On 4th February, at Trinity Church Scarborough, I led a teaching evening on the subject of assisted dying. I won't rehearse the reason in this blog post, as it was all covered in the presentation. Suffice to say that the UK government is currently debating a private member's motion to legalise assisted dying.
Not everyone could come to the evening, so we produced a video version of the resource. This material may well interest people wider than our church in Scarborough, so I'm sharing it here.
Below is an embedded copy of the video, followed by a transcript.
The sub-headings of the transcript are each followed by the timestamps in the video. Each of the timestamps is hyperlinked to the video on YouTube, so you can click on the timestamp and go straight to the video at that point in the presentation.
There are also links throughout the transcript to the various source materials referred to.
Introduction (00:00)
At the beginning of February, at Trinity Church in Scarborough, we ran an evening event for our church family to look at the whole question of assisted dying. Not everybody was able to be present at that event in person, so we wanted to produce a video version of that teaching and of that resource so that those who couldn't be there in person can access it and can have the opportunity to think these things through a little more clearly.
Just to say, there is an extensive handout that goes with this presentation if you're watching on YouTube. You'll be able to download that—the link to the handout is in the description on YouTube under the video itself. There are a number of things in that handout. There's an outline of where we are going in this presentation, but there are also various cross-references to other links online. Where I'm quoting facts and figures, I want you to be able to see (if you wish) where I get those from. It's important that you can see I'm not just making numbers up, but I'm accessing research that others have done carefully.
And it may be that you want to look into some of the topics we will be considering in greater detail, so perhaps you'd like to follow some of the links to various articles, videos, and other resources that are available online. I'm also planning to put most of the web links to those resources on the screen as we go, so you should be able to follow those links should you wish, without having to have the handout in front of you.
One of the benefits of doing this as an in-person event in the evening was that there were a lot of different Christians in the room with different life experiences and perspectives to share, and it may be that you get the opportunity to watch this with some others, and if so, hopefully, this will spark useful conversation. There are a few points as we go where I will suggest that this might be a good point to pause the video and to chat with those you're watching with or to reflect on your own and then to resume the video and come back into the conversation.
Quotations (02:13)
We're going to start with three quotations. The first is from the filmmaker Woody Allen, who is often misquoted but famously said,
"I'm not afraid of death I just don't want to be there when it happens."
Obviously, he's making a joke, but I think he's on to something, and I think this underlies a lot of what we're talking about here. I think he's saying the thought of being dead doesn't particularly fill him with any fear, but the thought of the process of dying (of going through death) does.
The second quotation comes from an American author, Pearl Buck, who said,
"Our society must make it right and possible for old people not to fear the young or be deserted by them for the test of a civilization is the way that it cares for its helpless members."
Our third quotation comes from the author Aldous Huxley and his 1932 novel A Brave New World. In this book, he imagines a fictitious future in which science has advanced to the point where it can eradicate all pain and suffering and everything is purely and only pleasurable. But then, in the story, at this point, two characters go on holiday and visit what is called in the book "a reservation," an area that has been unaffected by these progresses in modern science, and they encounter somebody who is really old and wrinkly. And they've never seen anybody like this before.
So, Lenina says, "What's the matter with him?"
"He's old, that's all."
"Old? But the director's old; lots of people are old; they're not like that."
"That's because we don't allow them to be like that. We preserve them from diseases. We keep their internal secretions artificially balanced. So, of course, they don't look like that, partly because most of them die long before they reach this old creature's age. Youth unimpaired till 60 and then crack: the end!"
Current Law (04:38)
Let's start by getting clear on what the law currently says. In 1961, the Suicide Act was passed. Previously, before this point, suicide itself was a criminal offence. Now, you might wonder what the point of that is—if somebody has committed suicide, surely there's no interest in prosecuting them for that after their death. But this affected their relatives, who may be accused of helping them, and it also affected those who attempted suicide but then lived on—they could be prosecuted for their failed attempt.
So, in 1961, the law was changed, and suicide was declared to be no longer a crime. However, having said that, there is then an explicit follow-on clause that says that helping somebody else to end their own life does remain a crime. Now, in deciding whether to prosecute someone suspected of assisting somebody else to end their own life, prosecutors are directed, as with most laws, to have regard to evidence—is there enough evidence to secure a conviction?—but also public interest—is it in the public interest to follow this case through the courts and to prosecute?
Interestingly, from 2009 to 2021, a period of 12 years, 167 cases of suspected assisted suicide were referred from the police to the Crown Prosecution Service. Of those, only four made it as far as a court case. One of those was acquitted, and three were convicted. So, in 12 years, there have been precisely three convictions for this. Since 2021, when those stats were published, there has been a fourth conviction.
The current Prime Minister, Keir Starmer, when he was Director of Public Prosecutions, directed prosecutors basically not to pursue these cases unless there was overwhelming evidence and public interest that said it really couldn't be ignored. So, what we're dealing with here is a law that has been effectively disused for quite a long period of time. It may be against the law to help someone to end their own life, but effectively, for some time now, the practical reality in this country has been that those who do so will face no consequences at all.
Terminology (07:17)
Now, we have to get our language and our terminology clear. Here are two definitions that I have pulled—believe it or not—from the NHS website: euthanasia and assisted suicide. Both of these are where someone's life is voluntarily ended as a way to bring an end to their suffering. But euthanasia is where somebody else ends the life of that person—this might often be a medical professional administering some medication to bring their life to a close—whereas assisted suicide is where the person ends their own life but with assistance from somebody else. The crucial thing here is that the person who does it, the person who does the deed, is the person whose life is ending and not somebody else.
Now, what's before the UK Parliament at the moment is variously called assisted dying or assisted suicide. It is not euthanasia. If you listen to the people advocating for this, they will tell you repeatedly that the person who ends their life must be the person themselves—this is not euthanasia. Interestingly, there is a choice of two labels: assisted dying and assisted suicide. Broadly speaking, those who want to see this law passed seem to prefer the label "assisted dying," whereas "assisted suicide" seems to be the label preferred by those who oppose this change.
Now, that's very interesting in itself. Ask the question: which label most accurately fits what is being proposed? Well, the answer is assisted suicide. As I say, we're told over and over again that the person who takes the action must be the person whose life is ending. But which is emotionally more palatable? Well, it has to be assisted dying.
I've taken a great many funerals during the course of my ministry, and the one that stands out more than any other was of a young man in his 40s who died as a result of his own suicide. It was a tragic, tragic occasion—his death and his funeral—and I can remember it vividly to this day. If you've had anybody in your friendship circle or your family commit suicide, you know better than I do just the untold pain that is involved. In addition to the pain of grief and loss, there is, it seems to me, often a sense of shame—a stigma that someone ended their life by suicide.
You can quite see why those wanting to see the law changed in this way in the UK would not want that change of law to be branded "assisted suicide." If you say to a random person on the street, "We're thinking of passing a law that says that a form of suicide is fine," people would say, "We don't want that." But "assisted dying" somehow just sounds more acceptable. So, straight away, the choice of label being used by both sides of this debate helps us to see, I think, that what is emotionally acceptable is being used as an argument to persuade us to change our view more than what is rationally or morally acceptable. This is an appeal primarily to our emotions.
Issues to Think Through (11:25)
Let's have a look, then, at what the issues are before us. What I want to try to persuade us of here is that it's really important for us to seek clarity in this area from God's word, but that as we do so, we mustn't present these issues as simplistic.
So, here are some of the things we need to think through. I don't promise this presentation will give us answers to every one of these.
One question we have to think through is: is it wrong for someone to take their own life? If it is, is it wrong to help somebody else to take their own life? Or, because theirs is the life that gets taken, does the responsibility for what they do rest with them and exonerate the person who helps them?
If you think it is wrong to help somebody else take their own life, does that mean it should be a crime to help someone else to take their own life? There are lots of things, after all, that are sins, but they're not crimes. If you think it shouldn't be a crime to help someone else to take their own life, well, we're not starting from a blank piece of paper, are we? We inherit a country where that is a crime. So then the question is: should it—would it—be right to change the current law to make it no longer a crime? Because the act of changing the existing law itself says something, and is that something good to say?
And even if you decide it is right to change the law to decriminalise assisting suicide, is the way that is proposed in the current Bill the right way to do it? Or would it be right to change the law to allow assisted suicide, but not in the way that is before us at the moment?
That's one whole section of topics—then there are others.
What's the difference between killing somebody and withholding treatment from somebody? And then, what's the difference between withholding treatment from somebody and withholding food or water?
And then here's a really important one. If you've had a dog or cat, sometimes—tragically—the dog or cat develops health issues where the genuinely compassionate, kind thing to do is to take your pet to the vet to be put down. You have the animal put to sleep.
Why is it okay to do that if your dog is sick but not your granddad? What's the difference?
Many, many questions lie before us, and they are far from simple.
Interviews: Esther Rantzen and Kim Leadbeater (14:25)
What I want us to do now is listen to some of the arguments being given to us—why people think the law as it stands should be changed. We're going to listen to two people present their case.
First, we're going to listen to a lady called Esther Rantzen. Now, if you're around my age and grew up in this country, you'll know her well—not personally, but she was a well-known television personality during my childhood, producing what was really good-quality, wholesome television for the whole family to enjoy, largely celebrating people's achievements and their lives. She's a much-loved figure.
But in January 2023, she was diagnosed with cancer and told she had probably six months—twelve at most—to live. She has since begun a campaign to have the law changed to allow people like her to end their own life when the time comes.
So, we're going to hear her being interviewed by two BBC journalists, Nick Robinson and Amol Rajan. Then, we're going to watch an interview with Kim Leadbeater, the MP for Spen Valley in West Yorkshire. She is the Member of Parliament who has brought the current bill before Parliament for debate, and here she is being interviewed on Sky News, explaining why she thinks the law needs to change in the way she is proposing.
Now, this may be one of those moments where, if you're watching with a few other people, having listened to these two clips, you may wish to pause the video and discuss them a little bit. Either way, listen out for three things as you listen to these clips.
What are the rational arguments that we are being presented as to why the law needs to be changed?
Second, what are the emotional appeals being made as to why the law needs to be changed?
And then, third, look out for what I've called false dichotomies. What's that, you say? It's where you're being presented with a choice between two things—you must choose this or this, you need one or the other—but it's a false choice. It's like telling somebody who wishes to lose weight that they need to eat lots of lettuce, otherwise they will gain weight. Well, it may be that eating lettuce can help you lose weight, or it may not—it depends on a whole lot of other things. But it's a false choice: do you want to gain weight, or do you want to eat lettuce? You need to say, "Hang on, slow down—I don't want to do either of those things," and that's fine because it isn't a simple binary choice between two things.
So, just listen to see: are there points in these presentations where you're being presented with a choice that is actually a false dichotomy? You don't need to choose between the alternatives you're being shown. And when you've listened to these clips and had a chance to think about those things, we'll come back, and I'll talk through a few of them.
Nick: Well, let's start with some good news. You're going to celebrate this Christmas, and you were very open with people—you feared you might not be—so that really is a bit of good news.
Esther: "Well, it's very unexpected, and my children are very funny with me because, having decided, Ed, that it would probably be better to tell people the truth when I got the diagnosis back in January, I thought I'd fall off my perch within a couple of months, if not weeks. I certainly didn't think I'd make my birthday in June, which I did, and I definitely didn't think I'd make this Christmas, which I am.
