Assisted Dying — A Review of Fundamental Principles

Last week, I received an email asking me to share my views about Assisted Dying. It was a request from the Royal College of General Practitioners UK for members to complete a survey. While surveys can be great for getting quick answers to questions, they often do not capture the depth and nuances of a response.

Also, given the enormous significance of this particular issue, I decided to try and do a bit more justice to my survey response with this essay.

Trigger warning: This essay contains details associated with suicide. If you suspect that you may find it distressing, please do not proceed.

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At the time of publishing this essay, it is illegal to assist a person to commit suicide in the UK. However, on 29 November 2024, MPs voted in favour of a bill to legalize ‘assisted dying’ for terminally ill adults. As a result of this vote, the bill moved a step further on its journey towards becoming a new UK law.

There have been many strong feelings for and against this bill which makes it a highly contentious issue to discuss. But here, I hope to make a gentle case for why I think the bill should not become a law.

Every year, over 300 terminally ill people kill themselves in England.¹ More than 3000 attempt to do so unsuccessfully. On average, 50 of them travel to places like Switzerland to seek a medically assisted death. They often feel compelled to end their lives because of the progressive and debilitating symptoms of their illness, and it is difficult not to feel great sadness and sympathy on hearing personal accounts of the horrific ways many of them try to put an end to their lives.

Their loved ones also suffer. Apart from watching a terminally ill relative deteriorate, loved ones live in the terrifying uncertainty as to whether they would be prosecuted if they helped their dying relative to die earlier. The assisted dying bill was therefore put forward as a solution to this difficult problem. It proposes that the law should be changed to allow terminally ill adults to end their lives in a way that they wish, at a time of their choosing, so that they need not continue to endure suffering, and so their loved ones need not continue to fear the possibility of prosecution under the current law.

There are 3 major arguments advanced by supporters of this bill. They are:

1. Choice

2. Compassion, and

3. Dignity

The most powerful argument is for “choice.” Those who support the bill make the case that a terminally ill person who suffers unbearably from symptoms of their illness should be given the choice of how and when to end their life. This belief is neatly summed up in statements like these:

“There should be a presumption in favour of you having sovereignty over your own body.” — Sir Nicholas Mostyn (retired British High Court judge)

“If I decide that my own life is not worth living, please may I ask for help to die. It is a choice.” — Dame Esther Rantzen (veteran BBC Journalist)

Next is the argument for “compassion.” Those who support the bill see it as an act of virtue and kindness to help end the life of a terminally ill person who is suffering to the extent that they wish for their life to end sooner. We see this thought reflected in the following statements:

“I believe this is a compassionate change to the law.” — Rishi Sunak (Former UK Prime Minister, Conservative MP for Richmond and Northallerton)

“This is not about ending life, it is about shortening death.” — David Cameron (Former UK Prime Minister, Member of the House of Lords)

The third argument focuses on “dignity.” Those who support the bill posit that a terminally ill person will suffer progressive injury to their dignity unless they are given the option of being assisted to die as they wish. Here are another two statements that reveal the strength of this feeling:

“A dignified death is our right — I am in favour of assisted dying” — Desmond Tutu (Former Archbishop of Cape Town, South Africa)

“My Lords, in the last stages of a terminal illness, there are people who wish to end their life rather than struggle for the last few months, weeks, days or hours. Often it is not the pain that motivates such a wish, but the loss of independence and dignity.” — Charlie Falconer (Former Lord Chancellor and Secretary of State for Justice, Member of the House of Lords)

It is important to be clear that many of those in favour of assisted dying support it with good intentions. But as is often the case in life, good intentions do not always translate to sound conclusions. There is much to be said about assisted dying, even about the choice of words, but I will begin by focusing on the arguments themselves.

I do not support assisted dying, and the reasons for my objection are philosophical and practical. First, we need to examine the argument for “choice,” because this is at the core of what makes this debate contentious.

Choice is the prerogative of an owner. If you own something, then you can choose what to do with it. As a society, for us to justify granting ourselves permission to end one another, the first question we have to answer is this:

Do we own ourselves?

At the risk of offending some readers, I will make this clear: I believe we are created by God, and thus, we do not own ourselves. I believe we are accountable to God for what we do with our lives, and with the lives of others. I am aware that not everyone shares this view of themselves and of the world. So, I will briefly press hold on my view, and push this argument forward from a secular worldview.

