After many years of delay and prevarication, the UK is finally grappling with an issue that has long been a source of polarised debate and ethical handwringing around the world.
The House of Commons has voted in favor of a bill to legalize assisted dying in England and Wales, marking a significant advancement of the issue globally. A separate bill is currently being considered in Scotland.
The proposed legislation, known as the Terminally Ill Adults (End of Life) Bill, would permit terminally ill adults, who meet strict eligibility criteria, to receive medical assistance to end their lives.
It is the beginning of a lengthy process, as the bill will now be subject to extensive scrutiny and potential amendments in both houses of Parliament. The possibility of the bill failing to pass and not becoming law remains, such is the contentiousness of the issue.
What makes the current debate different from any that has taken place in the UK to date, is context. The conversation around assisted dying has always been framed in terms of individual autonomy and the right to choose the time and manner of one’s death. While these are undoubtedly important ethical considerations, with people living longer than ever before, and with a growing requirement to exercise their rights as consumers, the issue is increasingly driven less by ethics than by market forces.
As societies grapple with aging populations and ever-increasing healthcare costs, the pressure to allow individuals to opt for a planned exit, thereby reducing the financial burden on healthcare systems, is making it increasingly difficult to resist.
Previously, debate tended to focus on cases of unbearable suffering where individuals with terminal illnesses sought a merciful release, and it was largely confined to the realms of medical ethics and individual compassion.
Because people are living longer, often with multiple chronic conditions and with the associated healthcare costs that entails, they are more aware than ever of their rights as consumers, including the right to choose how they live and, crucially, how they die.
This shift in perspective is not accidental. It reflects broader societal trends where individualism and consumer choice are highly valued. People want control over their lives, and for some, this extends to their death.
The rise of online communities and information-sharing has created a culture of empowerment in which people are less willing to accept traditional medical paternalism.
They question the need for their lives to be prolonged beyond what they consider acceptable, particularly when their quality of life is severely compromised. In this landscape, the idea that an individual should have the final say over their body and their end-of-life experience is gaining traction.
Lurking beneath the surface of this narrative is a more pragmatic, economic reality. Healthcare systems worldwide are straining under the weight of aging populations.
The cost of providing long-term care, particularly for individuals with complex needs, is astronomical. As people live longer, often with multiple conditions, the financial demands on healthcare infrastructure increase exponentially. In this context, the option of assisted dying, while often presented as a matter of personal choice, has the potential to significantly reduce the burden on already stretched resources.
This is not to suggest that healthcare providers are actively advocating for assisted dying in a cynical attempt to save money. Rather, the pressure to deliver efficient and sustainable care inevitably leads to a re-evaluation of resource allocation.
When individuals are kept alive against their wishes, often in a state of considerable discomfort and without any meaningful quality of life, it prompts difficult questions. Should time and resources be devoted to providing medical interventions that the patient does not want when those same resources could be directed towards areas where the impact on well-being could be greater? Is it ethically defensible to spend vast sums on sustaining life when the individual has explicitly expressed a desire to die?
It is estimated that there are more than 24,000 patients in a permanent vegetative state (PVS) or minimally conscious in NHS care in England. The cost of treating a patient in a PVS is more than £100,000 a year, excluding legal bills for the NHS and the cost of Legal Aid for the family.
The family of Jodie Simpson, who spent four years in a PVS between 2012 and 2016, was forced to apply to the Court of Protection to seek permission for doctors to withdraw feeding, to allow their daughter to die. Such applications are made by the local clinical commissioning group and usually cost around £50,000. Only about 100 such applications have been made in more than two decades.
Jodie, from Barrow-in-Furness, in the north-west of England, suffered irreversible brain damage after taking an overdose. She could breathe without assistance but was fed and given liquid through a stomach tube. After spending 10 weeks in intensive care, she was moved to a nursing home. While her physical condition was stable, doctors said there was no sign of consciousness and she suffered occasional seizures.
Professor Derick Wade, an Oxford-based consultant in neurological rehabilitation estimates that managing one person in a vegetative state for 10 years costs the NHS the equivalent of saving five avoidable deaths in other people.
Although rarely stated explicitly, every healthcare system operates within a fixed budget. Choices have to be made about where to allocate resources and, equally importantly, where not to allocate them. While the rhetoric surrounding healthcare is usually focused on treating and curing illness, the reality is that healthcare providers must operate within a world of constraints, where money spent on one patient means less money for another.
The growing acceptance of assisted dying has been further fuelled by the fact that people now have greater power than ever before. The days when healthcare professionals held all the cards are long gone. Patients increasingly seek out information and are actively involved in decision-making processes, using online forums to share their personal experiences.
Celebrities speaking out on assisted dying, even though their views have no greater validity than anyone else’s, help to keep the subject in the public domain and legitimize the debate. This has created a more consumer-driven dynamic in which individuals are taking greater responsibility for their health and are pushing for once unimaginable options.
Ultimately, the economics and market forces surrounding healthcare are shaping the debate on assisted dying. As populations continue to age and healthcare costs continue to rise, the pressure to allow people to make choices about their end-of-life experience will only increase.
While moral and ethical considerations will always play a part in the discussion, the financial pragmatism of the situation cannot be ignored. The conversation is shifting from one based on what is morally acceptable to what is economically sustainable and the growing demand for consumer choice will be the deciding factor. The current trend indicates that the push for the acceptance of assisted dying is likely to become an irresistible force in the coming years.
About Ivor Campbel
lIvor Campbell is the Chief Executive of Angus-based Snedden Campbell, a specialist recruitment consultant for the medical technology industry.