"But when you say 'feared,' I can't remember which famous person—it might have been Woody Allen—said he's not afraid of death; he's afraid of dying. And that's a bit where I am. You know, we've all got to leave this world, have we not? Death and taxes. It's how you go, you know. And my late husband went very well, and my mother went very well, but my dog went better than both of them."
Nick: You talked about your husband, Desmond Wilcox, the famous television producer and presenter, and you made a documentary after he died called How to Have a Good Death.
Esther: We asked you to describe what are the essential elements in a good death.
"Our poll of a thousand people throughout the country told us they are, in this order of importance: to be with your family or close friends when you die, to be pain-free, to spend your last days in dignity, to have privacy and peace, and to be told clearly about your medical treatment and options.
"So, you've obviously given it a lot of thought. What's the answer to the question?"
"Yeah, well, the reason I suggested making the programme to the BBC is that when he died, the doctors around him found it very difficult to stop trying to rescue him. Even when it was quite clear that there was nothing they could do, they kept trying. And this got between us. I mean, they kept testing him and doing this, that, and really, we would have just liked to cuddle each other and be together.
"So, I thought it was worth saying to people: look, there comes a point when, really, what you've got to do is treat people as if they're human beings enjoying the last few precious minutes together—not as if they're a problem you've got to solve.
"So, the answer to your question, which buoys me up a bit in my situation, is that, according to our survey among a lot of people and a lot of families, hospices are really, really good at palliative care. So, if I was going to be cheered up by anything, I suppose that would cheer me up."
Amol: "You know, Esther, on the programme last week—you may have heard it—I did a very brief sort of 90-second mention of something in the context of my own dear dad dying last year. I just said that grief had made me reconsider the appeal of religion. And I'm not particularly religious—I grew up in a religious family, but I'm not myself. I know you have got Jewish heritage. I wonder, since your diagnosis, has it made you reappraise your faith or your religious hinterland? Has it made you think differently about it? Have you even got some consolation from all that?"
Esther: "We don't know what will happen next. We really don't know. So, the thing that cheers my family up is the thought that all the lovely people who I have loved and lost, who have gone before—like my late husband, my parents, my friend John Pitman, and others—will be waiting for me with a cup of tea."
Amol: "There's so much else we want to talk to you about—I'm conscious of time—but there is one thing, just on this subject, that I feel we should get your wisdom on. I just wonder, have you reappraised your own view of assisted dying at all? You had a firm position before—has that position changed?"
Esther: "When I was making the programme How to Have a Good Death, I agreed with whoever I last spoke to, you know, because everybody's got a very good argument for being in favour of assisted dying or against it.
"I am in favour of it because our survey showed that almost everyone, when asked, says yes—people should be given the choice. You're given the choice over so many other things, medical and otherwise—why should you not be given the choice about how and when you want to go?
"And I get all the arguments about not wanting to be a burden and pressure being applied and all that. But, as with dangerous dogs, you can come to the wrong conclusion if you just base everything on the worst-case scenario—you've got to look at the advantages as well.
"And, you know, I have joined Dignitas. I have, in my brain, thought, well, if the next scan says nothing's working, I might buzz off to Zurich. But, you know, it puts my family and friends in a difficult position because they would want to go with me, and that means that the police might prosecute them. So, we've got to do something. At the moment, it's not really working, is it?"
Nick: "Is it your view that you might actually do it, or is it just the comfort of knowing you could?"
Esther: "Well, I think it's both, isn't it? When you look at countries and states where they've brought in limited circumstances under which assisted dying is possible, they say an awful lot of people never use it—because knowing that they could, as you rightly say, comforts people. And then the palliative care works, and they drift away."
Amol: "Can I just ask, on that particular thing, though, Esther—how does your family feel? It's obviously something that all of us who've grappled with these issues keep very, very close to ourselves. But how does your family feel about your joining Dignitas and that being an option?"
Esther: "My family say it's my decision and my choice. I explain to them that, actually, I don't want their last memories of me to be painful. Because if you watch someone you love having a bad death, that memory obliterates all the happy times, and I don't want that to happen."
Interviewer: Just give us a quick snapshot—why do you believe in this bill?
Kim: I think, for me, as a parliamentarian, we have a duty to fix things that aren't right. If I look at the status quo in terms of the law around end-of-life choices for people, it's not fit for purpose. We've got people who are having harrowing, horrible deaths because, even in some cases with the very best palliative care, their needs cannot be met. We've also got people who are taking their own lives in really tragic circumstances, and we've got people who do have the choice of assisted death but only in a different country—so, if they can afford to spend thousands of pounds travelling, and often doing so prematurely while they're still well enough to do so.
If we look at that situation, in which there is no real legal framework around it, that can't be right. I think we have a duty as legislators to fix that situation.
And then it would also go via the High Court as well, yes—so two doctors would be involved in the process. What I've tried to do with the bill is build layers of safeguards and protections because I understand this would be a huge change to the law. Two doctors would be involved, working independently, and there would be a High Court judge. That wouldn't just be a tick-box exercise—the judge would speak to the doctors, be reassured that all the processes had been followed, and always check in with the patient. The doctor could speak to the patient if they wanted to, and at any point, the patient can change their mind.
So, there are lots and lots of layers of safeguards and protections, which I hope reassures people that we're solving the problem we need to solve. Because, at the moment, there are no safeguards—we don't know if people who are taking their own lives are being coerced, and we don't know what's happening to people who are going to different countries. By putting that legal framework around it, it will actually create a much more robust situation.
Interviewer: Earlier in the show, we played Ashish Joshi's report on this, and one thing that really struck me is this aspect that it has to be self-administered. Why is that?
Kim: Well, there's a very clear line between the bill that I'm proposing and euthanasia—someone else doing the deed. This bill is about autonomy and choice, so it has to be the decision of the individual, and it has to be the act of the individual. I think, again, that just creates that extra level of safeguards and protections for anyone who might have concerns about the bill.
Interviewer: "Quite sort of brutal to self-administer?
Kim: Well, by the time the patient gets to that point, they've gone through a huge process of thinking about whether this is what they want to do, and also, they can change their mind at that point if they want to.
Actually, the experiences that have been described to me—it's not a brutal process. It's actually a compassionate process, with loved ones around you. And that's the kind of death people want, rather than—as I've heard many stories—hours, sometimes days, of people choking to death, vomiting, and, you know, horrible, horrible circumstances. All that these people, who have got a very short period of time left to live, want is that choice.
Interviewer: And the Justice Secretary saying, quote, ‘I feel that once you've crossed that line, you've crossed it forever,’—that sort of principle and the slippery slope argument
Kim: Well, I'm good friends with Shaban, and I fully respect her position. She has said, as a person of faith, as a Muslim, this isn't a piece of legislation she would be able to support, and I respect that. But I have also had conversations with people of faith who have said, ‘Actually, even though I might not choose this, who am I to stop someone else having that choice?’ And those are actually some of the most powerful conversations I've had.
So, within the Cabinet, there are a range of views. The Prime Minister has been very open about his view on the issue, informed by his work as the Director of Public Prosecutions, seeing the failings in the current legal system. And there are views—there are other people within the health team, Karen Smith, who's campaigned on this issue for 20 years, and he's fully supportive of a change in the law. So, there are mixed views, as there should be and as I would expect within Parliament and on a cross-party basis as well."
Analysing the Interviews (28:30)
Welcome back. I wonder what you made of those two presentations. Here are some of the rational arguments that I noticed and that people in the room noticed.
When we ran this as an in-person event, Kim Leadbeater was very keen to stress that what’s being proposed is not euthanasia. This is not somebody taking somebody else’s life; this is about you having control over your own. Esther Rantzen said that she found herself most persuaded by whoever it was she spoke to last. That suggests that she doesn’t want us to see assisted dying as a matter of right and wrong; rather, different people will have different perspectives, and each person should be allowed to do as they choose.
That relates to Kim’s point that she spoke to a number of faith leaders who were supportive. Their argument was that they wouldn’t wish to do this themselves, but they see no reason to stop other people doing what they wish to do. And then there’s the argument that this is an opportunity to end someone’s suffering. You remember Esther Rantzen talking about what she looks forward to and what she thinks this could lead to. She looks forward to this great reunification with all of her friends and family.
Now, I’m a firm believer there will be plenty of cups of tea to be had in glory, but it’s interesting, isn’t it, that her argument only works if there is no afterlife? She very clearly said, “We don’t know what comes after death.” Well, as Christians, we do know what comes after death, because Jesus has himself returned from the grave to come back and tell us so. We’re not in the dark. The argument that this is the opportunity to end someone’s suffering and to reunite them with those who have died before only works if you don’t believe that.
There are some of the rational arguments; here are some of the emotional ones. Esther Ranson’s dog. My mum died a good death. My husband died a good death. My dog died better than both of them. She’s saying, isn’t she, do we really want human beings to have a worse death than our pets? It’s very powerful. Could you realise that what she’s actually saying is she wants to be treated the way we would treat a dog? I’m not sure that’s quite what we want.
Then there’s the whole appeal to our personal choice. I think this is an emotional rather than a rational argument. Esther was very clear to say this is all about giving people the choices they want to make, the ability to make their own choices about where their own life goes. Kim said several times this is about giving people autonomy, giving people control over themselves.
Why do I say this is an emotional rather than a rational argument? Simply because it’s so appealing, the idea of being in control, of being free to make choices. That appeals to us so deeply that who could possibly deprive somebody of the right to make their own choices? It’s very hard to argue against. But we’ll meet that same emotional appeal in another clip of Esther’s, we’ll listen to a bit later on, where she talks about some countries that have already legalised assisted dying as being more free. It’s the same thing, isn’t it? Which kind of country would you like to live in: one where you’re free or one where your freedoms are curbed? Well, of course, you choose to be in a free one. It’s a very powerful emotional argument, and it relates to Kim’s point that at any point down the line, someone can change their mind.
When she’s asked by the interviewer, “Is it a bit brutal to have to administer the medication yourself that will end your life?” she says, “Well, you would have thought about this a great deal before you get to that point, but even at the last minute, if you wish, you could change your mind.” Of course, you could. But her point, her emotional point here, is that right to the very end, until you swallow those tablets, you are in control.
And then there’s the emotional point I’ve heard articulated many times by many people in this debate: the fear of prosecution for people’s relatives. If Esther wants to go to Switzerland to end her life there, she would love to be accompanied by her family and friends. But if they went with her, they could be arrested when they land back in the UK and accused of helping her.
Now, I highly doubt it would be in the public interest to do that or that there would be enough evidence to prove that they didn’t just accompany her, they actually helped. But you can see the emotional appeal. Do you want to die alone?
And then, here are some of those false dichotomies.
First of all, what makes for a good death? We got a picture of that from Esther's survey in the documentary she made, and we get that in Kim's description of dying well—being comfortable, being free of pain, and being surrounded by those you love. If you want to have a good death, how do you get there? They're both implying that, in order to get there, you need to have the option of this assisted dying provision; otherwise, there's no guarantee that you will have that kind of good death—completely ignoring the fact that what they've both just described is precisely the kind of care that you would get in a hospice and in other environments as well. It's a false choice.
