New York’s proposed Medical Aid in Dying Act threatens to undo this presumption in favor of lifesaving, especially for people with disabilities such as me. This month, the bill passed in a vote of 81 to 67 in the Assembly, the lower chamber of the state legislature. It is now on its way to a vote in the state Senate.

If the Empire State joins the 10 states (and the nation’s capital) that have made assisted suicide legal, it will be adding killing to the options available in doctors’ toolkits. Given my own brushes with death over my 34 years — and those moments of staring into the suicidal abyss as a result of depression associated with my condition — I pray Empire State lawmakers take a step back, and rethink.

This isn’t, and shouldn’t be, a partisan issue. Just last year, John Carney, then the Democratic governor of Delaware, vetoed a similar bill that had passed the state’s General Assembly. In 2012, when Massachusetts voters re-elected President Barack Obama by a whopping 23 points, they also rejected a ballot measure to legalize physician-assisted suicide.

In Britain, former Labour leader Jeremy Corbyn bucked his party to vote against legalization, while former Prime Ministers David Cameron and Rishi Sunak broke with their fellow Tories to support it. Republicans may be more against legalization than Democrats, but Democrats’ long tradition of protecting the vulnerable should militate against Empire State lawmakers passing this bill.

The bill, a mere 12 pages long, is deceptively enticing. At face value, it requires two doctors to sign off on a request for lethal drugs by a patient of sound mind with six months or fewer to live, with a diagnosed terminal illness. The bill proposes, without using such language, to offer those wracked by painful, terminal illness “death with dignity” on their own terms.

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By Alexander Raikin

Death with dignity is a real thing — many ancient cultures speak of it. In the Jewish religion in which I was raised, a good death is considered a kiss from God. Dying well is likewise an art in the Catholic faith I adopted as an adult. But a good, dignified death cannot come at the hands of doctors helping patients dispatch themselves. It cannot serve the cause of health insurers trying to save a buck. Still, any opponent of the legalization of physician-assisted suicide has to grapple with the fact that the demand for it is there for a reason.

I was born with a recessive genetic neuromuscular condition called nemaline myopathy. Over the years, it’s developed to the relatively stable point where I use a portable ventilator to breathe — hence, my blacking out last September — and a motorized wheelchair to get around. I often require assistance with basic tasks. I’m not terminal — at least, not without taking into account that life itself is terminal, for all of us. But many times, my own body can feel like a straitjacket, and that’s without the physical pain that surges from time to time.

I don’t want to die, and God willing, I’ve got another couple of decades left, at the very least. Under the law as proposed, I wouldn’t be eligible, all things being equal. But all things aren’t always equal. Eighteen years ago, bedridden for a month after major back surgery, I wished more morphine than was necessary for pain relief had been available to me. Watching my late grandfather wasting away in his last six years in a hospital bed at around the same time, I could and still can empathize with those who favor medical aid in dying.

For others, such existential moments can tip into a yearning not to exist — to escape it all.

Which is, of course, the point. If no one wanted physician-assisted suicide, there’d be no reason to make or keep it illegal. But there is such demand. Yet New York would go down a very dark moral path by enabling doctors to accede to such requests, even — as of now — in the extremely limited circumstances of terminally ill patients with six months or fewer to live.

The way the bill is drafted is itself prone to abuse, lacking the necessary safeguards to prevent nonconsensual physician-assisted suicide. A lot has been made of abuses in other countries, such as Canada and the Benelux region, where the category of people approved for suicide-by-doctor has steadily expanded to include the mentally ill, those with autism and ADHD, even teenagers.

The problem is that no safeguards could possibly be adequate. Even with the most tightly drafted laws, patients and people with disabilities are likely to face subtle forms of coercion (“The treatment would be difficult and costly for your family; there is, of course, another option…”). Equally troubling is the way in which legalized euthanasia and assisted suicide twist and distort the medical profession’s oldest commitment, turning physicians into angels of death.

True, the principle of primum non nocere (“first, do no harm”), to which doctors are bound, has on occasion been reinterpreted such that “harm” is taken to include permitting a patient to suffer. At times, we allow medical care or nutrition to be withdrawn, despite the certainty of death. But the trouble is that allowing doctors to help their patients kill themselves means that killing now becomes a legitimate medical option.

