At the end of November, a bill that would legalize assisted suicide for terminally ill patients in England and Wales passed its second reading in Britain’s House of Commons, with 330 members in favor and 275 opposed. While the bill still faces several more hurdles before it is enacted, no other bill on the topic has ever made it this far.
Members of Parliament were free to vote their conscience, rather than being expected to hew to their party’s position, and ministers within the current Labour government voted on both sides of the issue. Even though the outcome of the vote was tragic, the quality of the debate was striking, at least as viewed from this side of the Atlantic. In particular, there was serious engagement with the question of whether or not the availability of assisted suicide could lead to pressure on patients to opt to die in order to avoid being a burden on their families and loved ones.
The debate in Britain often turned to whether or not the safeguards in place in the law were sufficient or whether adequate palliative care was available so that suicide would truly be chosen freely by a patient. The guardrails in the proposed law are significant: Only patients with fewer than six months to live would be eligible; their decisions would need to be endorsed by two doctors and a judge; a waiting period would be required before proceeding; and the dying person would have to self-administer the lethal dose of medication.
Certainly, those are far more stringent conditions than have applied in Canada, where “medical assistance in dying” (MAID) accounted for more than 4 percent of all deaths in 2022, according to the government’s most recent report. This year, Canada delayed the implementation of a law that would make people suffering solely from mental illness eligible for assisted suicide; that is now scheduled to go into effect in 2027. Part of the reasoning that led to the delay was to improve the provision of mental health services to reduce the risk of people choosing death because they could not access care.
There is a striking parallel between these debates—the question of when a health system can be said to provide enough care to make it “safe” to offer people the choice to kill themselves without running the risk that they will do so for the wrong reasons.
The absurdity of that question once it is laid out in clear terms should reveal the moral crisis of the whole idea of assisted suicide. But there are tremendous pressures, involving our compassion for those suffering at the end of life and our own fear of death and loss of control, that cloud our vision when we consider such questions.
Some people may try to resolve the absurdity of that question by rejecting the idea that there are “wrong reasons” to want to die. The New York Times recently featured an interview with Ellen Wiebe, a Canadian physician who has performed hundreds of MAID procedures. She described her commitment to patients’ ability to choose to die in terms of human rights.
Chillingly, she also told the story of a man, confined to a bed in a hospice, who asked for MAID in order to avoid being a burden on his family. “Sorry,” she said, “that’s not a good enough reason.” But just when a reader might think the safeguards in the system have worked, she goes on to explain that “he also was very distressed at the fact that he had been a person who’d taken care of his family and now he could have people take care of him, and it was unbearable to him that he was in that state and wasn’t getting better. So I had to determine that his suffering also included that.” That determination having been made, she found him eligible to ask for his own death.
Perhaps Britain’s more stringent proposed safeguards might avoid such an outcome or at least make it less likely. But no guardrail, no matter how high, can manage to completely distinguish our own suffering from the suffering of those who love us and share our pain, and the burden we might want to spare them at the bitter end.
Instead, we need to recognize that suffering and compassion are not just inevitably intertwined but are in fact interdependent. We cannot be truly compassionate unless we are willing to share in others’ suffering and to let others share in ours. Assisted suicide presents itself as a compassionate answer and a way out of suffering, but the goal it really serves is not compassion but an illusion of final autonomy: that we can and should control our own lives completely, even as we are losing them. No matter how many rules and procedures we put around it, that can never be a safe or compassionate way to relate to other human beings.
The truth is, our lives have never been exclusively our own. From our first dependence on our parents to our last dependence on those who love and care for us, human dignity is ennobled, rather than degraded, by our need for care from others.