We were also presented with a false choice over what looks like a bad death. Kim described some of the horrible deaths she has seen people enduring—choking, vomiting—"It's terrible," she says. So, you don't want a bad death, and to avoid that, we need this assisted dying provision. The problem with that is it's actually a false dichotomy on both sides of that coin. If you don't have the provision of assisted dying, it doesn't at all mean that you will have a bad death. It is a myth that most deaths are inherently painful and accompanied by a great deal of suffering—it just doesn't need to follow. It's also a myth that the kind of assisted death we're being told to legislate for will be free of pain and suffering.
In fact—and I owe this insight to one of our doctors at church who shared some research with me on the different drugs that are taken—most people assume that if you take some kind of lethal medication, as we're talking about here, you would die within seconds, nearly instantaneously. A voice from the floor, when we ran this event a few weeks ago, made the same assumption. The reality, for the most common drug, is that 40–60% of people take longer than an hour to die. The average is either two to three or three to four hours, with a sizable percentage taking over six hours to die.
What's more, the human body knows that these medications are extremely bad for you, so your body does all it can to expel the medication that you're trying to take. This means that an assisted death is frequently accompanied by a great deal of choking and vomiting. It's a false dichotomy.
Esther said, did she not, that if you die that kind of bad death, it will obliterate all the happy memories that your loved ones had? "You don't want them to remember you like that." But I've spoken to many people who have had family members die some time ago—enough time has passed, and it's less raw—and they're happy to talk about their memories and experiences. Almost universally, people remember the many happy times, and the tragic close of life is just a blip in the life they enjoyed with the one they loved. It's just a false choice.
Then, we were presented with a false choice in the whole area of safeguards. Kim said the current system is broken—it doesn't work. At the moment, she argued, there are no safeguards as to how people end their lives, where they go, how it happens, and so all kinds of abuses could be possible. So, she says, by passing this law for assisted dying, we will ensure there are proper safeguards in place to make sure the end of life is not handled irresponsibly.
But again, that's a false choice, isn't it? First of all, if you think the current safeguards—whatever she's thinking is a gap—is missing, then there will be other solutions to that besides what's on the table before us. And then, the other thing to say is that, as we will see later on, what's being proposed itself has a serious lack of safeguards. So, to say, "If you want to have safeguards in how people's lives end, you need this legislation and not what we have at the moment," is a false choice.
And then the last one—the last false choice I noticed—is the false choice about the role of medical intervention as someone reaches the end of their life. Do you remember Esther saying that the doctors couldn't stop trying to keep her husband alive, and actually, all they wanted was just a cuddle and to spend some time together? As if, once you bring doctors in, the only thing they will do is interfere and unnecessarily prolong someone's suffering and life.
That is a caricature of what doctors should be doing. If that was their experience, then they did not experience good medicine. There are other ways for doctors and healthcare professionals to help people at the end of life, as we will see later on.
I wonder what you noticed there—reasoned arguments, emotive appeals, false choices? Here's something else for you to think about, and we'll come back to this. Just think for a moment about the various needs that we're being told exist—the needs that mean the law must change.
It's just worth asking the question as we think about exactly what's being proposed: Will what's being proposed here address what we're being told are the problems with the way things work at the moment? Or is there an element of false pretences about all this?
We're being told that the current system is broken, so something must change. But then, for that reason, we go ahead and make a series of changes that don't actually address the problems that we're being presented with. We'll come back to that.
Process in Parliament (40:16)
So, where are we in the process?
What we have before us is what's called a Private Member’s Bill—that's where a Member of Parliament gets the opportunity to present some potential legislation for debate, rather than the government itself. This was proposed by the lady we just saw on Sky TV—the Right Honourable Kim Leadbeater, MP for Spen Valley in West Yorkshire.
There's a slight catch with Private Member’s Bills. In a typical parliamentary year, there are 13 Fridays of parliamentary time given over to debating Private Member’s Bills, meaning there is less time in the House of Commons for scrutiny and debate than there might be for government legislation.
That Bill had its first reading on 16 October 2024 and its second reading on 29 November 2024. It passed, with 330 voting in favour and 275 voting against. That agrees to the principle that this is something the House of Commons would like to see become law.
So next, it's time to debate the exact details of what that will look like. That means it enters what's called the committee stage, where a committee of MPs meets on multiple occasions to debate and discuss every single paragraph and line of that legislation, getting the details right. They will hear from various witnesses with different specialisms to feed into that debate.
That process began on 21 January 2025. So far, there have been 11 sessions of that committee, with another one scheduled for today, as I film this.
As that process reaches a close, it then enters what's called the report stage, when the committee reports back, followed by a third reading in the House of Commons. If the House of Commons then approves what’s before them, it goes to the House of Lords, who will debate it. Then, you get a process called "ping-pong," where the law passes between the Commons and the Lords, each side requesting changes, until both houses agree. At that point, it becomes law.
We still have some time to go, though this time is about getting the details right, not deciding whether to go down this road.
As this happens, do pray for Christian MPs involved in all of this.
Just to give you one little example, I watched a little bit (watch from 15:44:03 to 15:48:44 for a taste) of the very first of those committee stage sessions, and what they were debating there was exactly which people should be brought in to address the committee and give professional statements of assessment. There's a committed Christian MP who's on that committee—an MP called Danny Kruger, who is the MP for East Wiltshire—and you just get to watch as he has to push and push to make sure that some of the voices heard by the committee are those who can expose some of the potential problems with what's before us and not simply smooth those over as if they're not there.
Anyone who's sat in committees knows that very few people enjoy committee meetings. It is just painstaking work for people like Danny, sitting through these committees, pushing their angle, and keeping their research current. It's a thankless task, and there are Christians really working hard to try to ensure that the very best outcome they can achieve comes from this—so do pray for them.
Well, what exactly is on the table? Here is the summary of it. On the handout, you will see Parliament's own sort of briefing—three paragraphs long—but I've distilled out of that the heart of it.
We are talking about something for adults who are terminally ill and, in particular, have a maximum of six months left to live. They must have full mental capacity, so they are making their own choices about the end of life. Those two things—six months to live and mental capacity—will be assessed by two different doctors or medical professionals. There's a little ambiguity as to whether these actually need to be fully qualified, registered, and practising doctors or whether other medical professionals will qualify.
Once both doctors have signed off, the original proposal was that this would then go before a High Court judge—you heard Kim talk about that in her interview a moment ago. Interestingly, since running our in-person event on this, the goalposts have shifted. She's heard the feedback that the legal system is currently overstretched and that the judges and the courts don't have the capacity to hear all of these cases. She can see that there's a risk the bill could fail if it puts too much weight onto the courts.
So she's now proposing to amend the legislation so that, instead of there being a High Court judge, there will be a panel of three people—a more junior legal professional and then two other professionals, such as social workers, who can comment. This panel of three she's calling "Judge Plus." It's being presented to us as offering even greater scrutiny than that of the High Court judge we were first told about.
However, as one journalist pointed out, that's a little bit like saying that your appointment with a hospital consultant with a specialism that you need is now going to be replaced with a panel of three first-aid volunteers—and we're going to brand that panel "Doctor Plus."
After the legal professionals—whatever form that takes—sign it off, there's then a 14-day cooling-off period. Then you have to go again to one of the two doctors you saw the first time and ask them for a prescription for the drugs that you will take to self-administer.
That's what's on the table. Let's just be clear, though: what we're talking about here is physician-assisted suicide. This is not just anyone being able to assist you with your death; it is specifically medical professionals and doctors assisting you by prescribing the medication that you need after conducting these various checks to make sure that you're suitable for that.
Now, to return to something that we said earlier:
Let's consider the needs that were being presented as to why the law needs to change, and then let's ask whether exactly what's being proposed here addresses those needs or not. We've thought about what the law currently says, we've heard the appeal as presented in the media as to why the law needs to change, and we've outlined what exactly is being proposed.
Perspectivalism (47:46)
To assess what we think of all this, I'm going to draw on the thinking of a theologian by the name of John Frame. He's developed a model of thought that he calls "perspectivalism." He's got a book-length treatment of that, but that might be intimidatingly long. However, there's a really helpful short article that gives you a basic layout of what he means by perspectivalism, and I commend that to you.
He's basically asking the question: how is it that finite beings like us can know anything that is actually, meaningfully true about God? Indeed, how can we come to know anything at all? To do that—because we are finite and we cannot see anything from every angle all at once—we need to look at things from multiple perspectives.
He then wrote another book called The Doctrine of the Christian Life, in which he applied his perspectivalism to the subject of Christian ethics, and that's where we're going with this now. I'm going to vastly oversimplify everything that John Frame says and say that, in order to look at an issue like this, we need to look at it from three perspectives.
We need to look at the consequences: if we go down a particular path, where will that lead? If something leads to a good outcome, it's a good thing to do; if it leads to a bad outcome, we don't want to do it.
We have to look at the context: we have to ask who the people involved are, what the situation in play is, what is actually happening on the ground, and what the complexities of real life are—so that we're not just dealing with abstract theory.
And then we have to ask, what are the commands? That is to say, what does the word of God say? How does God directly speak into this situation?
Now, here's the really important thing about this: these are three perspectives on the same situation and the same choices. So when we've looked at these perspectives properly, we're not going to find, for example, that God's commands say something is a bad thing to do, but the consequences suggest it's a good thing to do—so we have to decide if we are "command people" or "consequence people." No, that's not the idea at all.
The idea is that either it's a good thing to do, or it isn't. As we properly look at it from all of those perspectives, we'll see that all those perspectives speak to the same conclusion. They are perspectives not just on the issue, but on the other perspectives, if I can put it that way.
We see the consequences more clearly by looking at the commands. We see the commands more clearly by looking at the consequences, and so on. What we're trying to work out—whatever ethical issue it might be—is what decisions, what choices, best fit all three perspectives and take best account of all the data before us.
If you only consider one perspective, then you will have a very stunted conversation, and you'll reach some very poor and superficial conclusions.
So what we're going to do is look at each of these perspectives in turn, knowing and trusting that these won't lead us to contradictory conclusions, but that each perspective will contribute to our ability to see things clearly.
Commands - Biblical Examples (51:39)
Well, let's start by looking at the commands. Let's get our Bibles out and see what God has to say about all this.
The first thing to say is I've not found any examples in the Bible of what we're talking about before us—assisted suicide. There are examples of suicide in the Bible.
1 Samuel 31 is the death of King Saul on the battlefield. As he realises he is injured by the Philistines to the point where he won't recover, and he fails to get someone to kill him, he basically falls on his own sword and then bleeds out.
Matthew 27 tells the story of Judas Iscariot, who takes his own life, having betrayed the Lord Jesus.
What's striking about all these examples of suicides in the Bible is that the Bible narrator doesn't particularly make any moral comment on the suicide itself. Now, frequently, we're dealing with characters that we may already know from the narrative are not role models for us. We're not meant to emulate Judas Iscariot or the Old Testament King Saul, but the suicide itself simply passes without comment.
We need to be very careful using narratives to construct our sense of what's right and wrong because narrators record what happens, often in such a way as to give us the understanding of what the narrator—and therefore God—thinks of what happens. But we can never draw the simple equation that because something happened, it's good, or because something happened, it's bad. So, we are just presented with these examples.