My situation as someone with serious physical disabilities may be unusual. But most everyone has dealt with the byzantine bureaucracy of insurance companies and medical billing. Do we really want to make physician-assisted suicide a legitimate form of “treatment” in end-of-life cases? We bemoan the fact that people nowadays have fewer friends, or even close family members. Do we really want to make it so that there’s an “out” to the natural burdens of familial love? Or to mere loneliness?

I’m lucky to have a family and friends who love me. But others aren’t so fortunate, and even my family, by the natural way things go with time, won’t always be around. In medical dramas like Grey’s Anatomy or The Pitt, the medical profession is portrayed as valiant teams of heroes coordinating to save lives — and, don’t get me wrong, plenty of doctors, nurses, phlebotomists, and radiologists are heroic. But reality is far more chaotic and disorganized.

If not for my constant vigilance at my recent stint in the emergency room last year — the price of which was not sleeping for nearly the entire two days I was under observation — I’d have been administered several painful antibiotics I didn’t need, received precious little nutrition, and ended up with a tracheostomy in my windpipe. And that’s with doctors having no right to kill any patient. Let them do that — legally? You can bet death will become an easy option.

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Advocates of physician-assisted, when not resorting to subterfuge, insist that the terminally ill who want to live out their remaining days should be able to do so. So what differentiates them from those who advocates say should be allowed to die? Pain, physical or spiritual. And don’t we all suffer pain? Aren’t we all terminal? Six minutes, six days, six weeks, six months, six years, six decades — one day, the curse of Adam will catch up with us all. I’ve lost friends to tragedies who I thought would live 100 years.

Simply put, we don’t know when our time is. If that’s the case, then the logic of assisted suicide leads inevitably to the conclusion that those with doctor-approved expiration dates are living lives not worth living. Lives unworthy of life, as the Nazis referred to people with disabilities when they set out to exterminate us with their Aktion T4 program.

A life not worthy of living. Well, I’ve heard that before. From peers, from rivals, sometimes from myself. I haven’t been suicidal in a good number of years, but I can’t say that about my teens and early 20s. I’ve had my fair share of heartbreak and physical pain that might have crushed many. Yes, no one wants to end up like Tithonus, locked away to wilt and fade while still breathing. But neither should the state of New York give reason for loved ones to abandon the frail. I’m one of the lucky ones. I fear for a world in which life is cheap.

It’s notable that some New York lawmakers are trying to push the bill in the wake of the death of Pope Francis. The late pontiff was especially vociferous in decrying what he labeled “throwaway culture,” a culture of waste that most afflicts “children, the elderly, the needy, and the disadvantaged.” Euthanasia epitomized that throwaway culture for Francis, and should New York enact the Medical Aid in Dying Act, the trend would only intensify.

The New York Senate must vote down this charter of death. Failing that, it would be an act of supreme political courage for Gov. Kathy Hochul to veto it. As a young man with disabilities — albeit ones that, with assistance, would still allow me to live a full and familial life — I fear what this state should become if the suicide-by-doctor becomes law. All New Yorkers are imperiled when the lives of the most vulnerable are rendered cheap.

An obdurate Leadbeater seemed to think her bill’s wording excluded this disturbing outcome in principle. Assisted suicide on the NHS, she insisted, will be reserved for the terminally ill, with a stipulation that “a person is not to be considered to be terminally ill only because they are a person with a… mental disorder”. But as Chelsea Roff, the lead author of the anorexia evidence pointed out, the disease is — by definition — a mental disorder with devastating physical effects. In particularly severe and prolonged cases, a doctor might well diagnose the case as hopelessly terminal with recovery impossible, in which case eligibility for an early exit would be nearly assured.

This would be a mistake, though an understandable one. In fact, with anorexia, you can only say with confidence that recovery genuinely was impossible and further treatment futile, if and when the sufferer actually dies from the disease. Until then — doctors’ illusions of omniscience aside — you don’t know for sure. Some will seem to be at this point and then later recover; for occasionally, even entrenched anorexia can loosen its grip, and fuel-starved minds start to change. If a sufferer opts for assisted dying, then, we will never know for sure whether the same could have been true of them.

