Dr Ashley Frawley: Why I support Better Way

Like many people, I was initially on board with the idea of assisted suicide. As a liberal type, I asked: ‘Who am I to stand in the way of another person’s choice about their death?’ However, the more I learned about the practice and the healthcare systems in which it has become embedded, the more I realised the drive for assisted suicide has less to do with our society becoming more liberal, and more to do with it adopting a blasé attitude towards human life. 

Ironically, for assisted suicide to work, we have to believe in the profound value of humanity in all its aspects so that the practice is never, ever wrongly pushed or misused. Can we honestly say we live in a society that believes this? I’m not so sure. At many times, and in many ways, it appears that we are pulling in the opposite direction – away from a world where every life has equal value.

As a sociologist, I am keenly aware of deeply entrenched inequalities. Patients with terminal illnesses are often denied the quality palliative care they need on the NHS. Whilst the disabled community are barred from accessing the same opportunities as other people and the support they require to live full and happy lives.

In a context of such widespread and deeply embedded inequality, the idea of enacting legislation to allow state-assisted suicide is alarming. I worry for patients with terminal conditions, particularly the vast majority who would not choose to access an ‘assisted death’. Do we really think the quality of care afforded to these vulnerable people would be improved with the option of ‘assisted death’ on the books?

In my home country of Canada, which introduced assisted suicide in 2016, the scope and quality of palliative care is rapidly diminishing. Hospices in Canada that refuse to provide assisted suicide, wishing to focus on conventional end-of-life care, are losing public funding. Why are we seeing this decline? Because assisted suicide is more cost-effective. We are constantly told that strains on public health systems must be reduced at all costs. It is easy to see how certain lives and certain needs can come to be seen as too much of a burden. 

In Canada, the state isn’t even hiding the fact that assisted suicide is economical. At the end of last year, a report by the Canadian Parliamentary Budget Officer noted that extending the law to include citizens whose deaths are ‘not reasonably foreseeable’ could lead to increased healthcare savings of $149m – almost £87m – in 2021. Economic advantages are also being discussed in the context of forthcoming legislation to extend assisted suicide to people with disabilities and mental health conditions.

Canadian doctors have already witnessed a disturbing change in the way disabled people are treated by the medical establishment. One recounted how she has encountered “story after harrowing story of disabled people sharing their experiences being demeaned, disempowered, and denied dignity by the healthcare system”. “I learned more about power in society and who is written off and who gets given the benefit of the doubt”, she said.

There is no doubt in my mind that as access to assisted suicide is widened to include people with disabilities and mental health conditions, entrenched inequalities will get worse, not better. In the same way that terminally ill Canadians face increasingly limited access to good palliative care, marginalised groups will have less access to services they require to help them live and flourish in Canadian society. 

In light of Canada’s experience, politicians face seismic questions. Do they see falling access to quality palliative care and a worsening of inequalities across society as a risk worth taking to bring about this change? And do they want to open the door to ‘assisted dying’ for terminally ill patients when the picture overseas is of rapidly expanding laws allowing citizens with non-terminal disabilities and mental illnesses to commit suicide in healthcare settings? Who will be affected by this decision five, ten, or fifteen years down the line?

For those who may, like myself, find themselves instinctively in favour of assisted suicide, I urge you to think about the ramifications of this change more deeply. Why is it that every major disability group in the UK opposes it? And why do so many medics working with patients at the end of life take offence at the idea? I think they fear, as I do, that this radical change would seriously harm the lives and worth of many citizens.

There is a better way for our society: ensuring every patient has access to quality palliative care; redoubling efforts to prevent suicide; tackling abuse and stigma against elderly and disabled citizens. We can make progress towards these noble aims, but only if the door to assisted suicide remains firmly shut.

Dr  Ashley Frawley is senior lecturer in sociology and social policy at Swansea University in Wales. She lectures in the sociology of health, mental health and illness, social problems, social movements, and in the economics of social policy.