There's one example in the Bible of euthanasia, which is in 2 Samuel, chapter 1, and, interestingly, that is also King Saul. Having, uh, taken his own life on the battlefield, he didn't die straight away. Another man comes across King Saul, sees that he's not going to last the day, and so Saul asks him to finish him off. The chap is more than happy to oblige and then runs to King David to tell him that the predecessor, King Saul, is now dead.
He thinks he's bringing David good news, but in fact, David says, "Your own words have condemned you. You have taken the life of the king—the Lord's anointed."
Now, what's really interesting about that is that here was somebody—King Saul—who was going to die anyway. Never mind six months; he was going to die that day. The man who therefore finished him off thought that the fact that Saul would die anyway gave him an excuse—it was okay to kill him. But in King David's mind, the fact that he was going to die anyway was no excuse and did not justify this man taking Saul's life.
So, there are only a few examples of suicide and none of assisted suicide.
Commands - Taking Life (55:26)
Let's have a look at the rights and wrongs of suicide. When it comes to this, there's a long school of thought in Christian thinking that sees suicide as self-murder. This goes back to Augustine, (if following the link, it's section 1.20 - search for "That Christians have no authority for committing suicide in any circumstances whatever") a bishop in part of Egypt in the earliest centuries of the Christian Church.
Suicide is taking the life of another person—it just happens that the life you're taking is your own. But it's still murder; it's taking someone's life—your own. So, the first place we have to start is actually to ask, well, what's wrong with taking someone's life, whether that's yours or someone else's?
Bearing in mind as we look at this, on this occasion, we're talking about taking your own life. The biblical teaching against murder goes back to Genesis, chapter 9, just after the flood in the time of Noah.
Now, the background here is that up until this point, the human race has only been given plant matter to eat—fruit and vegetables. From the flood onwards, God allows his people to eat meat as well. But God says to Noah that he cares deeply about animals—about the way they're treated, about the way they're killed—and, in particular, God cares about their blood because their blood symbolises their life. We talk about "lifeblood"—the blood pumping around their veins is the animal's life. So, the way you shed animal blood matters to God.
Against that backdrop, God says these words to Noah:
"Whoever sheds human blood, by humans shall their blood be shed; for in the image of God has God made mankind."
God is saying that whenever human blood is shed, his justice requires that the person who took that life should forfeit their own. Why? Because, he says, human beings are made in God's image.
Zebras, kangaroos, and goldfish are all part of God's good creation, but only human beings are made in the image of God. Therefore, to take the life of another human being is to do the most serious thing, and the only consequence for that is for the life of the murderer to be forfeit.
Now, this is really interesting because it shows us two things.
The first thing it shows us is that killing a human being is more serious than killing an animal. So, here is the answer to one of those questions we started with: why is it okay—well, not okay, it's never good, it's always painful—but why is it sometimes the right thing to do to put down a pet but never to do the same with an elderly relative?
And the answer is: your elderly relative is made in the image of God, with all the dignity that comes from that—so, very different from a dog.
But the other thing we notice here is that the person who does this—their life should be shed—which tells us that God's command not to murder is not simply saying, "Don't kill." There are circumstances when taking the life of another human being is the right thing to do.
So, "Do not murder" means do not take an innocent life—do not take a life that God doesn't say should be taken. But it's more nuanced and more subtle than simply saying, "Do not kill."
Actually, this particular example helps us to understand the situations when it might be right to take another life, because what's happening here is that this is justice and deterrence for the life that's already been taken.
So, actually, the reason why the perpetrator's life should be taken is precisely because this will protect the sanctity of life in human society. To protect the life of precious human beings, sometimes God says the right thing is to take a human life.
Commands - 10 Commandments (59:11)
Next, we're going to consider the Ten Commandments. You find them in Exodus, chapter 20, and in Deuteronomy, chapter 5.
I shall put them on the screen for you as well. Maybe just take a moment to pause the video at this point and look down that list of commandments, and ask yourself: which of these commandments would be broken through the act of assisted suicide?
Just take a moment to think about that, and then we'll carry on.
I wonder which commands you thought were broken through assisted suicide. The obvious one is "Do not murder," but there are others.
Let's take it from the top:
You shall have no other gods but me.
It is God's role to take life; it is God's role to give life. To be God is to be the one from whom all animal, human, and plant life derives its vitality—its livingness. God is the living one, and others live because of him.
There are areas of being made in the image of God where part of being in his image is that we seek to do the things that God himself does. We are creative people; we look after, sustain, protect, and care for the world we live in, and so on. But the authority to give and take life is not something God has delegated to the human race. To set yourself up as the one who decides the time of your own death is to take from God a role that properly belongs only to him—it is to create another god.
You shall not make for yourself any graven image.
This command is often misunderstood. It does not refer to having other gods or to worshipping the wrong god. This command refers to worshipping the right God—the true God—but in the wrong way. In particular, in its original context, this refers to using visual images in our worship of God.
It's not immediately obvious how this relates to assisted suicide, but we need to probe a little more carefully. Why was it, in the Old Testament, that worshipping God through the use of images was forbidden? If you read the early chapters of Deuteronomy (Deuteronomy 1:5), you will discover that God did not show his people at any point what he looked like. Instead, they heard his voice. God says, "You saw no form; you heard only a voice. Therefore, see to it that you don't make any image."
We do not know what God looks like, so every time we make a visual image of God to help us in our worship, we are using our imagination. God says that imagination will supplant the word of God from our minds.
So, the command not to make images isn't really about saying, "When you teach the children's groups during your Sunday morning service, don't use any pictures to help them understand the Bible story." That's not really what it's about—although we need to think carefully about how we do that rightly. It's really about ensuring that our understanding of God and his ways is not moulded by what we think God is like, but by what he has said.
Now, when unbelievers say we should legislate for assisted suicide, they don't worship our God, so it's understandable why they've come to those conclusions. But if Christians start to argue for this, I want to show you in this session that the only way to do so is to close our Bibles and say, "I don't like to think of God as someone who would want somebody to continue in their suffering. I like to think that God would want their suffering to end more quickly." And so, we disregard the commands of God—his words—in favour of the way we think God should be. That is to make an image of him.
I'm struggling to see how commandment number three is broken—let me know if you think of one.
But number four—honour the Sabbath day by keeping it holy.
When we had an in-person gathering on this, someone suggested that you might break this command if you go about your assisted death on a Sunday. I like the idea, but I don't think that's it.
If you read Hebrews chapter 3 and Hebrews chapter 4, you will discover that the rest God gave the Old Testament people in the land of Canaan was really just a shadow of the real, eternal, lasting rest that God has for us. The promise of Sabbath rest for the people of God still remains, and the invitation is still there for every human being to come to the Lord Jesus, who will give us rest.
Ultimately, when we die, we enter into what that great pastor of centuries past, Richard Baxter, called "the saints’ everlasting rest." That is the rest God holds out to his people and invites us to join him in.
If, as you near the end of your life, you decide that life in this tent of a body—as Paul calls it in 2 Corinthians—is unpleasant and uncomfortable, and you desire a shortcut to get straight to glory, bypassing God's purpose for you to get there in his own time and way, then that is to try to enter God's rest through your own effort, in your own way, rather than trusting the Lord Jesus to give you the rest he's promised as he redeems you. And so, we break the fourth commandment as well.
Honour your father and mother.
There's a long-standing school of thought in the Christian world that sees this command as not just about how you treat your biological parents, but how you treat other groups of people—generations past, and those who are simply older than you in society: your elders.
So, this command tells us to honour those who have gone before us in following the Lord Jesus through life. We should honour them and treat them with the utmost respect, which is not what we do when we end their lives.
Another command I'm struggling to see the connection with is the seventh commandment: "Do not commit adultery." Again, let me know if you think of a connection there.
But the eighth commandment—"You shall not steal."
We've been thinking about how our life belongs to God. We belong to God, and so, to end a life is to take something that is God's from him.
"You shall not bear false witness."
This may be a little tenuous, but I think there is something in the use of language here—just the language of "assisted dying" versus "assisted suicide." There's something about how we deal with all of this that feels like we're engaging in some dishonesty, in part. So, maybe there's something going on there.
But there is definitely something with the tenth commandment: "You shall not covet."
You shall not covet what belongs to your neighbour.
So, there you are, suffering with some illness—some health issue that won't go away. Yet, your next-door neighbour, your work colleague, or someone else in your family doesn't have the ailments and struggles you have. How tempting it is to covet—to wish you had their lot in life, to wish there was a way not to endure the suffering, pain, and hardships that the Lord, in his wisdom (for reasons we don't understand), has allowed us to endure.
You shall not covet.
So, I think what we're talking about here breaks seven, maybe eight, of the Ten Commandments.
Commands - The Vulnerable (01:08:34)
There's another strand of the Bible's teaching we need to engage with, and that is a whole load of passages that speak to how the Lord's people care for those who are most vulnerable and fragile.
There are texts about how we look after widows. In Old Testament times, widows were no longer provided for by their parental home, and the husband who had pledged to care for them had died. So, they were all on their own—vulnerable and fragile—and God's people were called to care for them.
That teaching is echoed in the New Testament as well, in James 1, where orphans (as in some Old Testament texts) are also identified as a group deserving special care and attention.
The elderly are generally worthy of the greatest respect—something we've already thought about in regard to the fifth commandment. But that principle is taught in a number of places.
Then there's this verse in Leviticus, chapter 19, where God tells his people:
"Do not curse the deaf or put a stumbling block in front of the blind, but fear your God."
The blind and the deaf can't see what's coming, so you can say what you like, do what you like, and they can't push back against you in any way. But God says the fact that they can't defend themselves doesn't give you a pass to mistreat them—it means you should be especially courteous and kind towards them.
There's a consistent message here that those who are the most fragile and most vulnerable should be cared for the most. One of the things that is concerning about this proposal for assisted dying is the way we are treating those who are at their most fragile and vulnerable—those who are in great physical pain, those battling incurable sicknesses, those who are depressed or struggling in other ways. How do we respond when people like that are in our society? We should do the very best we can to make sure they are loved, cared for, and cherished, and simply giving them a way to end their life does not treat them in that kind of way.
Commands - Suicide as Sin? (01:10:56)
So, we've reached a bit of a conclusion as we ask the question: is suicide sinful? I think everything we've looked at today says yes, it is, and therefore suicide with help from somebody else also would be sinful. But just as we say that, there's a really important thing we have to say, which is that suicide may be a sin, but it's not an unforgivable sin.
The reason we need to say that is that there are some strands of Christian thought that classify sins into two kinds. There are the ordinary sins that we all commit every day, and then there are the really serious sins—things like murder. These are so serious that they impair your relationship with God until you take steps to put things right. The thinking goes that suicide is self-murder, and therefore the person who commits suicide has committed one of those sins that fractures their relationship with God, temporarily leaving them unforgiven. But because that's the last thing they ever do, they don't get the opportunity to make amends or put things right with God, and therefore they die alienated from him.
For some Christians, this leads to the argument that suicide is inherently an unforgivable sin. Let me say—that is totally wrong. We all sin in many ways, and if you are a Christian, if you know and love the Lord Jesus Christ, then you are united to him by faith. That means all your sins—the things you've done wrong in the past, the things you're doing wrong in this moment, and the things you will do wrong in the future—are forgiven. Every single one of them. Therefore, the fact that committing suicide doesn't leave you time to repent does not mean that you're unforgiven, because God forgave that suicide the moment you put your trust in the Lord Jesus Christ. In fact, he forgave it when Jesus died on the cross and applied it to you as you turned to him to trust and follow him, receiving his grace and loving mercy.