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Indeed, it is potentially worse than this; for it seems that a diagnosis of terminal illness in the case of anorexia might have a rigidifying effect on a sufferer’s intention to give up on life. This is one between-the-lines reading of a case history offered by US medic Jennifer Gaudiani concerning Alyssa, an anorexic who was eventually euthanized at her request. In an email to Gaudiani four days before her death, Alyssa insisted that her course of action was not being “pursued in isolation, but rather in the context of being in Hospice care following a terminal [diagnosis] of anorexia (i.e., estimated six months or left to live)… In my individual case, death was inevitable. I clearly understood my prognosis and accepted this. I saw [medically-assisted dying] as an opportunity to select a specified time and circumstances for my death.”

Gaudiani is herself supportive of assisted dying for so-called “terminal” anorexics; but relatively few general campaigners for assisted dying positively want this sort of outcome, as such. Still, the logic of their own position inexorably corners them into it. For, though it is often unnoticed, the assisted dying movement is a collaboration between two radically different ethical ideals, whose goals have only surface compatibility. The state-enabled deaths of willing anorexics is just one side effect of the underlying tensions.

First, we have the Freedom Lovers. These are campaigners whose buzzwords are “my choice”, “my right to die”, and the like. Freedom Lovers are steeped, whether knowingly or not, in a liberal tradition which emphasizes freedom from interference from others in various personal domains. Their pronouns of choice are usually I/me/mine. They tend to think of death-seeking as a wholly private matter.

The vision of the Freedom Lover can be seen most clearly when away from the morally murky domain of assisted dying, considering suicides of the unassisted kind instead. Possibly the most hardcore Freedom Lover there ever was, was anti-psychiatry psychiatrist Dr Thomas Szasz. A Hungarian-American, he wrote many books railing against the coercive nature of the medical establishment. He thought that if you decide to kill yourself, you have a right to noninterference from everyone else, even in the case of severe mental illness. Any reason to end your life is a good one as long as it is yours, and any attempt to stop you is an infringement on personal autonomy. Inspired by the pejorative “Big Pharma”, he once coined the concept “Big Suicide Prohibition” — though for some reason it didn’t catch on.

Alongside Freedom Lovers, another archetype is also heavily involved in pro-assisted dying campaigns. I’ll call her the Altruistic Helper. Whereas the Freedom Lover is, at base, a suicide permitter, the Altruistic Helper is a suicide enabler: not so much interested in leaving people alone to do their thing, as positively helping them do it. Her preferred language mentions “compassion”, “humanity”, “mercy”, and “quality of life”. Her preferred pronouns are not first- but third-personal.

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Unlike the Freedom Lover, she does not think of the value of a life as subjective, or that any reason to go is a good one, as long as it is yours. Some circumstances are more deserving of death than others. Though sometimes reticent to spell this out, it seems clear that Altruistic Helpers have firm views about what should happen, objectively, when a life contains so much suffering that it is not worth living. In that case, they think, its owner should be helped to die; it’s the morally correct thing to do.

While she pays due deference to the presence of consent to the assisted dying process, unlike the Freedom Lover the Altruistic Helper is not massively interested in it for its own sake. Rather, she simply takes consent as good proxy evidence for the presence of unbearable suffering in a person’s life. Her background thinking seems to go: if you have a terminal diagnosis, and you are deliberately seeking an early exit, the only possible reason for which you could be doing this is that you are suffering unbearably. (Indeed, Kim Leadbeater seems so sure of this fact that in her proposed process, the candidate won’t be asked about her personal reasons for seeking death at all.)

To say that the Freedom Lover and the Altruistic Helper are strange bedfellows is an understatement. Strictly speaking, what should interest the Freedom Lover according to the logic of his ideal is decriminalizing private voluntary acts of suicide assistance, organized contractually between individuals. You want to die, for whatever reason; I want to help. It’s all voluntary, and nobody else’s business to interfere.

Yet thanks to the Altruistic Helper’s input, they tend to get something else entirely: a huge state-sponsored machine, involving thousands of healthcare employees, policies, and supposed safeguarding constraints upon who can access the service. Uber-Freedom Lover Szasz knew this, and was critical in his writing of assisted dying procedures, viewing them as constraining of personal autonomy. When he broke his back, aged 92, he killed himself alone a few days later.

Another weird feature of the awkward collaboration between these ethical archetypes is that the Freedom Lover can’t really justify why terminally ill people already able to kill themselves on their own, if wished, are deserving of state-sponsored medical assistance to help them do it. Though unpleasant to dwell on, many already have this freedom, as the example of Szasz demonstrates. It is perhaps why Freedom Lovers tend to focus so heavily on paralyzed or otherwise incapacitated people in their motivating examples. In contrast, the Altruistic Helper has no trouble explaining why terminally ill people who ask for death are deserving of state assistance, however mobile they are. Namely: they are clearly suffering too much, and so it is the right thing to do.

