again chose death this year. The two ministers whose departments would add assisted suicide to their services both opposed the bill.
The health secretary, Wes Streeting, did not disagree that the state should be in the business of death, but he did have some business concerns about the “resource implications” for Britain’s already tottering NHS. Allocating funds to assisted dying would mean cutting funds for other services. This financial squeeze could put patriotic suicides on a “slippery slope.” Streeting believed that national affection for the NHS is so great that people are willing to die for it: “I would hate for people to opt for assisted dying because they think they’re saving someone somewhere money, whether that’s relatives or the NHS.”
“As a Muslim, I have an unshakeable belief in the sanctity and the value of human life,” said Shabana Mahmood, the justice secretary and lord chancellor. Mahmood identified another “slippery slope,” this one leading to “death on demand,” with “the right to die for some” becoming “the duty to die for others.” Justin Welby, the Archbishop of Canterbury, had similar ethical objections. He spoke from experience. The Church of England has euthanized itself by liberalization.
The split within the vote, however, turned less on religious views of the sanctity of the soul than on political, which is to say philosophical, views about the nature of society and the role of government. Serious socialists and conservatives united against the bill. Jeremy Corbyn, a communist expelled from Labour, voted with Kemi Badenoch, the new Conservative leader. Nigel Farage, the leader of the nationalist Reform UK party, voted with George Galloway, an old-school leftist and Islamist ally. This was surreal, but it made sense. The socialist and the conservative agree that collective responsibilities must limit individual rights.
Socialism and conservatism are 19th-century responses to liberalism, the doctrine of personal rights and rational choices. Liberals, both classical and modern, backed the bill. Libertarians, most of them liberal Conservatives of the Homo economicus kind, supported the extension of personal autonomy, regardless of social cost. Centrist Labour technocrats, the local equivalent of Progressives, supported the extension of state power, regardless of state capacity. Jess Phillips, the Home Office minister and practicing halfwit, admitted that the NHS “is not in a fit enough state” to organize assisted suicide but supported the bill anyway because “you cannot stop progress happening.”
Meet Dr. Death
Another oddity in the Commons debate was that the MPs discussed assisted suicide as a hypothesis. But “progress” is already a reality across the West. Physicians may already prescribe and administer lethal drugs for assisted suicide in Holland and Belgium (2002), Luxembourg and Switzerland (2009), Canada (2016), Spain and New Zealand (2021), and the six states of Australia (2017-2022). Prescribing lethal drugs for self-administration is legal in Austria (2022). Court rulings have opened the path to legislation in Italy (2019) and Germany (2020).
In the United States, doctors can supply drugs for suicide in Oregon since 1994, Washington (2008), Vermont (2013), California (2015), Colorado (2016), Washington, D.C. (2017), Hawaii, Maine, and New Jersey (2019), and New Mexico (2021).
Canada’s experience confirms the risks of the slippery slope. Canada’s Medical Assistance in Dying, or MAiD, laws of 2016 were supposed to ease the final weeks of the terminally ill. In 2019, however, a Quebec court ruled that limiting MAiD access to those with a “reasonably foreseeable death” was unconstitutional. A chronic diagnosis now suffices. The Canadian government reported that written requests for MAiD services rose by an annual average of 28.2% between 2020 and 2022. In 2022, MAiD was granted in 13,102, or 81.4%, of cases. Canada now leads the world in euthanasia, with doctors aiding 4.1% of deaths.
Some 70% of Canadian MAiD suicides have cancer. Yet “inadequate control of pain, or concern about controlling pain” comes third on the list of MAiD candidates’ reasons for wanting to die (59.2%). Their most common motives are psychological: “loss of ability to engage in meaningful activities (86.3%)” and “loss of ability to perform activities of daily living (81.9%).” In March 2027, MAiD will become available for those suffering from mental illness, including anorexics and drug addicts. In little more than a decade, MAiD has gone from the last resort to a quick way out for depressives and dropouts.