So, suicide is sinful, but it's not unforgivable.
Commands - Cannot be Voluntary (01:13:26)
There is one more thing to say before we move on from the commands to look at the context. We've been looking at God's commands as taught in the Bible. Those advocating for change may not agree with those commands, which is a problem, but we mustn't think that means they have no commands at all. In fact, there is much common ground between those pushing to see the law changed and Christians who derive their authority from the Bible.
In particular, there are two distinctions that those pressing for change would say are very important, and that we as Christians would entirely agree with.
Firstly, we need to be clear on the distinction between assisted dying and involuntary euthanasia. You'll remember that euthanasia is when someone's life is ended to alleviate their suffering, but the person who dies is not the one who takes the life—somebody else does that for them, perhaps a medical professional. There is voluntary euthanasia—this is essentially the way assisted suicide is carried out in some other countries, where somebody wishes to end their own life, but somebody else does it for them. There is non-voluntary euthanasia, where someone is not able to give informed consent—perhaps a child or someone in a coma. But then there is involuntary euthanasia, where somebody is euthanised against their will.
We need to be really clear that the assisted suicide being talked about here is not involuntary. The person's choice is key—their life is being ended because they want that to happen.
Secondly, we need to be clear on the distinction between assisted suicide and any suicide. We're not proposing here to legalise suicide in every situation and for all cases. So, while the person's choice may be important, it is not paramount—more is needed than simply that the person wishes for their life to end.
I want to show that it is not possible to achieve both of those things. It is not possible to devise a way of having assisted dying that both holds on to the individual's free choice and ensures that we don't legalise all forms of suicide at the same time.
Let's start by looking at the distinction between assisted suicide and any and every kind of suicide. The only way you can maintain that distinction is by saying there needs to be some objective assessment of whether a particular person has reached the point where their life is essentially over anyway. Someone in that position, you say, is permitted to end their life, but not anybody else. That can't just be subjective—someone feeling that their life is not worth living—it needs to be an objective reality that this is where this person is.
The current legislation being proposed would say the criteria are that a person has only six months left to live. But there are other versions of that that you could offer. Whatever it is, you have to come up with some definition of a life that is no longer worth living. That distinction between any suicide and assisted suicide in these particular cases depends on that definition.
Now, what's the problem with doing that? The problem is—what do you then say about somebody who meets the criteria of a life that is no longer worth living but does not wish to end their life? Logically, they should be able to, but actually, it's worse than that. Logically, they should end their life. Their life has no value; their life is objectively deemed to be no longer worth living. Yet, for them to continue life beyond that point requires them to keep drawing a state pension, perhaps receiving other benefits. Their sickness may mean they have occasional residential stays in a hospital, using up beds that somebody else might need, at great expense.
Morally, if this person's life is objectively not worth living, how can they justify using those resources and taking them away from somebody else? If the logic of this position is correct, and this person's life is no longer worth living, such people ought to die. It would be morally wrong for them to continue living beyond that point.
Therefore, as you try to maintain the distinction between any suicide and the kind of assisted suicide we're talking about, it leads to the collapse of the distinction between voluntary assisted suicide and involuntary euthanasia where lives must go whether the person wants it or not. Paradoxically as you try to preserve the conviction that it's all down to a person's choice, you actually end up eroding people's choices.
Context - Hospice (01:19:07)
So there are our perspective on the commands. Our second perspective is to look at the context. To help us to do that I would like to introduce you to three people.
So, I've come to visit Ben and Penny, who are a doctor and a nurse and a part of our church family here in Scarborough. They both work at the hospice here in Scarborough, and I thought it would be useful for us to hear a little bit about them, their work, and some of the people they meet, to set some context for the things we're talking about.
James: So first of all, perhaps it would be really helpful if you just introduced yourselves and talked a little bit about what your job is and what it entails— that kind of thing.
Penny: So, I'm Penny. I'm a staff nurse on the inpatient unit at St Catherine's, and I work there along with a multidisciplinary team. There are doctors, nurses, physios, OTs, and social workers, and we look after the patients who come to stay in the hospice. We look after their families as well—it's not just about looking after the patient, it's their family too.
We care for patients for a period of time. Some patients come in for symptom control, so they might stay in the hospice for a few days or weeks and then go back into the community. Others choose to come and stay for the end of their life and come to die in the hospice.
Ben: Yeah, and I'm Ben. I work as a speciality doctor at St Catherine's Hospice. I am a GP by background, but I mainly work at the hospice now. My role entails a combination of working in the community with patients and also working in the hospice.
On the community side of things, I visit patients at home, speak to GPs on the phone, and give advice around medications and difficult symptoms to manage. Some of the more difficult symptoms we come across are problems with pain and issues around nausea and vomiting—those are the most common areas people ask about.
I also work on the inpatient unit, managing patients when they've come in to stay with us. Some of those patients will be new to me, and some I will already know from having worked with them in the community before seeing them on the inpatient unit.
And do inpatients in a hospice tend to be just people at the end of their life because of various forms of cancer, or are there other illnesses that might lead to someone coming to a hospice?
We accept patients with any terminal diagnosis. About three-quarters of our referrals are for cancer patients, and that matches up quite closely with the proportion of patients who come through to the inpatient unit. Usually, about three-quarters of our patients have cancer. Some patients may have neurological diseases, heart failure, or chronic breathing problems—those are some of the other conditions we see.
James: That's helpful. So, perhaps talk to us about some of the pressures that patients might be experiencing, or that relatives, carers, and friends might be feeling. What are some of the things that worry people, and how are you trying to help at that level?
Ben: I would say, and this might sound a little obvious, but one of the things people are concerned about is just the reality of dying. That’s something that worries some people. But more commonly, people are anxious about particular symptoms—especially the worry of dying in pain or gasping for breath. That’s a phrase people often use with me—they’re afraid of being short of breath at the end.
I recently had a patient who came to see me in our outpatient clinic. She wasn’t in significant pain at the time, but she had spoken to her oncologist, who had used the phrase “excruciating pain” as a vague possibility for the future. She had really latched onto that phrase and was terrified that she was going to die in pain. We had a consultation for about an hour, talking about pain, all the different options, and the possibilities for managing it. I think her mind was put at rest because there are so many options available. But she had really fixated on that phrase, and it had caused her a lot of anxiety.
James: And how far can you help with pain? Are there levels of pain beyond which you can’t help, or are most types of pain manageable?
Ben: I think almost all pain can be managed. I wouldn’t say that every single person is completely pain-free— that would be a little false of me—but the vast majority of patients we look after are comfortable. If they’re not completely comfortable, then I would say we can significantly help their pain. So, this concern that people have about dying in agony is just not something we see in reality.
James: And what about pressures on relatives? What worries do they tend to have?
Penny: One of the most common worries for relatives is about symptoms, of course, but one particular concern is that, as people near the end of life, they tend to lose their appetite and don’t want to eat or drink. We recognise that in the hospice, which is why we offer food when people want it, in small portions, and tailored to their preferences. But for families, this can be really distressing—they worry that their loved one is starving to death. That can be really hard for them.
Another thing families find difficult is not knowing when their loved one is going to die. We can recognise signs and symptoms that someone is nearing the end of life, but we can’t say for definite whether it will be in a certain number of days or hours. That uncertainty is really difficult for friends and family, especially when they have other responsibilities—jobs, other relatives to care for—but they also want to spend as much time as possible with their loved one. It's just really hard not knowing.
Obviously, part of life in a hospice is about helping people make the most of whatever time they have left. How do you help with that? Are there activities or ways to fulfil unfulfilled ambitions?
Penny: Yes, absolutely. The idea that you can’t have quality of life in the last weeks and months is just not something we see in reality.
For example, we had a patient who went to a fair at the hospice with her partner. While she was there, she was in a wheelchair, but she was able to pet the animals that were there. It was such a lovely time, and it created beautiful memories that stayed with both of them. There are many similar examples within the hospice—moments that really bring quality of life to people in their final days.
James: How could the changes being discussed in Parliament affect the quality of life in those final weeks or months? What could the implications be?
Ben: I worry that it would preoccupy people with the process of sorting out assisted dying, rather than allowing them to focus on having quality time, as Penny mentioned.
By the nature of the proposals, people would have to cut their lives short while they still had quality time left. Towards the very end of life, people may be unconscious or unable to make decisions for a period of time, but they’re not necessarily uncomfortable—they’re just unconscious. The concern is that, in order to access assisted dying, people would have to make that decision before they reached that point—before they physically or mentally declined too much. That means they’d have to cut their life short while they were still able to do things, to make memories, to spend quality time with loved ones.
James: So, bizarrely, while people say they want to avoid a "bad death" that creates distressing memories, that isn’t something that actually tends to happen in reality. But instead, by bringing in assisted dying, we would be robbing people of the opportunity to create additional good memories and to experience a well-managed, loving death. So actually, the way to give someone the best memories and the best possible death is to care for them in exactly the way that you do, rather than cutting that time short.
Yes.
That’s really quite striking.
Context - General Practice (01:29:50)
So, it was really useful to hear from Ben and Penny how we can really care for people at the end of their life through the network of hospices around the country. But one thing that a number of people are fearful of is that there are only so many of those. In some parts of the country, they're in really short supply, they're always struggling for funding, and they often seem to be full.
So, what happens if you reach the final stages of your life, but there is no access to hospice care? Does that necessarily mean your death will be painful and terrible because you can't access the one way there is to be looked after well in your final days and weeks?
I've connected up with Felicity, who is a partner at one of the GP practices in the area here, and I thought it would be useful if she and I talked about that for a little bit.
James: So, Felicity, thanks for a bit of time on this. Just talk us through what kind of care—what's the reality for people who are outside the hospice system?
Felicity: Yes, the hospice is great, and it can give excellent care for people, but actually, a lot of people don't necessarily want to go into the hospice. They want to die at home. As GPs, we do get a lot of experience looking after people in their own homes when they're dying at home.
Over the last 10 or more years, when I've been a GP, I've cared for a lot of patients who have either chosen to die at home or potentially haven't been able to get into a hospice. We start having conversations with people as soon as we realise that they're going to be dying. We talk about where they want to be cared for, how they want to be cared for, and we put in place medication and plans to make sure that they're going to be comfortable at home.
So, actually, yes, the hospice is one place where people can have a good death, but home can be just as good—and preferable for some people. GPs are really experienced at doing this. We get a lot of support from the hospice as well, so if we have somebody who has a lot of symptoms that we just can't quite get on top of with our expertise, then we can ask the hospice team for help. They can come out and see somebody in the community as well as caring for people in the hospice.
James: I imagine that will hopefully really reassure people that there isn't only one way to be well looked after by the medical profession as they reach the end of their life.
Felicity: Yes, that's good.
James: The other thing I'd be interested in talking to you about is this whole thing in the proposed bill. This is for people who have no more than six months left to live, and two doctors or medical professionals—it's a little ambiguous—would be required to sign off on that. How possible is it to be exact about things like that?
Felicity: It's very difficult, to be honest. Often on TV, they'll say, "Oh, I've been told I've got three weeks to live," or something like that. Sometimes, as it's getting closer to someone dying, it is possible to say that they've got days rather than weeks, weeks rather than months, or months rather than years. But actually, I've never really found a doctor who will pin it down and say, "You've got X number of weeks or months to live."
