Behind the Assisted Dying Bill

The issue of “assisted dying”, to be voted on in Parliament on 29 November, is complex and emotive. Most Disabled organisations oppose assisted dying, currently at least. Most organisations of palliative and geriatric care workers do too. Polls suggest that most disabled individuals support some provision of assisted dying; but also that most are concerned about undue pressure.

In a sense it is a debate between, or concerning, two groups of disabled or potentially disabled people. I don’t believe that our Marxism gives us any specialist insight on the Bill before Parliament itself, and there is a range of opinions among supporters of Solidarity. This article seeks mostly to explore the background issues.

Disability Rights UK (DRUK) says: “Disabled people and those with health conditions find ourselves battling to get NHS treatments, receiving inadequate care and support and having limited access to palliative care.

“The UK Government has been found guilty of ‘grave and systematic’ violations of Disabled people’s rights by the United Nations. This includes an increase in the reliance on institutionalisation, limiting our access to basic necessities, and dehumanising us as ‘economic burdens’ on society.

“The Covid-19 pandemic vividly demonstrated the fragility of our rights in the UK as blanket Do Not Attempt Resuscitation notices were [involuntarily given to disabled people, including in cases where CPR would be no less successful than for non-disabled people], and our access to critical care was denied. 60% of Covid deaths were those of Disabled people.”

Today, the NHS, social care, mental health services, and palliative care are “broken”. Poverty has risen dramatically among disabled people, even before recent cost-of-living crises, and on top of the housing crisis. Perhaps 100,000 people who could have benefited from palliative care die each year in the UK, without having received any. Hospices rely mostly on charity for their income. Labour has no adequate plans in funding or policies to fix any of these services. They promise further cuts to benefits, further invasive treatment for benefit claimants.

Disabled asylum seekers are routinely deprived of their basic needs, then refused asylum. Many workplaces and institutions are inaccessible. 300 people die in poverty every day.

Liz Carr’s moving documentary, Better Off Dead?, notes the horrific attitudes many (particularly visibly) disabled people come up against. Complete strangers, or even friends, remark that “if my life was like yours, I’d want to kill myself”, or even suggest they should, to “stop being a drain on society”. Them doing so is sometimes even celebrated as heroic, rather than tragic.

“Our fight should be for better funding and access [to] social services, restoration of benefit payments and high-quality public service,” say Disabled People Against Cuts. DRUK assert that “[a]ssistance to die should not be easier to access than assistance to live.”

Thus many worry that the Bill may encourage or legitimise ideas that will harm care, and encourage shame or guilt for disabled people, a feeling of being a burden on society, family, or whoever; and could pressure individuals towards choosing assisted suicide. No safeguards can be completely watertight.

For the additional option of assisted dying to be truly empowering, it needs to be one of a set of real choices along with reliable access to the best available treatments, support, care, and palliative care. To not risk impoverishment with any choice.

People experiencing new impairments and conditions often despair initially. But things can get better, despair can pass, especially with adequate support.

The richest 350 families and individuals in the UK’s net wealth alone grew this year to around £800 bn. In comparison, the annual budget of the NHS this year grew to less than a quarter of that around £177 bn. Net annual “benefit fraud” costs under £8 bn, paltry by comparison, also substantially less than the £23 bn of unclaimed benefits.

Adequate support is possible, by taxing the rich. For or against the bill, winning that is most important.

May legitimising assisted dying may make other treatment pathways seem less important, and be underfunded? No-one advocates that. Health secretary Wes Streeting, opposing the bill, claims that money spent on assisted dying would mean less money spent elsewhere in the NHS. But treating social services as a zero sum game, each competing for scarce resources, does not support disabled people or those at the end of life. It is part of the problem.

Fighting over scraps from the ruling class, rather than the working class fighting for more for us all, fits with treating those who need more social support as “burdens”, rather than as individuals with rights which must be protected. Those who reply, cold heartedly perhaps, that the cost of assisted dying is significantly outweighed by net savings, miss the point in the same way. The net costs in question are likely tens and hundreds of millions respectively, pennies.

We should not let the wider context of crumbling social welfare be a side comment in a “matter of conscience” devoid of a class perspective. Diane Abbot’s choice to co-author a letter opposing the bill with Conservative MP Edward Leigh betrays that mistake. Leigh has consistently voted for benefit cuts, for healthcare privatisation, against reducing the cost individuals must contribute for social care, more. He is on the wrong side of the important issues. Meanwhile, mainstream supporters of assisted dying often just ignore the dire context.

Many argue that a right to assisted suicide follows from bodily autonomy. To give up on living and on the prospect of finding ways to navigate one’s new impairments or suffering seems unavoidably tragic; but there is a limit to what the best palliative care can do. As Terry Pratchett’s tear-jerking Choosing to Die illustrates, assisted dying is often more painful to those left behind. But what if someone wants to pursue it as a “selfish” act, and says we should not condition support for this ugly “right” on societal context? I lean towards backing individuals’ right to access it, even if I suspect that in many cases doing so is misjudged.

Supporters of the bill argue that it would offer safeguards in what is currently a grey area. There’s a harm reduction case compared to people choosing unassisted suicide or travelling to Dignitas in Switzerland.

No-one thinks that this “right”, if any, is uncomplicated or unqualified. No-one advocates that it should be available on demand to everyone, on a whim, without safeguards. Nor, for example, that society shouldn’t intervene to try to save victims of attempted unassisted suicide. Everyone advocates some safeguards and restrictions. Are the proposed safeguards adequate? Are the conditions too loose? Too strict? I’m not sure of what I think in great detail.

But we can agree on the wider issues that need to be campaigned on. However the vote goes, we should galvanise organising for social care, the NHS, and benefits.