Let us say, for argument’s sake, that God does not exist. Let us say, for argument’s sake, that the world and everything in it is a product of inexplicable chance. If this is the case, that we arrived here by spontaneous cosmic forces and unguided evolutionary processes, then on what grounds do we own ourselves? On what grounds do we argue for “choice” or arrogate any “rights” to our lives?

In a random universe, a “right” does not exist because there is no basis for it. In a random universe, things just are. There is only what is, and what is not. In a random universe, a presupposed “right” is arbitrary and meaningless. There is no de facto “right to live” or “right to die.” In that world, you are just able to live and able to die. If a person wanted to end their own life, or the life of another, they could do so because they are “able” to do so. But being “able” to do something is not the same as having the “right” to do it.

A “right” can only exist where there is a concept of value. Only a creature of value can possess a “right.” If a creature does not have value, it can not have rights; and without rights, it can not make a presumption of “choice.” If we agree on the premise that a human life has value, then we must answer the question: Where does that value come from?

The value of a thing is determined first by its maker, before anything else. If human beings are made by nothing but chance, then we have no intrinsic value. However, if we are made by God, does that give us any value?

“Then God said, ‘Let us make human beings in our image, to be like us.’” — Genesis 1:26 [NLT]

“Know that the Lord is God. It is he who made us, and we are his; we are his people, the sheep of his pasture.” — Psalm 100:3 [NIV]

The basis for the value of human life is that we are made in the image of God. In the order of created things, nothing else was made to resemble God. This makes us profoundly valuable irrespective of our physical attributes or life experiences, and it is on this basis that we have such a concept as “human rights.” If we accept that we have value, and that God is the source of our value, we must then ask ourselves: Does God, who is our source of value, permit us to intentionally take our own lives, or to assist others in doing so?

“Life is a certain gift from heaven bestowed on man, and is subject to his power who kills and brings about life. And thus whoever takes his own life sins against God: just as whoever kills another’s servant sins against the master of whom he is the servant; and just as he sins who usurps to himself judgment of something not entrusted to himself. For to God alone belongs the judgment of death and life: according to Deuteronomy 32, “I will kill and I will make live.’”²

In his Summa Theologiae, Thomas Aquinas nails the precise point that if we are created and sustained by God, we can not justify ending our own lives or aiding others to do so, because it violates God's unchanging principle of life and death. But you might say: “None of this helps a person who is experiencing unbearable pain and suffering from a terminal illness.”

You are right, and that leads us to examine the arguments for compassion and dignity.

Right now in England, the Southport killings are still fresh in the memory of the public.³ News of the event pierced through the heart of the nation. Three young girls were mercilessly killed at the hands of a deranged monster, and many others were injured. Those who know this tragic story would immediately, without hesitation, agree that the perpetrator deserved the death penalty. But he did not get it because, in 1969, capital punishment was abolished in England.

You might ask: “What does this have to do with assisted dying?”

The principle.

The reason why capital punishment was abolished in England was not to show leniency to murderers, nor was it to observe the first principle that ultimate judgement should rest in the hands of God. Rather, it was because of a second principle:

That the state should not be involved in the taking of a life.⁴

Inasmuch as we would like to see the Southport killer confined to a chair and served up as a meal to dozens of starving rats, the state had long ago abdicated its role in executing death penalties — and for good reasons. Chief of those reasons is our fallibility as human beings. Judges and juries can often be wrong. If there was another case, and we retrospectively found out that the wrong judgement was passed, and it had led to the sanctioning of death against the accused person, there is no option to go back and restore the ended life.

This is a concern that can not be ignored in discussions about assisted dying. Unfortunately, many supporters of the bill are quick to make light of this concern. They highlight two major provisions in the proposed bill to bolster their claim that it has adequate safeguards. They say:

1. Assisted dying will be restricted to terminally ill adults with 6 months left to live

2. Assisted dying will not be prone to error and abuse because two doctors and a judge will be involved in the decision-making process.

There are two big problems here:

1. No doctor can tell you, with absolute certainty, that you have 6 months left to live.

2. These experts (two doctors and a judge) are not able to see and know all things.

To propose a bill with a prognostic limit of 6 months is to think that doctors have special insight into the future. In case you did not know, doctors often avoid telling terminally ill patients how long they have left to live, because we do not know. There are patients who have lived far longer than they were expected or told they would live. I have met such patients myself. Thus, the 6-month provision is not a safeguard; it is a dangerous guess and a random qualifying criterion.