The anorexic with suicidal intentions — for all we know temporarily — ends up as collateral, falling between the two stools of these ways of thinking. Anorexia is a relatively anomalous condition, hard to fit into familiar binaries of active cause versus passive effect. The mind produces a willed behavior with devastating effects on the body. The physical effects of anorexia are not exactly voluntary, given the role of persistent, near-automatic habits of approaching food; but not exactly involuntary either, and certainly not involuntary like those of cancer or arthritis.

Effectively, anorexia acts as a Rorschach test for assisted dying campaigners. To a committed Freedom Lover, the behaviors associated with anorexia, including accompanying suicidal intentions, look active enough to count as an expression of free will — at least, assuming mental capacity has first been established, as was the case for Alyssa. (Purists like Szasz may not even require this.) Those who are Freedom Lovers by instinct are not particularly inclined to go out to bat for the exclusion of people from assisted suicide provision who appear to have rationally decided it is their time to go. To say otherwise would look like a kind of interference in personal autonomy, and Freedom Lovers can’t have that.

Meanwhile, the Altruistic Helper is likely to frame the terrible physical suffering produced by severe and prolonged anorexia as something that happens to a sufferer, rather than something she has any part in actively causing; an irrevocable, settled fact that merits a compassionate release into peaceful oblivion. As intimated earlier, Altruistic Helpers tend to see a person’s firm desire to die, accompanied by physical affliction, as an indirect indication that the amount of suffering present is objectively too hard to bear. This is supposed to be what justifies helping him to end his life. If Helpers were to admit that the physical torment of a severe anorexic, as awful as it is, is not enough to make an assisted death justified, they might just have to rethink their whole model.

And so, like the Freedom Lovers but for different reasons, Altruistic Helpers are also unlikely to argue forcefully for the exclusion of suicidal anorexics from an assisted dying service. Depending on who is looking, these troubled women and the occasional man will be seen as captains of their own ships or helpless victims of the storm. And either way, an artificially hastened exit from a sea of troubles will be theirs for the asking.

Everyone was partnered, successful and “shiny”. I — an Iris Murdoch-obsessed homosexual statistician — lay on the lakeside beach, dully hungry from the latest pointless attempt to lose weight, surrounded by the mountains about whose majesty everyone insisted. I saw nothing but rocks. No bildungsroman lurked, waiting to be written: just pointlessness mixed with failure.

That sense of being “outside, looking in” at what others took for granted and which they claimed was the obvious key to contentment at times became unbearable.

Or almost so. I moved back to the UK where I had my heart broken one last time, took a few years’ worth of SSRIs, got over the death of my father (the spark that lit the fire of my depressive proclivity), found purpose in work and salvation through exercise, and met Mr Keith.

I’m a good Conservative, staunchly lower-middle class, the class whose strongest and perhaps most biddable instinct is not to cause a fuss. If someone had said to me at certain points between 1998 and 2002 “Would you like us to help you kill yourself?”, I’m not sure how I would have replied.

“What would I have done?” is the thought I cannot banish since Parliament voted yesterday in favour of Kim Leadbeater’s “Assisted Dying” Bill. To be or not to be; that, it turns out, is not the only question. Of more immediate attention, thanks to Leadbeater and the 330 MPs who supported her, is a semi-corollary: if the answer is “not to be”, Parliament believes the NHS should be allowed to “assist” you. That is: the British state should be permitted to kill you.

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Be permitted to kill you “if you so desire and are terminally ill”, the proponents of the Bill would append. I am opposed to the Bill both in its own terms but also because I doubt the very clause “if you so desire” would survive three months of judicial activism.

While life has turned out better than I dared hope, there were those earlier points in time when it didn’t feel that way, and I owe it to that younger Graeme not to pretend that he never existed. A state with agents whose targets would be met by hitting their quotas for “assisted suicide” would have smacked its lips had I wandered into one of its clinics.

