What would you give to protect the NHS? This is a question that the UK public has been asked in different ways in recent years – not least through the rationale of Covid lockdowns being, in large part, to “protect the NHS”. It is a question we need to remember as we debate assisted dying, as there is every risk we inadvertently ask it of the most vulnerable people in our society.
In reality, the NHS is a mediocre health system that used to be a reasonable healthcare system. It is not now (and perhaps has never truly been) the envy of the world.
Almost 80 countries have some form of universal healthcare, and almost none have copied the UK’s model. By definition, it is not something patients across the world – at least those in countries comparable to us – yearn for. Similarly, it is not a system that healthcare professionals yearn to work in, either – unless they are from poorer countries and coming here for a better wage.
The King’s Fund – one of the most prestigious UK health thinktanks – confirms this assessment: the NHS is relatively efficient in spending terms, and protects patients from high medical costs. Yet it does this at the cost of having less medical equipment, fewer hospital beds, and fewer doctors and nurses than comparable countries. And crucially, it also does it at the expense of worse patient outcomes than any comparable country except the US.
But to criticise it is a social faux pas akin to kicking Paddington Bear in the nuts or saying you think Olivia Colman is overrated. Anyone trying to start a conversation about the NHS as it actually is will inevitably be assailed with stories about how great staff were with a relative, as if healthcare workers in other countries would have just unceremoniously dumped them into a ditch to die.
We are locked in a toxic relationship with the NHS, where everyone knows it isn’t working, we won’t reform it (though ministers of successive governments endlessly tinker with it, as Wes Streeting will now try), we can’t keep endlessly funding it, and we all know deep down it isn’t working as it should be. But we won’t change it because our relationship with the NHS isn’t rational.
Perhaps the worst possible thing that could be inserted into this toxic dynamic is the issue of assisted dying, which the UK is about to consider through the mechanism of backbench bills – which will minimise the time for proper scrutiny and consideration of how such a system can work in favour of endless amendments from pressure groups, and emotive lobbying through celebrities.
The early debate is off to an unedifying start, with Kim Leadbeater – the backbencher introducing the measure – claiming that the UK wouldn’t have the same complex legal and moral issues with assisted dying that have plagued Canada because the latter is a much larger country in terms of area. This is not a promising start to an incredibly complex debate.
Canada introduced Medical Assisted In Dying (MAID) in 2016, and has quite rapidly expanded its scope from people with terminal conditions to also include those with chronic ones. Controversial cases have included someone granted permission to die due to suffering with depression, while patients with disabilities have complained of medical staff asking them whether they’d considered taking that option.
Some people are implacably opposed to assisted dying, often for religious reasons, but others – who would otherwise be open to the idea – look to Canada with alarm as to how such a system might work in practice.
It feels like there should surely be a way to introduce a decent, compassionate regime for assisted dying that is more humane than the awful way too many people currently have to die.
But many previously ardent proponents of such a system have looked at Canada and balked: it has expanded rapidly beyond its original scope in exactly the sorts of ways that advocates of assisted dying promised wouldn’t happen.
There is always the risk that assisted dying morphs – slowly or quickly – from an option to a default. People worry about being burdens on their loved ones, or on the healthcare system, or worry about what they are costing.
The norms around some illnesses change: if some people with a particular condition or disability choose to die, why do others choose to live when doing so requires healthcare that costs £500,000 a year or more? The pressure is both real and insidious.
The NHS primarily cares for sick, older people – who often have exactly these concerns. The UK population is getting older and sicker every year, and the NHS is struggling to cope already. Social care has resisted reform for decades, and its failure is adding to the burden on the NHS.
It is not hard to see how that will contribute to a sense that some people will feel it is the “right” thing to do to end their lives earlier to spare the NHS – essentially sacrificing themselves on the altar of the UK’s national religion.
This does not have to be the intention of anyone introducing the bill for it to be a real and present risk: anyone who has spent time talking to older or infirm adults will surely be aware the fear of “being a burden” is a real one.
There is a case to be made for assisted dying, and its advocates are doing so from a place of compassion. But the debate needs to be an informed one, a considered and a clear-eyed one – and unless we consider in advance the risks of assisted dying measures in combination with our attitudes towards our failing healthcare system, the outcomes could be tragic.
The debate over assisted dying needs to take into account the potential increased burden on our already failing health system