Sometimes, with cancer, it can be a little more predictable. If we know that someone's cancer has spread, particularly if they don't want further treatment or there isn't further treatment available, then it might be possible to say that it's unlikely they would survive more than six months. But there are lots of other conditions that can be life-threatening where it's much more unpredictable. They may die in the next six months, particularly if they develop a chest infection or something like that, but actually, they could potentially still be alive and no worse off in five or six years' time. So, it's very difficult to predict.
James: I'm just trying to picture what this looks like in your consulting room. I know you personally would not be happy to refer someone for an assisted death, but imagine a similar GP to yourself who doesn’t have those ethical concerns. A patient comes in with, say, a heart condition or a certain stage of cancer, and they say they think they would like to end their life under the provision that, by that point, has become law.
What are they asking you to assess? How do you let them down if you can't guarantee they've only got six months left to live? Even for a GP who is supportive of this, what pressures would that create for them trying to actually implement it in practice?
Felicity: I think it would be very difficult to give that level of precision, expecting them to not live for more than six months. As I say, doctors are often quite reluctant to put timescales on things, just because we know how often you can get it wrong.
I think all of us have had situations where we've said to somebody, "I think your family needs to come and visit; I don't think you've got long left." In that situation, we're thinking they have only days or weeks left, and then, several months later, we realise they've made a recovery and are doing much better. So, we're all quite reluctant to put timescales on things.
Even for someone who is supportive of the bill, I think pinning it down could be quite difficult. There will be doctors, I'm sure, who will be on the generous side. If somebody is saying they don’t want to live anymore because of ongoing health problems that might be terminal, they'll say, "Well, yes, we wouldn’t be surprised if you died in the next six months." But then there might be other doctors who hold to it much more rigidly and say, "No, unless I actually have evidence that you are deteriorating and will die in the next six months, I’m not happy to sign it."
So, I think there could be some variability in how people interpret the guidance.
James: And presumably, if someone comes to you and you say, "I'm sorry, I don’t do that," they could then go and find a different doctor who will?
Felicity: Yes.
James: If one doctor says, "No, I think you’ve got at least nine months left," there's nothing stopping them doing some research—perhaps on a Facebook group—to find a doctor who takes a looser approach, and then going to talk to them.
Felicity: So, in a sense, it's very inexact and open to interpretation.
James: I think one other area I'd love to explore—obviously, you're a partner in a practice. Now, I'm not asking you about your practice or your colleagues; this is all just at the theoretical level, based on your experience of how partnerships work in the health system.
So, your personal view as one partner is that you wouldn't do this. You could have other partners in a practice, or salaried GPs, or locums. Obviously, general practice is struggling at the moment with recruitment and retention. How would implementing this kind of change affect the relationships between partners, doctors, and other practitioners? Would this have any impact on that, or would there just be a way to make it work, like there is with other ethical questions?
Felicity: Good question. I think the easiest comparison is to abortion. I think the vast majority of practices will have a mixture of people who are happy to refer someone for an—well, to sign the form for an abortion—and people who are not. I think that, generally, for most practices, this has just worked.
It's become a lot easier in recent years because people can self-refer for an abortion, and all the paperwork is dealt with by the organisation arranging it. So, a doctor who wasn't happy to sign a form in the past—one stating that a woman needs an abortion—would have had to arrange for them to come back and see one of the other doctors. Whereas now, we can just give them information, and the patient makes their own decision. They can self-refer if they choose to or not.
I think the issues start to arise within a practice when there's a transfer of workload because one person is not doing what others see as reasonable. That's where I could see this causing issues. If, for example, you have a practice where some people are happy to be part of assisted dying and others—other GPs—are not, then if you have to keep passing these patients over to somebody who is happy to do it, that obviously increases their workload.
There are a lot of doctors—you see it with abortion—who aren't so against it that they would refuse to sign a form for somebody, but they don't actually find it an enjoyable or comfortable part of their job. So, if they had lots of people coming in asking for an abortion—or, in this situation, assisted dying—they wouldn't find it particularly pleasant. I have heard some people say that it's not the best part of the job, it's not a particularly happy part of the job, and therefore, everybody should just get on and do their bit.
I could see that happening with assisted dying. If the numbers increased, it could certainly cause tension within a practice.
James: Thank you.
No, that's really helpful, and I hope that will help people get a better picture of the world of general practice—especially for those who aren't familiar with it and how this could affect it. So, thank you.
Consequences (01:39:58)
So, we've thought about the commands—that was our first perspective. We've thought about the context—that was our second perspective. Now, let's think about the third perspective: what are the consequences of all this?
Now, obviously, we can only talk about the possible consequences—we can't see into the future. Only God knows where changes like this will actually lead. But we can have a look and see what might unfold. There are two kinds of possible consequences: there are consequences to changing the law in the way that's being proposed, and there are consequences for the people who might choose an assisted death.
So, let's start by looking at changing the law. What are the possible consequences if we go down this road? What we're going to do is look at other parts of the world where these changes have already taken place, see what evolved there, and then ask the question: where might things lead here as a result?
Consequences - Canada MAiD (01:41:00)
First, we're going to look at Canada. Canada legalised assisted dying in 2016. There, it's called MAiD, which stands for Medical Assistance in Dying. The requirement in 2016 was that a person needed to have what's called a "reasonably foreseeable natural death" (RFND). Now, this is immediately different from the UK because what's on the table here is much more specific—there has to be a prognosis that someone has only six months left to live. Canada did not have that; it simply said that your natural death had to be "reasonably foreseeable."
But in 2021, in a process led by the courts—which argued that the legislation was discriminatory—this was changed. The provision was expanded to remove the requirement that someone had to have a reasonably foreseeable natural death. However, at the point when that was changed, a new clause was added, specifically stating that someone whose only illness is a mental illness is not eligible for MAiD.
So, you no longer need to have a reasonably foreseeable natural death—other forms of suffering and illness can qualify you for MAiD—but not if your only illness is a mental illness.
Now, before you're too reassured by that, you need to realise that under Canadian law, neurodivergence is not classified as a mental health issue but as a disability—and disabilities are eligible for MAiD. So, neurodivergence would be allowed. Someone struggling to integrate into society because of, for example, autism or ADHD would be allowed to end their life under the Canadian system. And there are plans to expand this further.
In 2021, the requirement for a reasonably foreseeable natural death was removed. But a further amendment, which has been postponed twice and is now scheduled for 2027, will do two things. First, mental illness will then be allowed as a legitimate reason to use MAiD. Secondly, what's referred to as "mature minors"—that is, under-18s who are deemed able to make their own decisions—will be able to have their life ended under MAiD without parental consent.
Now, youth mental health is a really big and important topic here in the UK, and I'm sure I'm not alone in finding it hugely concerning that the Canadians are going to implement a system where those who are not yet 18—young people, not adults—will be allowed to end their life for reasons solely to do with mental illness, and to do so without parental consent.
The other thing you need to know about Canada is that the vast majority—over 90%—of MAiD deaths are cases of euthanasia, not assisted suicide. That means a physician or somebody else actually administers the drug.
Consequences - Canada Outcomes (01:44:26)
Well, that's the position in Canada. How's that all working out in practice? Not great is the answer.
In 2016, when this first became law, just 0.4% of deaths in Canada—just over a thousand—took place under the MAiD system. By 2019, that had expanded to 2%. When they removed the requirement for a reasonably foreseeable natural death in 2021, the forecast was that, without the change, 2.2% of deaths in the population would be MAiD deaths, but with the expansion, it would become 2.6%.
In 2023, the number of deaths due to MAiD was 4.7%—a total number of deaths across Canada that year of 320,000, of which 4.7%, or 15,300, were because of MAiD. One estimate is that, since this became law in 2016, the total number of MAiD deaths has been about 60,000 people.
For context, that is roughly the population of Scarborough, Newby, Scalby, Eastfield, Cayton, Seamer, and Middle Deepdale combined—the whole of the sort of Scarborough and outer Scarborough area together is roughly 60,000 in the last census. Since 2016.
Then, look at the reasons people have given as to why they received MAiD. People were asked to give all the reasons that applied—so, obviously, something like this wouldn't be allowed as the sole reason. But in 2021, just over a third said that one of the reasons they wanted to end their life was that they felt they were being a burden on their family, friends, or caregivers. By 2023, that number had risen to nearly half.
Now, that's relevant because one of the things we're being told here is that this wouldn't happen. Campaigners for assisted dying are regularly asked the question: "Won't people do this because they fear they're going to be a burden on their family if they continue to live?" And we're being reassured that this would not happen. And yet, in Canada, we've reached a point where that's true of nearly half of MAiD deaths.
Another concerning feature about Canada is that healthcare providers are the ones bringing this topic up. It's not always the case that patients go to the doctor and say, "I wonder if I might end my life under MAiD?" Rather, doctors might approach patients and ask, "Have you considered...?"
And that is happening because there's an industry body that regulates and oversees assessors and providers of MAiD services, and they specifically advise their members to be proactive in bringing this subject up with people. They say that people might not be aware this is a legal option in Canada, so it's the duty of healthcare professionals to tell them and to offer them an assisted death if they think it might help.
And that's led to some horrendous abuses.
For example, one woman who was preparing for a double mastectomy was asked three times in the lead-up to that operation if she would like help to die as an alternative to going through with the surgery.
Another woman, who had various allergies to different cleaning chemicals and paints, was unable to find suitable housing where these allergies would not be triggered. Rather than helping her to secure appropriate accommodation, the local housing association offered her help to die.
And then there's another example of a military veteran—a woman whose spine was damaged in a military training exercise.
We're going to watch this one in a news report. You'll notice that Justin Trudeau, the Prime Minister of Canada at the time, is horrified that this situation has come about. But, of course, it's his government and his approach to these laws that have led directly to such situations.
Just have a watch.
The Canadian veteran shocked MPs on a parliamentary committee with the details of a call for help and the response she received. Rather than getting the assistance she wanted, a government caseworker asked the former soldier if she wanted an assisted death.
Here's CTV's Atlantic bureau chief, Creeson Agecoutay:
Retired Corporal Christine Gauthier testified that the department that is supposed to help her instead offered her a medically assisted death.
"And the person mentioned at that point, 'Well, you know that we can assist you with, uh, assisted dying now if you'd like.' And I was just shocked because it was like, 'Are you serious? Like, that easy? You're going to be helping me to die, but you won't help me to live?'"
The Prime Minister said he will ensure that Veterans Affairs does not offer medically assisted death to veterans again.
"This is absolutely unacceptable, uh, and as soon as we heard, uh, about this, uh, we took action."
A former member of the Canadian military and a five-time world champion Paralympian, Christine Gauthier suffered permanent damage to her knees and spine during a training exercise in 1989. For the last five years, she has been fighting for a wheelchair ramp for her home and says the current system is broken.
"It took 18 years to receive a second set of wheels for my wheelchair. Does anybody have just one pair of shoes?"
Gauthier has since provided a copy of the letter to the Prime Minister for review.
"You cannot just start submitting and offering the right to die to people who are not at that state."
At least four veterans have received an offer of a medically assisted death by Veterans Affairs, allegedly by the same service agent.