The next big problem is to do with intangibles. These are the things that experts, regardless of knowledge and experience, can not see. The most worrying of them is “coercion.” Are doctors and judges omniscient enough to know when someone is silently being coerced to kill themselves? This is, unfortunately, another issue downplayed by proponents of assisted dying. And it should not be downplayed, because the consequences for the most vulnerable members of society are massive.

“We are told that there is no evidence of coercion in jurisdictions where assisted dying is possible. But people do not generally write letters to sick relatives urging them to consider assisted suicide and then put those letters on file. Coercion in the family context can be about not what you say, but about what you don’t say — the long meaningful pause.”

— Diane Abbott (Labour MP for Hackney North and Stoke Newington)

No one disputes the plight of people who suffer unbearably from terminal illness. No one disagrees that, as a society, we should be compassionate. No one disagrees that we should, in every way possible, attempt to make death as painless and dignifying as possible. There are ways to do this, we already do it, and we can get better at doing it.

Palliative care is assisted dying. The whole ethos of this specialty is to make the terminally ill comfortable as they make their journey towards their final breath. Administering a lethal medication to hasten death is not assisted dying. We know what it is, and we must be honest about it. It is assisted suicide.

There are those who say even the best palliative care can not ameliorate certain degrees of pain. Two things I will say to that:

1. Pain is multifactorial and it is treatable.

2. Inequalities exist in access to palliative care which must be fixed.

Pain, by itself, is a symptom. But the degree to which you experience pain can be influenced by many things. For example, there are people who begin to require less pain relief because of a positive change in their living conditions, and there are people who begin to require more pain relief because of depression, family stresses or financial anxieties.

That is not to say that pain, by itself, can not cause an unbearable amount of suffering — it can. But modern medicine is not at a stage where pain control for the terminally ill is impossible to achieve. Non-drug treatments have often been shown to significantly improve pain outcomes when combined with drug treatments. And we should be mindful that there is a difference between “severe” pain and “unrelieved” pain.

The more pertinent issue here is inequality of access to care. Because in the UK, fewer than half of all cancer patients receive a strong opioid before they die.⁵ If a terminal patient does not receive all the treatment they can get, and they express a wish to be helped to die, will that count as a “clear, settled, and informed” choice?

“How can we be possibly satisfied that this bill will deliver equality and freedom in death, when we do not yet have this in life?” — Florence Eshalomi (Labour MP for Vauxhall and Camberwell Green)

“The issue of choice is that people need to have real choices in care, and not be driven to see death as their only option because they are not getting the treatment and support that they need.” — Baroness Ilora Finlay (Professor of Palliative Medicine, Member of the House of Lords)

It is too perilous to pass a sweeping rule that legalizes assisted dying in a context where thousands of people do not have access to decent palliative care. If the law is passed, it is obvious that people who would otherwise not have opted to die will choose to die.

I am hoping we can agree that the primary purpose of a law is to protect people from harm, not expose them to it.

There is more to be said, but I must admit, I need to stop here because my eyes are getting tired. In another essay, I will discuss other concerns with this bill, such as the real potential for the bill to widen in scope and to include people who are not terminally ill. Again, many supporters of this bill are quick to frame this concern as baseless fearmongering. I am afraid it is not. But for now, I will end with this:

As a society, we must take a bird’s eye view of this proposed change to the law. We must examine it in its totality, and it must become clear to us that apart from breaching the cornerstone principles of preserving life, we are at acute risk of killing people who are already at risk of being pressured to die.

1. Lloyd Riley and Davina Hehir, ‘Last Resort: The hidden truth about how dying people end their own lives in the UK’ (Campaign for Dignity in Dying, 17 October 2021) Link accessed 28 January 2025

2. Jason T. Eberl, ‘Aquinas on Euthanasia, Suffering, and Palliative Care,’ ‘The National Catholics Bioethics Quarterly, (2003) 3 (2): 331-354

3. Henry Vaughan, ‘Southport child killer Axel Rudakubana jailed for life with minimum of 52 years’ (Sky News, 24 January 2025) Link accessed 31 January 2025

4. Thomas James Wright, ‘A barbarous penalty which the community has no right to exact’: why capital punishment was abolished in Britain, 1947-69, PhD Thesis, York, University of York, 2014

5. Faculty of Pain Medicine, ‘Opioids for pain management in palliative care’ (Royal College of Anaesthetists UK) Link accessed 31 January 2025