when choices collide

The National Health Service Act of 1946 gave the Minister of Health a duty ‘to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness.’

Aneurin Bevan, the Labour Health Minister instrumental in establishing the NHS, said in 1959, ‘I’m proud about the National Health Service. It’s a piece of real socialism; it’s a piece of real Christianity, too.’ A former Archbishop agreed with the latter assertion by describing the NHS as ‘the most powerful and visible expression of our Christian heritage’ because it ‘sprang out of a concern that the poor should be able to be treated as well as the rich’.

Whatever means a nation favours to facilitate healthcare, a core value of concern for the poor, flowing from a recognition of the equality of value between all human beings, is certainly profound. And profoundly Christian. After all, ‘Whoever mocks the poor shows contempt for their Maker’ (Proverbs 17:5a).

So, what of the news that the Westminster Assisted Suicide Bill would change the understanding of this foundational Act? Is anything lost if we change our reading of the National Health Service Act so that ‘improvement in health’ includes the provision of suicide assistance? Can the Secretary of State hold both a duty to promote health for all and to assist some in ending their lives?

For proponents of the Bill, increasing patient choice is a central aim, but if this increase in choice for some requires a fundamental change in the values and legal structures of healthcare for everyone, should we not at least consider if this change might be taking something away from everyone else? Many people, and particularly some speaking for disabled people, minority ethnic groups, those prone to suicidal ideation and women, think this choice will bring in changes that disadvantage them particularly. Many in these groups, and others, would like to choose not to live in a country where the normalisation of assisted suicide disproportionately threatens their ability to find safety.

We all share the same country and the same NHS, but perhaps those who wish to be protected from environments where assisted suicide is normalised could find safe spaces within the health service where their desire to choose an environment of life affirmation and suicide prevention can be provided. But the bill committee has refused multiple such amendments.

The Bill explicitly enables doctors to raise the option of assisted suicide with patients who have not asked about it. The committee was not amenable to removing this clause nor even to the introduction of a clause designed to prevent a doctor from raising the idea if a patient made an advanced decision that they would not in future wish to seek assistance under the act (Amendment 278). No way to choose a safe space in the consultation.

What about the possibility of choosing a safe space in an institution? The bill committee considered whether hospices and care homes could have the option to ‘opt out’ from allowing assisted suicide within their organisations. Amendment 441, sought to ensure there would be ‘no obligation on any care home or hospice regulated by the Care Quality Commission or the Care Inspectorate Wales to permit the provision of assistance under this Act on their premises.’ Furthermore, new clause 23, sought to ensure that funding for care homes and hospices could not be ‘conditional on that care home or hospice providing assistance in accordance with this Act, or permitting such assistance to take place on their premises.’

Bill proponents on the committee stood firmly against such amendments. The Bill sponsor herself stressed whilst rebutting them, ‘The word that we have used a lot—maybe not enough in some respects—is choice’ (Kim Leadbeater MP – Hansard). Such amendments should, to her mind, be rejected for being anti-choice – care homes and hospices must not be allowed to prevent choice, or at least not for someone wishing to access government assistance to end their life through suicide on their premises.

But what if choices collide? What if, in enabling the choice of one person, I would impact others around us in the same hospice or care home community?

Danny Kruger MP told the committee that he thinks ‘it should be appropriate for the management of a place… to convey to everyone else who lives there that this is, as it were, a safe space in which there will not be state-assisted suicide.’ He suggested that this sort of safe space is something ‘many residents will want.’

Not only is it the sort of care home or hospice that many of us might want, the absence of such safe spaces may also make it even more difficult for marginalised groups to feel able to access the care offered in these spaces. In this recent article, disability rights groups and ‘racialised communities’ expressed fears that if assisted suicide is introduced, it will disproportionately be forced on them – such fears would inevitably lead to a self-preserving self-exclusion from environments which are not seen as safe spaces. Another group who may feel unsafe are those who suffer from chronic suicidal ideation – can’t they choose to find a community that will offer them suicide prevention that will continue even if they receive a terminal diagnosis with a potential prognosis of under six months?

The Bill committee rejected these amendments, meaning that if this Bill passes, these groups will not have the choice to opt in to a safe space should they need or benefit from joining a hospice or care home community.

This Bill doesn’t provide a choice of a safe space for those among us who most need the support of the community around them to reclaim or continue to see the worth and value in their life. It doesn’t provide safe spaces for those who have already been treated as less than their value demands, for those who may have been made to feel burdensome, for those who have been mocked or otherwise mistreated in ways that show contempt for their Maker. This Bill removes from all of us, should we need hospice or care home support, the ability to receive that care in an environment where the equal and inestimable value of every human being is recognised and consistently upheld, all the way to the end of our lives.

Should this Bill be passed into law, this loss will not be limited to the hospice or the care home. This loss will also be felt throughout the NHS. The Secretary of State simply cannot fulfil both a duty to promote health for all and a duty to assist some in ending their lives. Wherever we live, the choice to receive suicide prevention and not suicide assistance from state-funded services throughout all stages of our lives (including the last six months) will be lost.

If this Bill passes, it will not merely offer an additional choice for a few. We would all lose the opportunity to live in a country where all lives are recognised to be of equal and inestimable value, and this loss will inevitably fall most heavily on those who are already most frequently undervalued.