"Veterans call because they need help. This is where they're told to go to get the supports they need after their service to this country. So this is a huge betrayal, and we need to see it fixed immediately, and I'm calling on the minister to do that."
A spokesperson for the Ministry of Veterans Affairs says it doesn't provide advice on medically assisted death and that employees have no role or mandate to recommend it. An investigation is now underway. Heather Grayson
Thank you.
And then, one more piece of how this is all working out in Canada is to see the impact on care homes, nursing homes, and so on for the elderly. This is anecdotal: A Canadian bishop, who was bishop of the equivalent for the Anglican Mission in England in Canada, had lunch with us in 2019, and obviously, they had only been going for three years at that point—MAiD. But he shared with us how, when relatives are settling a family member into a care home, they are routinely asked by the care home staff how long they envisage their elderly relative will be living there.
And by that, they don't mean at what point might they need round-the-clock nursing care. Instead, they mean, "How long do you think they will be here before we take them through the MAiD process?"
It's become routine.
Consequences - Canada: UK Comparison (01:52:05)
So what's happened in Canada in just eight years is hugely alarming. But the question we need to ask responsibly is: could the UK go down the same road? We need to note that there are some important similarities and yet differences between the UK and Canada.
One big difference is that in the UK, this is only for people who have got six months left to live. But we have to ask whether the law could change here to allow people to die if they don't have that specific prognosis or if they have issues with mental illness. We'll come back to that question.
But one thing that is common to the UK and Canada is that healthcare professionals could raise the topic with their patients without needing the patient to bring it up first.
Section Four of the Bill, as proposed to Parliament, is headed Initial Discussions with Registered Medical Practitioners, and here's how it starts:
"No registered medical practitioner is under any duty to raise the subject of the provision of assistance in accordance with this Act with a person."
You don't have to bring it up.
But:
"Nothing in subsection one prevents a registered medical practitioner exercising their professional judgment to decide if and when it is appropriate to discuss the matter with a person."
So, right into the legislation, healthcare providers are encouraged to use their professional judgment to decide when to raise this topic.
An academic paper was published by Cambridge University in 2023 that looked into MAiD and the way that it's worked in practice. Here's what they said in their conclusion:
"The cases we discussed here reveal a troubling normalisation of MAiD as standard treatment for a broad range of suffering, including suffering caused or augmented by socioeconomic factors."
Consequences - Canada Finances (01:53:58)
Another piece we need to consider with the Canadian example is the finances.
When they did the 2021 expansion to remove the requirement for reasonably foreseeable natural death, Parliament in Canada commissioned a report to look at what the cost implications of this would be. Here's what that report discovered:
MAiD was already saving the Canadian healthcare system $110 million a year. People who would have needed treatment and care for illnesses were no longer needing that care, and that was saving the healthcare system money. However, the MAiD system—the paperwork, the bureaucracy, but also the medical time—costs 22 million Canadian dollars to run.
So there's a net saving per year of $87 million.
That report then said: if we expand beyond those with reasonably foreseeable natural death, then the extra cost will actually be small. It will just cost an extra $4 million a year. And that's because most of the people who would die without a reasonably foreseeable natural death would probably have used the MAiD system in the future anyway. So we're not really doing any more, so it doesn’t cost any more.
However, the extra saving will be an extra $66 million.
So by removing the need for a reasonably foreseeable natural death, the Canadian exchequer will save an extra $62 million a year, with a total saving of $149 million.
Now, I'm not suggesting that the change to remove the requirement for a reasonably foreseeable natural death was financially motivated. And I'm not suggesting that MPs in the UK are driven by a concern for public finances.
However, we would be naïve to assume that, in the back of people's minds, there will not be the thought: This will save money rather than cost money to do.
We live in a time when our health service is very stretched financially, and public finances are stretched. Here is a proposal before Parliament that will net save the country money. And that is bound to be a factor as people consider whether or not to go down this road.
Consequences - Origen (01:56:22)
The second example from elsewhere to look at is the example of Oregon. Now, currently, assisted dying is legal in 10 of the 50 states in the USA. But Oregon is often quoted in the debate for the UK, partly because it's the oldest—so the Death With Dignity Act was passed in Oregon in the year 1997—but also because what you have in Oregon is most similar to the proposal that we have for the UK.
Okay, and in particular, Oregon has this thing where two doctors have to be involved in the decision, and it's only eligible for those with likely six months left to live. So, for example, there's a campaign group in the UK called Dignity in Dying that is pressing for assisted dying to become legal, and they use Oregon as an example. So, on their website, they say this:
"There have been no cases of abuse, and the law has not been extended beyond terminally ill adults. Assisted dying in Oregon works. It prevents unnecessary suffering at the end of life and provides dying adults with choice and control over their death. Assisted dying in Oregon is only available to dying people and has remained so since its inception." [moved to a different webpage since quoting, with slightly altered wording]
Now, in the year 2022, three authors did some research to mark 25 years since the Death With Dignity Act became law. They remarked that data is limited for them, partly because, there's no data collected when a lethal dose is prescribed but isn't later taken, and detailed records of why someone wanted to end their life are only retained for a year. But nevertheless, they were able to draw enough conclusions to, tell us that Oregon is far from being this wonderful and reassuring example that we're often told it is.
So, for example, just as we saw in Canada, where the numbers went up year on year, on average over the 25-year period, they found that the number of deaths per year has risen by 16% year on year, until in 2022 there were 431 prescriptions for lethal medication and 278 people died.
Then there's the time and the relationship that doctors making these assessments, had with their patients. So, back in '97, on average, the doctor who prescribed the medication to end the patient's life would have known their patient for 18 weeks at that point. But in 2022, that was just five weeks. So doctors were making this assessment based on purely five weeks' knowledge of a patient—and just knowing them for that short time—had to decide how long this person was likely to live and whether they were fully of sound mind and not under influence from other people.
Furthermore, there's always the provision to say, actually, a doctor can't assess someone's soundness of mind, so they should be referred to a psychiatric specialist to consult further. Back in 1997, 28% of cases of assisted dying were referred for psychiatric assessment, but in 2022 that had dropped to just 1%. So you have doctors knowing their patients, on average—sometimes much less—for just five weeks, with no consultation with other specialist professionals, reaching these conclusions.
Again, similar to Canada, in the year 2022, 46% of those who ended their own life cited that one of the reasons for doing this was that they feared being a burden on others.
And then there's the issue of what the real choices that people are presented with are. So, obviously, in the States, they don't have a sort of national health system like ours. You need to take out health insurance to cover possible medical costs in the future, and those who were unable to afford it or hadn't arranged to do so, there are a couple of state providers of kind of bare-bones medical insurance that people can fall back on.
Now, back in '97, when this first became law, 65%—two-thirds—of those ending their own life had private health insurance, and only a third were dependent on the state. Twenty-five years later, in 2022, the numbers have completely inverted, so that only 20% have private health insurance, and 80% are reliant on the state.
Now, that means that for those 80% who only had state medical cover, they would surely have had at the back of their mind the concern that if they continued with treatment rather than ending their life, then what would be available for them in terms of hospital or palliative care could be, much more minimal than might be the case if they had private medical insurance instead. And certainly, it would be the case that those who don't have private health insurance will be amongst the poorest in society and those from the most deprived communities in society.
So it's very striking that 80% of those choosing to end their own life in the state of Oregon do so from the poorest backgrounds. Those who can afford it choose medical care; those who are most vulnerable and who live in the greatest poverty instead choose to end their lives. Oregon is far from a reassuring comparison for us.
Consequences - Implications for Britain (02:02:25)
So, that's looked at how assisted dying has played out in Canada and in Oregon in the United States. We could have looked at other countries and other jurisdictions—we could have looked at the Netherlands and Belgium or Switzerland; we could have looked at Australia or New Zealand—but there isn't time. The pictures are largely similar. The question is: what would or could this mean for us here in Britain?
Now, those who want to press against allowing assisted dying often speak of the slippery slope or the thin end of the wedge. They argue that allowing this change now will lead to further changes later that see the situation deteriorate.
On the other hand, those who argue for assisted dying, don't like it when opponents of assisted dying bring in the so-called slippery slope argument. They would say that that is scaremongering—it's far from proven that introducing one change now will lead to other things later. All we can do is decide on what's before us.
In fact, they so dislike the slippery slope argument that it's got to the stage where, if someone opposes assisted dying and lays out their arguments for opposing it, if you can demonstrate that their opposition really amounts to a form of slippery slope argument, the person who wants to see assisted dying become law—all they have to say is, "Ah, what you've just argued is that this is a slippery slope. We know that that's a false argument, so what you've just said as an objection doesn't stand."
So the question is: is there a slippery slope in play here? And we're going to have to look at this really quite carefully.
First of all, we need to notice that Kim Leadbeater is exactly correct when she says that the bill is named the Terminally Ill Adults (End of Life) Bill and that this bill does not allow assisted suicide for other reasons and in other circumstances, and it does not legalise euthanasia. She's quite correct that what's before us—the law itself that would be passed—prescribes really carefully what can and can't be done.
However, there are other things we have to say. One is that the law will quite fundamentally change the role of the state and the judiciary with regards to death, but also the medical profession.
Now, the foundation of Hippocratic medicine is that doctors are working to secure the best health of their patient—the best outcomes. At the moment, when you go and see a doctor, you can be assured that your doctor has at heart your best interests and that they want to do the best they can to either offer you cures for the things that are not right or to offer you comfort where a cure is either not possible or not quite certain. But that is what motivates and drives them.
Once it becomes an option for a doctor to offer a patient an assisted death, it fundamentally changes that relationship. It alters what the doctor might be offering to you. You can no longer have quite the same confidence that that is what is driving the doctor—that it is what he or she wants for you.
Many medical conditions can be hard to diagnose and can lead to a series of tests at hospitals or other specialist centres, often with a complete lack of clarity as to what is wrong. Even after a diagnosis, there can be an extensive course of treatment to see if things can be improved. Are you absolutely confident that the doctor you go to see is not going to be swayed towards an option that solves things more quickly, more cheaply, and more simply than that whole round of tests, diagnosis, and treatment?
Even if your doctor is opposed to assisted dying, the confidence that ordinary people will have in the medical profession is changed because the role of the medical profession is changed. Many doctors would be keen to say that this whole process of assessing and administering assisted death should not be associated with doctors.
Now, somebody who can say that even more clearly than I have is someone called Larry Worthen. In the UK, we have an organisation called the Christian Medical Fellowship. It's a wonderful organisation that helps doctors and other medical professionals in the UK to network and support each other if they are Christians. Well, Larry heads up the Canadian equivalent of that. He actually has a background in law, not in medicine, but he's extremely informed and able to speak about the effects of the Canadian legislation.
So, I'd like you to listen to this brief comment from Larry:
When I looked at this, I thought, 'Lord, we're a small organisation. We can't possibly take on this issue. Let's just focus on conscience.' I thought that was a piece we could handle. And I wish I could do it over again, because once it becomes legal, then it becomes ethical. Once it becomes ethical, then if you don't do it, you're a bad doctor.
You could have the best conscience protections in the world—California has really good conscience protections—but eventually, years down the road, not very many years down the road, people will say, 'Why should we let these people into medical school if they're not prepared to provide all ethical medical procedures?' And so, once we use the term 'conscience', we've got ourselves into a ghetto.
What we need to do is say: this is not good for patients.