In 2010, the Netherlands had two cases in which psychiatric suffering qualified for Physician Assisted Dying, or PAD. In 2017, there were 83. In 2023, there were 138. Are the Dutch suffering more, or is the state becoming more willing to kill them? In 2018, doctors judged that Aurelia Brouwers, a 29-year-old who had suffered a lifetime of mental illness, was nevertheless qualified to choose PAD rationally. Last May, Zoraya ter Beek, another 29-year-old Dutchwoman, was granted her request for PAD. Beek, too, is physically healthy but has suffered from lifelong depression, anxiety, and trauma and has been diagnosed with an unspecified personality disorder and autism. These cases sound uncomfortably similar to those of young women drawn into the self-harm of the gender cult by social media.
MAiD and PAD are only available to Canadian and Dutch citizens. The Leadbeater bill proposes a similar restriction. Socialized healthcare systems are already overloaded. No one wants to add “suicide tourism” to the existing problem of “healthcare tourism.” Foreigners must go kill themselves in Switzerland. The Swiss decriminalized assisting suicide back in 1942. They are now pioneering suicide tourism for all. My mother has signed up for it. She says that when she is tired of life, she will fly to Zurich and drink the fatal potion in a suicide clinic. I hope she does not.
Dr. Philip Nitschke, also known as “Dr. Death,” is the Swiss designer of the Sarco pod. This resembles a one-person car from a 1950s sci-fi film or a Tesla moped with a glass hood. It asphyxiates its user with pure nitrogen. Doctors across the West almost universally condemn this method as agonizing when it is used on death row in American prisons, but some of them support it as the last lifestyle choice.
“We want to remove any kind of psychiatric review from the process and allow the individual to control the method themselves,” Nitschke said in 2021. Two Sarco pods have already been printed in Switzerland. A third is about to be printed in the Netherlands. It is not hard to imagine them being printed in Silicon Valley. Dr. Sarco has now offered his pod for export to Britain. Perhaps my mother will not have to fly to Switzerland.
Assisted dying of the West
“It was a large room, bright with sunshine and yellow paint, and containing twenty beds, all occupied. Linda was dying in company — in company and with all the modern conveniences,” Aldous Huxley wrote in Brave New World. “The air was continuously alive with gay synthetic melodies. At the foot of every bed, confronting its moribund occupant, was a television box. Television was left on, a running tap, from morning till night.”
Huxley’s dystopia became my father’s end-of-life care. There are worse things. The futuristic 1973 movie Soylent Green upgraded Huxley’s television to a wraparound screen but degraded end-of-life care to a suicide potion. The future is here. The ex-Supreme Court justice Jonathan Sumption said that parts of Leadbeater’s bill read “like the protocol for an execution,” turning a private decision into a “form of state-licensed killing.”
Wes Streeting and Jess Phillips understand the reason: resource management. The liberal dream of infinitely expanding autonomy is hitting the reality of beds and budgets. The demands of rational choice must conform to the supply of rationed services. The liberal state struggles to deliver on its promise of “cradle-to-grave” care and offers shortcuts, each unkind.
“There will be imperceptible changes in behaviors,” Robert Jenrick, who recently lost the Conservative leadership runoff to Badenoch, warned the Commons on Nov. 29.
“There will be the grandmother who worries about her grandchildren’s inheritance if she does not end her life,” Jenrick said. “There will be the widow who relies on the kindness of strangers who worries — it preys on her conscience. There will be people — we all know them in our lives — who are shy, who have low self-esteem, who have demons within them. I know those people. I see them in my mind’s eye. They are often poor. They are often vulnerable. They are the weakest in our society. And they look to us. … Sometimes we must fetter our freedoms. We, the competent, the capable, the informed, sometimes must put the most vulnerable in society first.”
Government cannot annul death, but it can put a price on it. The state distorts any market it enters, and markets cannot substitute for morality. When the state enters the business of death, it creates a new social ethic and a new caste of state employees. These judges and executioners of misery will create and enforce a new set of perverse incentives.
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The ruinous and exploitative American healthcare system denies security and dignity while amplifying the perverse incentives even for the healthy. When staying alive means beggaring your children and grandchildren, no one wants to be a burden. Better to drink the poison goo or glide down the slippery slope in a Sarco pod.
Should it be like this?
Dominic Green is a Washington Examiner columnist and a fellow of the Royal Historical Society. Find him on X @drdominicgreen.
