The Price of Life

Ben Wildsmith

I have always believed that assisted dying should be offered to terminal patients. Of all the views I hold, it was the one least likely to change.

Having seen people very close to me endure horrifying, protracted deaths, it’s a belief forged in the furnace of adversity.

I don’t want you to go through what my loved ones experienced, and I’m bloody furious that anybody would compel me to. It frightens me even to think of it.

So, when the issue arrived in the Commons for debate, with a reasonable chance of making it into legislation, I was wholly supportive. Unusually, the debate around it seemed measured and serious.

Nuanced

The Health Secretary, Wes Streeting’s position was nuanced. He won’t be supporting the legislation, not because of a fundamental objection, but because the current state of palliative care is likely to be an incentivising factor in the decisions people make.

I disagree with that, we all have to play the cards we are dealt in my opinion, but Streeting’s is a respectable pragmatic argument.

Something else the Health Secretary has proposed, however, stopped me in my tracks. In the same week that assisted dying was under consideration, Mr Streeting floated plans to offer weight loss injections to unemployed people.

His case was that the NHS is overburdened with obesity-related illnesses and that they were keeping sufferers out of the workforce. On the face of it, that’s a reasonable position, isn’t it? If conditions can be prevented before they cause complications necessitating expensive care, surely it makes sense to address them.

The problem with Streeting’s position is that these treatments are being proposed only for the unemployed. The proposal explicitly seeks to address a workforce problem with a healthcare solution.

Frightening

Here is where the instinctive pragmatism of management-class politicians can lead to some frightening places.

The Health Secretary should not be so morally impoverished as to need reminding that the desired outcome of healthcare is improved health. Employment may be a desirable ancillary benefit of treatment, but that is a happy bonus for Liz Kendall, the Employment Secretary, not the business of doctors and nurses.

Kendall, of course, is keen to send work coaches on to psychiatric wards, so cross-pollination between these departments appears to be coordinated in service of the government’s arbeit macht frei ethos.

Often criticised as an opportunistic and overly ambitious politician, Streeting’s arrival at this policy suggests that he is ethically unmoored.

In matters of life and death, the contracts we make with society must be transparent so that ulterior motives cannot be concealed. The prospect of doctors offering treatments to the unemployed that remain unavailable for other patients is antithetical not just to the principles of the NHS, but to the trust placed in the medical profession by patients.

Troubling

So, the question of assisted dying has become rather more troubling. Streeting’s admirable caution on the issue itself is complicated by the wider direction he appears to be taking.

In the spreadsheet used to calculate the viability of treatments for obesity, a column has been created for employment prospects. Such a column is unprecedented. Were assisted dying to become an option in hospitals, is it not concerning that a column detailing the costs saved by patients making that choice would appear in future calculations?

I still support assisted dying, but with considerably more trepidation than used to be the case. I don’t for a moment believe this government, or any likely replacement, would actively pressurise people into euthanasia.

I’m concerned, however, that counselling services designed to explore the validity of patients’ decisions would be vulnerable to cuts the next time a ‘black hole’ was discovered in public finances.

If the unemployed can be removed from the deficit column with an injection, so can the terminally ill.

Creating legislation that protects the dying from the juggernaut of cost-saving zeal is work for principled statesmen and women. Do we have them at hand?