That objection is swept aside by Leadbeater. As currently drafted, the Bill is designed only for very strict cases where organic illness will end a citizen’s life in a short period of time. Depressed patients wouldn’t qualify. To which there are a couple of pertinent responses, the core of my objection. As Dominic Cummings puts it on X:

If struggling on assisted dying: wd you trust the Whitehall of 45 minutes, financial regulation, Iraq, Afghanistan, Brexit negotiations, ‘Online Harms’, covid & ukraine – with an NHS in meltdown & *already* encouraging families to put ‘do not resuscitate’ orders on healthy people…

— Dominic Cummings (@Dominic2306) November 28, 2024

Quite. But if that’s too pithily expressed, then supporters of the Bill must answer the question: “Why would the UK be any different to other Western democracies which have enacted such legislation?”

Whether one looks at Canada, Belgium or the Netherlands, similar Bills all started off making it very clear that state-sanctioned death would be imposed only if a compos mentis patient asked for it, and only in close-to-involuntary-death circumstances; yet in every case it is documented that “mission creep” has now enabled cases I find too disturbing to describe in words. Even “cases” is a cowardly word. As the Bill supporters celebrate their “win”, how do they know that our fantastically activist-driven court system could not cause such outcomes here?

The analogy made with the euthanising of pets is telling, here. But not for the reason (“We don’t let our animals suffer, so why do we let our parents?”) they think. Two great wee cats, Dave and Kitty, spent nearly 15 years as our household gods and without shame I loved them. Both became elderly-cat ill (Dave — cancer; Kitty — kidney disease) and died within a year of one another. They were euthanised, by our wonderful vet who performs home visits to spare the animals stress in their final hours.

The argument in favour of the Bill proceeds to say “And why can’t we do that for humans?”

In fact, I believe in many cases we do, which I’ll return to below. But the point about my cats’ deaths is that they were loved. What about the animals which aren’t? What do you think happens to them? Kitty was incontinent for the last six months of her life. It made our house stink and we spent hours every week mopping up. We welcomed the burden. It’s the price of love.

Can we guarantee that this will apply to every incontinent, elderly human? I believe the moral case for the Bill fails if a single human were to be killed through spurious arguments about “burden of care”. (I am no utilitarian.) There is a statistical correlation between the propensity to commit cruelty to animals and to humans. Those who have no qualms about killing their “nuisance pets” will be able, I’m sure, to find forms of words that justify the same case for their relatives, especially those left in the arms of the state’s Care Homes. For how much would such deaths count in Parliament’s new calculus of suffering?

This dystopian calculus seems to sit perfectly within the age we inhabit. It’s like the country has accelerated into the Ballard novel I inhabited in the late Nineties, even as I’ve matured into something out of P.G. Wodehouse.

So it isn’t surprising that a state which sanctions Hate Marches in its capital thoroughfares, loud with chants for death; that rips down its built history (Smithfield is going! What next? St Paul’s?) and whose museums it permits to linger only that they may hector its citizens about the sin of their supposed racism… It doesn’t surprise me that such a society would eventually find its apotheosis in the form of this Bill. If the culture upstream celebrates its own extinction, why are we surprised that politics downstream finds a way to codify your own obliteration into law.

Welcome to the age of death: look at the adverts on the Tube, grotesque beyond the imagination even of P.D. James, whose Children of Men novel foresaw and described our childless pitilessness in many ways. Even she didn’t imagine that the “Quietus” would be represented by adverts showing an ecstatic young woman dancing around her fitted kitchen in joy that one day the state will kill her.

These adverts defy explanation, other than that we have reached end-stage nihilism. If we are presenting death as an aspiration, ours is almost by definition a culture that cannot be trusted with assisted dying procedures.

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And, yet, there are already people that we can trust with ours. If you’ve had the privilege of being with someone at the end of their life you’ll know what “palliative care” means: the use of opioids to prevent pain, a side-effect of which is, eventually, the suppression of respiratory function. It is the greatest gift that medical professionals do for us. The crude mechanics of a Parliamentary Bill will rip apart the near-sacred, and sometimes silent, understanding between patient, doctor and carer.

Should I meet my end through a painful, lengthy condition like a cancer with no chance of treatment, I want that end to follow a conversation between myself and my physician — or my physician and my (power of attorney holding) spouse — and I want it to be about managing my pain, or my agitation. I’m completely aware of what that means and the very good reasons why it’s impossible to spell it out. With respect to Leadbeater, no MP has the right to insert their desires into that space.

Anyway, the Bill isn’t about palliative care, which is telling. It doesn’t guarantee that its extent won’t creep beyond the will of its writers. It represents one end of a slippery slope, in other words.