I told you he would say it better.
So, that's one thing we need to bear in mind as we consider the future for Britain: it changes the role of doctors and our relationship with our doctors.
The next consideration is that the law could be open to challenge. What I mean is that, at the moment, if we pass a law that says only people in certain circumstances—those with six months left to live—can choose to end their own life under these proposals, there is nothing to stop someone with other conditions or other forms of suffering from coming to the UK courts and arguing that, under the Human Rights Act, it is discriminatory for them to be denied the opportunity for an assisted death.
If someone with six months left to live due to cancer can end their own life, why should someone whose suffering takes the form of, say, Parkinson's disease—with no clear prognosis of how long they will live—be deprived of the same resolution for their suffering?
The law could be challenged.
The law could also be open to change. The proposal at the moment is very restricted—only those with six months left to live can end their own life with an assisted suicide. If Parliament were to debate a proposal that people could end their own life for any reason whatsoever, such a proposal simply would not pass. Parliament would refuse to vote for it.
But once people have got used to living with the proposals our MPs are currently debating, it would seem less of a stretch to amend the law to allow other people to end their own lives. Indeed, this is exactly what happened in Canada. Going all the way to assisted suicide for a whole host of other reasons would not be acceptable now, but it could become acceptable once we've got used to these more moderate proposals.
People are quick to say that Oregon did not change its requirement that only those who are dying should have an assisted death. But the fact that Oregon did not change that law does not mean that we in the UK would not. We could.
It's time to listen to another clip—this time from Esther Rantzen—in which she's asked exactly this point: where's the justice in allowing those with six months left to live to end their life, but not others?
And what she says is simply fascinating.
In fact, I can't quite believe she said it. Did she really mean to say this on national radio?
Just have a listen to this:
Nick: The argument goes: if you can choose to speed up your death after a terminal illness diagnosis and you're six months from death, well, why not do it if you're in extreme pain but not about to die? Why not do it if you think your life has no value because you're deeply depressed? Why isn't that a matter of choice for people—that the state shouldn't interfere with?
Esther: It is in some countries, with, I suppose, a freer attitude. But we're quite a conservative country. We like to take a single step rather than gamble all the way to our destination.
I mean, I do worry about people with Parkinson's, for example. But I think, actually, what we're talking about is what we would tolerate as a change in our legislation.
And I think Kim Leadbeater has got it right, actually. We need to tie it quite tightly down to terminally ill patients—adults with a physical illness in the last six months of their life.
Consequences - Comparison with Abortion Act (02:13:09)
Now, as we think about the possible consequences here for Britain and how things could unfold from this stage, I want us to briefly compare this issue of assisted dying with what happened when abortion was legalised. I want to do this quite briefly—please don't get distracted by this. They are separate ethical issues; they have a few things in common, but they're not the same. I certainly don't want you to think that if you don't agree with what I'm saying on abortion, that therefore necessarily this entire presentation on assisted dying loses its validity.
I want to make one very simple and specific point of comparison, and that's this: when abortion was legalised in 1967, it was because there were some very specific hard cases of danger to a pregnant mother's life, where it seemed the compassionate thing to do in these complex and hard cases was to offer the opportunity to terminate the pregnancy. That's how it began. But then what unfolded was a greater and greater availing of the provision of abortion. So, in 1967, there were roughly 27,000 abortions in the United Kingdom. In 2022, 55 years later, there were, in round figures, 270,000. It's gone up by a factor of ten.
Now, as I said, according to the Abortion Act—which, in this regard, hasn't changed; a few minor amendments have been made, but nothing of substance—there are four reasons given where an abortion might be allowed, and the law says: yes, in this case, you can. A, B, C, and D.
Ninety-eight per cent of abortions today take place because of Ground C, and Ground C says that continuing the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated. So, if the mother's life is more at risk by continuing the pregnancy than by having the abortion, then it's okay. Now, that is the reason given for 98% of abortions, and that's because it's almost always possible to argue that the health of the mother is at greater risk if the pregnancy continues. It's much safer in the Western world than it used to be to give birth, but nevertheless, pregnancy and childbirth are not without risks, whereas abortion has become such a common routine that the physiological risks can almost entirely be managed. So, in almost any case, it is more risky to the mother's life to continue the pregnancy through to childbirth than it would be to end the pregnancy.
Therefore, we've reached a situation in this country where, effectively, we now have abortion on demand. A law introduced in 1967 to allow compassionate resolutions in really hard cases has turned into something being used ten times as frequently as was the case back then, pretty much for any and every reason. That is sobering as we ask what might happen if we open the door at this point to assisted death. As Parliament considers passing a law where certain people, under carefully prescribed conditions, can choose to end their own life, who knows how common this might be in 50 years' time and what reasons might be given in the future for why ending your own life is acceptable?
A slippery slope is not scaremongering. To make this one simple change to our laws now does indeed produce a change that affects a whole host of things fundamentally and from which we cannot wind the clock back.
Just to remind you where we are in this presentation: we're considering three perspectives on the subject of assisted dying. We've thought about the commands of God and the context of people's lives, and then we've been thinking about the consequences of assisted dying. We've thought about the consequences of changing the law—we've looked at Canada and we've looked at Oregon, and we've asked what lessons we can draw from those places as to how things could unfold in Britain if we were to change the law in a similar way here.
Consequences - People (02:17:29)
But we also need to consider the consequences for the people involved—the people who could choose to end their lives under the legal provision that is proposed. The important thing to say as we consider the consequences for people is that nobody knows how long they've got left. It's true that the less time someone has left, the more accurate it is possible to be about how long that is, but it is impossible to be sure. There are many, many stories of people having much longer left to live than doctors had expected.
I know many Christians who are alive today who should not be, according to the prognosis that was given them. Many Christians are given many years to live that doctors thought impossible, and then are able to use that precious time to the glory of God. Unbelievers—those who are not yet Christians—will go when they die to meet the Lord Jesus as their judge, and if they do not yet trust and follow him, they are not ready to meet him. So, how could you possibly shorten that person's life, bringing forward their appointment with the risen Lord Jesus as their judge? Surely, every day longer that they live is a day they have the opportunity to trust the Lord Jesus and his death on the cross and his resurrection from the dead, to make peace with the God they are about to meet.
So, whether someone's a believer or an unbeliever, extra time is to the glory of God and for their good. The delay in our appointment with the risen Jesus is an opportunity for repentance and new life.
One friend of mine, a man called Jeremy Marshall, used to live about a mile from a previous house we lived in. In 2016, Jeremy was told that he had a particular rare form of cancer that had come back, having previously been thought to be eradicated, and he was given 18 months to live. He eventually died on the 13th of July 2024—eight years later.
Jeremy used those eight years to speak evangelistically at many gatherings, including to all the fans at a football match at Watford Football Club, where he had been a lifetime season ticket holder. He was invited to speak at half-time about his personal story and what he would like to say about the fact that he was still alive in spite of having this cancer.
He spoke at many churches and evangelistic events. At any given time, he was reading the Bible—John's Gospel—one-to-one with between 20 and 30 unbelieving friends, meeting up with each of them every two weeks to look at a bit of John's Gospel together.
He discovered that there was a bank called Kingdom Bank that was largely in disuse and was in danger of losing its banking licence, but that he and a few friends were able to buy out, rescue, and revitalise—launching it as a banking facility that would enable Christian ministries to invest and access loans to finance their ministry.
Jeremy drew on his leadership experience in the banking sector and in other areas of life to serve as a trustee for many Christian charities and to mentor many up-and-coming Christian leaders who valued his input as they sought wisdom and guidance to be of use to the Lord in their life on earth.
Those extra eight years that the Lord gave Jeremy were used mightily. So, who knows how long we've got and what we can do with the time that we have?
Summary (02:22:11)
We've covered a lot of ground together. Let me summarise what we've been saying.
In 1961, suicide was decriminalised, but helping somebody to end their own life remained a criminal offence. What's before Parliament now is a proposal to decriminalise doctors helping somebody else to end their own life by prescribing for them the medication to do so. They're only able to do so under very specific conditions.
The arguments for doing this are many, and frequently, they are emotive arguments rather than rational ones. In order to look at an issue like this as finite human beings, we need to look at it from lots of perspectives, but all those perspectives lead us ultimately in the same direction. If we look at God's commands, we discover that human life is precious indeed to God and that murder is theft because our life is the Lord's. Suicide is a form of self-murder. God is the author and giver of life, and life is precious and is not for us to take.
We should be caring for those who are fragile and vulnerable amongst us and those who depend upon us. The context of end-of-life care shows that there are many ways to care deeply for those who will die soon. We should understand the pressures on such people and the pressures on their friends and relatives and not add to their burden by giving them the pressure of choosing the time and manner of their death.
The consequences of changes like this elsewhere in the world have been disastrous. If Britain goes down this road, then the change we are discussing is not the end of the process—it's the start of a whole new chapter in this nation's history, and who knows how things could unfold from there? The life we have, the years God gives us, are time to be used to His glory, and if we choose to waste and cut short months or even years, that is, as much as anything, a tragic, tragic waste.
I want to finish by showing you a short video clip—an interview with my friend Jeremy Marshall. This interview was actually made during the time of the COVID lockdown. He's talking about lockdown and COVID, but a lot of what he says here applies equally poignantly to this question of death and assisted dying.
Trevor: Jeremy, in the past year, you've actually spoken at probably over a hundred churches and evangelistic events, sharing your faith with non-Christians. During that, you've obviously had the opportunity to take the temperature—to get the feel of where churches are at. It would be very helpful to get your thoughts on that—where you feel churches are at in this regard.
Jeremy: We'll come back to churches in a minute, but, friends, this is the greatest hour for evangelism in our lifetime. We have never had such an amazing opportunity because people are preoccupied with three topics that are right up the Christian street—death, suffering, and bereavement. And we have something amazing to offer, which is hope in the face of death.
Now, I can speak personally about that because—yeah—I should be dead. That's what I was told five years ago by the oncologist. But, as you can see, I'm still alive. I'm not cured; I'm like a walking, one-man medical disaster. But for all of us, our friends are looking for answers, I believe, and I believe many people who never paid attention to the things of life and eternity are now open.
So I really think what we've got to offer, friends, is hope in the face of death. The Lord Jesus Christ—this is my favourite quote from the Bible, of course—Jesus holds the keys of death and hell. People are uncertain, people are afraid, and we have a Saviour who's conquered death.
So, Trevor, it's the greatest gospel opportunity we've ever had, and I think it will continue, at least for a period of time, even after lockdown lifts. This is going to shake people, and a lot of people who are—you know, I spend a lot of time with business people, right?—people who are preoccupied with making money. It's shaken them. So we have a wonderful gospel opportunity at the moment.
Conclusion (02:24:34)
The fact that there is a demand for assisted death, the fact this conversation is going on, just shows how much people who live in Britain today need to hear about the hope, the life, and the joy that the Lord Jesus came to give. Jesus came that we might have life and have it to the full.
So we need to see both the threat posed by what's being proposed for the law here, but we also need to see that there is a wonderful opportunity before us. People are talking, thinking, and concerned about life and death in a way that they have not been before. Traditionally, death is the one subject you don't speak of, but suddenly, it's become a national conversation. And as Christians, we have something wonderful to inject into the conversation at this point—we can offer people hope in the face of death.
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