“I don’t want to be a burden,” I’d think to myself, lying on that godforsaken Italian beach. Either to myself, or to others. How tempting to slip under the water and stop being a nuisance.

But we’re all burdens — that’s the point of love. To the extent that we suffer pain at the end of our lives, then that pain must be ameliorated — as it can be — even should such amelioration shorten our existence. A Royal Commission into Palliative Care, and how to improve it, would be welcome.

That will not be the outcome of this Bill, should it become law. It will give power to Government to bring about your death, and for such a killing to be entirely legal. That’s not a state I want to be in and however much you’re suffering, I don’t wish you to be in it either.

The humanists talk blithely about “safeguards”, as if any legal system on earth can protect an elderly and highly suggestible person from the subtle forms of micro-manipulations with which someone can be persuaded that it is in everybody’s best interest for their death to be quick and painless. You can say “think of the children” with the tiniest inflection of the voice, make the subtlest of reference to money worries. We communicate with each other, often most powerfully, through almost imperceptible gestures of body language and facial expression. No legal safeguard on earth can detect such subliminal messaging.

And then to dress all this up as love for your mother — “We just don’t want you to suffer” — is the vilest of betrayals. Assisted dying legislation doesn’t just change the relationship between the dying and their doctors, and the dying and the state. It fundamentally alters the dynamics within families, and at the most emotionally complex period of someone’s life.

As the debate has unfolded over the past weeks, I have become less and less convinced of the noble declarations behind it. For some at least, the matter seems to be entirely ideological; namely, that the idea of choice has to be driven into every aspect of our lives. The attraction of this reasoning to our political decision makers is obvious: it exonerates them from their responsibility to keep people safe — their primary responsibility as law makers.

Consider capital punishment. Like assisted dying — or state-sponsored suicide — capital punishment is popular with the public. But whereas the opponents of capital punishment (as I am) point out that these terminations can be botched and cruel, few will make the same point with respect to assisted dying. Fundamentally, the state should not be in the death business. And making it easier and cheaper for the state to be allowed to kill people, rather than sort out the basic infrastructure of social and palliative care, and to keep people alive with dignity, is to push all the incentives in exactly the wrong direction.

The proposed legislation does not even mention the word suffering, though it is the desire to avoid suffering that is at the heart of the case for assisted dying. But suffering is so intrinsic to our existence that there is no legal or medical scalpel that is precise enough to excise it without also damaging the very things that give life its fundamental value. A radical project to rid the world of suffering, if carried to extremes, would also rid the world of love and hope, of courage and compassion. Of love, because love — love lost, love denied, love betrayed — is perhaps the greatest cause of emotional suffering; of hope, because hope walks a tightrope between success and failure, triumph and misery; of courage, because courage is so often a preparedness to suffer, risk suffering, for some greater good, and compassion, because definitionally means to suffer alongside. There is a vastly significant difference between wanting to alleviate the suffering of another through comfort and kindness and palliative care, and by seeking to alter the very terms of reference of what it means to be human. This assisted dying legislation is like introducing a zero hours contract with life.

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Yes, there is a religious point to be made — though not all opponents of assisted dying are religious. I believe human life is sacred, that we are all made in the image and likeness of God. This basic point has been a bedrock of the Western attitude towards how we are called to treat each other. It has been the fundamental starting point for our ethics for well over a thousand years. This week, though, a former personal trainer with a degree in fitness and health-related exercise from Leeds Beckett University is proposing a private members motion that will overturn perhaps the most basic of our moral and philosophical presuppositions — and Parliament will have only a few hours to debate it.

With what will we replace this ultimate theological grounding for human value? Perhaps the answer is economics. I am grateful to Matthew Parris for saying this out loud in The Times a few months back. Clarifying a utilitarian approach to human value, Parris is clear: “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.” He continues: “It may sound brutal, but I don’t apologise for the reductivist time with which this column treats human beings as units — in deficit or surplus to the collective.”

We are on the cusp of a fundamental redefinition of what it is to be human. This is one of those areas where the idea of God has served us well, a corner stone of treating human beings as of ultimate value. Opponents of assisted dying are trying to downplay this point, and I understand why. Strategically, religion isn’t a great debate winner, especially at the moment. But make no mistake, what is at stake here is a profound shift in the way we understand ourselves. Western culture has been founded on the idea that God is the ultimate guarantor of the value of human life, that human beings are metaphysically special.

We are about to trade all this in for “human beings as units — in deficit or surplus to the collective”. Human value will now be plotted on an Excel spreadsheet. Theology gives way to economics. This is the brave new world the humanists have been arguing for. And, sure, there will be a few lucky ones who get to end their last few days by slipping away quietly on a barbiturate cloud. But it will be the poor and the vulnerable who will suffer most.

***

You can call Samaritans for free on 116 123, email them at jo@samaritans.org, or visit www.samaritans.org to find your nearest branch.

Much as new lives were not automatically worth preserving, taking your own life in the ancient world wasn’t automatically bad either. Socrates’ decision to drink hemlock rather than face exile, was deemed honourable by many ancient philosophers.

Christian doctrine, though, taught that human life is sacred, because it holds a spark of the divine. Thus only God should be permitted to give or take life. The 325AD Council of Nicaea decreed that every Christian village should have a hostelry for the sick, a principle which extended to abandoned children. For the same reason, a long-standing Christian tradition forbids suicide. But as the Christian era has faded, so old debates about the beginning and end of life have re-surfaced – most recently, in the accelerating campaign to legalise assisted dying.

The latest such effort, Baroness Meacher’s Assisted Dying Bill, has been debated today in the Lords. It’s a campaign that kicked off initially as Christianity began fading in earnest, in the early 20th century, and has accelerated sharply in the last two decades.

But it’s not enough just to see this as further evidence of Christianity’s terminal illness. For even when Christendom dominated the West, the edges of life have always been vulnerable to a nudge this way or that. And this in turn shows why even non-believers should think twice about legalising such nudges — even when they’re justified in the name of choice, agency or compassion.

The “melancholy, long, withdrawing roar” of Christianity, picked up speed after World War I. When church leaders on all sides cheered on that bloodbath as a “crusade”, perhaps it’s no wonder “the Church says so” lost its shine afterwards, and “progress” began to look like ‘whatever the Church forbids’.

Unsurprisingly, campaigns challenging Church teaching on the sanctity of the beginning and end of life gathered pace in the Thirties. The Abortion Law Reform Society was founded in 1936, while the first Voluntary Euthanasia Bill was proposed even earlier, in 1931.

The Abortion Law Reform Society got its way in 1968; closely tracking this victory for individual choice, another effort was made to legalise voluntary euthanasia in 1969. Though this attempt was unsuccessful, more recent efforts have sounded an insistent drumbeat, in tandem with decline of Christian faith.

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The 2001 census reported that 71.7% of Britons described themselves as Christian; by 2011 that was 59.3%, and it’s predicted to be below 50% when this year’s census data are released. And since the 1997 attempt by Labour MP Joe Ashton to introduce a Doctor Assisted Dying Bill, there have been nine further attempts, of which Meacher’s is the most recent.

The principal defence of assisted dying is that an individual of sound mind should be free to choose whether he or she continues to suffer. Many today find this convincing. But when we weight the merits of this argument, it’s worth considering some of the less-counted costs of the successful parallel campaign for ‘choice’ at life’s beginning.

Today, legal abortion in the UK is widely viewed as a core feminist victory. But while this change eased the predicament of countless women facing unwanted pregnancy, it also had wider knock-on effects. For while legalisation gave more women the option to end a pregnancy, not all of them wanted to take it.

Meanwhile, though, the fact that carrying the baby to term was now optional eased social pressure on those men who caused accidental pregnancies. One US study shows that the availability of oral contraceptives so increased demand for extra-marital sex that — because the method wasn’t 100% reliable — it also increased the rate of extra-marital pregnancies by around 15%. At the same time, another US study shows that legal abortion drove a parallel decline in shotgun marriages that far outstripped the number of accidental pregnancies forestalled by abortion.

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Trans activism has mummy issues

By Mary Harrington

Thus, while advocates of legal abortion believed that it would reduce instances of single motherhood, its paradoxical effect was the opposite. By relieving social pressure on men to step up after impregnating a woman, legalising abortion accelerated the prevalence of single motherhood — a phenomenon now widely recognised as a central to the feminisation of poverty.

Most women in the UK support the availability of at least some legal abortion. My aim here isn’t to re-litigate this acutely sensitive debate, but to draw out a more general implication: that when a previously unavoidable life experience becomes avoidable, wider attitudes to that experience will change. And for some, it’ll stop being a matter for sympathy.

This is the shift which justified the Right-wing depiction of single mothers pervasive during my youth in the Major years, and still widely associated with individualist Thatcherite Toryism: lazy, parasitic “welfare scroungers”. Implicitly, those who took this position assumed that because such women could have terminated a pregnancy, the duties following on having not done so should be wholly on their shoulders. In other words: if suffering is avoidable, the choice to suffer comes to be seen as wholly private.

And it’s on these grounds that we should be wary of assisted dying, regardless of our views on the immortal soul. For in practice, over the increasingly liberal 20th century, it’s been consistently the case that what looks like ‘choice’ for the well-off gets underwritten for the less wealthy by the welfare state. In the case of accidental pregnancy, for example, as single mothers grew in number others rightly sought to relieve the resulting poverty and suffering.

Again, I mention this not to re-litigate these debates and certainly not to stigmatise those who rely on these resources. Rather, I want to sound a note of pessimism about how sustainable this dynamic will be in the 21st century. For the expansion of the welfare state as underwriter of last resort for personal choice is predicated on economic growth. And this in turn relies heavily on population growth. And while that well seemed bottomless in the Peak Boomer years of the 20th century, the 21st so far has seen economic shocks, concentration of wealth in a super-elite, and a globally collapsing birth rate. In other words: the enabling conditions for a 20th-century welfare state are crumbling in front of our eyes.

We’re already seeing intensifying competition for a dwindling pot of taxpayer support, between different interest groups. Thanks to the demographics of the UK’s voting public, which skews toward the old, victory in this struggle has thus far gone to the elderly. But this may yet change, as demographics shift and belts are tightened. And history teaches us that even during the Christian era, when life was explicitly defended as sacred, scarcity has at times driven people put a thumb on the scales.

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By Michel Houellebecq

Folk songs tell of women who give birth out of wedlock and murder the newborns. And at the other end of life, even Christian European cultures sometimes practised “mercy killings” of the elderly.

In Sardinia, the femina accabadòra, the “lady of the good death” would be summoned to the bedside of someone very old or terminally ill, and after reciting a final ritual blessing would kill the sufferer with a blow to the temple, using a special hammer. The Galluras Ethnographic Museum in Luras includes an example of this implement, resting with a gothic flourish on the pillow of an empty bed. Similarly, early 20th-century ethnographic reports describe Lapot, a practice in the Carpathian mountains in which an elderly person unable to care for themselves would be ritually killed by a relative.

The common factor in such killings was a shortage of resources. That is, societies making grim choices about what to do with those so old, young or ill they’re wholly dependent on care – and to whom a community is unable or unwilling to devote the necessary resources.

And notwithstanding cruel conservative stereotypes, it’s overwhelmingly scarcity that drives the “choice” to end a pregnancy. In the US, the poorest 12% of women account for almost 50% of abortions. And a glance through women’s stories swiftly illustrates just how far the individual “choice” to end a pregnancy is often far from free, but rather a reluctant decision driven overwhelmingly by poverty.

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The uncomfortable truth about death

By John Lee

In a world where dwindling welfare resources are ever more grudgingly funded by a shrinking working-age population, it’s easy to imagine the arguments from scarcity that will follow, ever more explicitly, upon the transformation of terminal illness into a “choice”. Indeed, they’re already foreshadowed by an assessment of assisted suicide by the Canadian government, which noted that legalisation “could reduce annual health care spending across Canada by between $34.7 million and $138.8 million”.

Those individualists now pushing to extend “choice” to the end of life are still wedded to a hyper-individualist twentieth-century mindset that relies on an ever-expanding welfare state to underwrite its freedoms. But they’re not paying attention: the age of abundance that shaped that dream of endless choice is already over.

And yet they push on. If they succeed, many people now healthy will face terminal illness in a “care” landscape created by individualists, for a society that’s enshrined “choice” over any public duty of compassion — and that can no longer afford a publicly-funded care infrastructure to pick up the pieces. I don’t want to live in a world where ‘tough-minded’ right-liberals write op-eds implying that those with terminal illnesses who refuse the Socratic way out are selfish parasites.

A cynic might argue that given all this, adjusting the statute book to allow for a 21st-century “lapot” is merely sensible. But if this is so, we should drop the rhetoric about freedom and compassion. We should be under no illusions about what this Bill is for, or about the callously neo-Roman attitude to human life that will follow in its wake.