On 1st January 2021, my mother died of cancer. This was shortly before the third national lockdown. I was permitted to be with her in hospital, clad in huge quantities of protective gear, but my partner was back at home. Driving back alone on New Year’s Day, I stopped to buy petrol and thought of telling the attendant, apropos of nothing, “my mum’s just died”.
It felt such a mad, surreal thing — how could that have just happened? How was it allowed? As though suddenly I was carrying an experience that could blow everyone else’s out of the water. Yet at the same time I knew it was utterly mundane. Everyone dies, in some cases slowly and painfully. Most of us witness the death of someone we love. What did I know that I didn’t know before?
This January the writer Anthony Horowitz wrote for the New Statesman about the death of his own mother from pancreatic cancer, and how it informed his view on assisted dying. I have no desire to rank deaths on degrees of suffering, but the experience was clearly horrific. What struck me, though, were the conclusions that followed. Horowitz believes that “almost everyone who has had this experience supports assisted dying […] while the majority of those who oppose it are coming from a theoretical, more high-minded starting point”. If you’ve had the experience, you will have the insight — the only insight, apparently, that matters — and if you haven’t, it’s all a bit abstract to you. Moreover, if you then argue that changes in UK law to permit assisted dying may put the vulnerable at risk, you aren’t just indulging in pointless pontification. You’re in the realms of fantasy.
Horowitz writes mockingly of those who “believe that allowing a change in the law will encourage pensioners less intelligent than themselves to sign their own death certificates the moment they get flu”:
… or that dastardly relatives will arrange Agatha Christie-style exits for their elderly aunts. They worry that people they have never met will be worried to death that they have become a burden. They might even expect the angel of the Lord to appear with trumpets and fires.
Ha! What a bunch of idiots! He goes on to note that “gay marriage, television, the internet, Big Mac hamburgers, trains, planes and automatic vending machines have all had their Cassandras”. It is strange, I think, for him to accuse others of taking a purely “theoretical” approach towards agonising deaths from cancer and then go on to write as though occurrences of potentially lethal coercion between relatives are not just “hypotheses”, but ridiculous, comical ones at that. They happen right now; the argument is not that a change in law would bring them into being, but make them worse. Do you really have to have experienced this yourself to grasp it?
Perhaps in some cases, you do. However difficult it is, it is possible to speak and write of the physical pain suffered by a relative towards the end of life. Explaining the dynamics of carer coercion is much more difficult, not least when it coexists with and masquerades as love. Suggest that some ‘care’ may not be quite what it seems and you may well be accused of lacking the deeper insight of the carer. Indeed, the carer may themselves be convinced that their insistence that an individual has no quality of life is motivated by empathy and that anyone questioning this simply isn’t close enough to the situation to see it.
These are complex human truths, not Agatha Christie stories. Love, abuse and coercion can intermingle. This is something that feminists have fought long and hard to convey with regard to domestic abuse. The typical abuser is not a pantomime villain and a victim does not have to be “less intelligent” to believe that what is being done is for his or her own good. You can make someone feel their life is not worth living in small increments. The outlandish, mocking scenarios put forward by assisted dying coercion deniers — alongside their insistence that coercion would be easy to identify — only suggest that in this, a situation where people can be even more vulnerable than the average abuse victim, coercion would be missed because it doesn’t look like the caricatured version. It never, ever does.
The very existence of assisted dying as an option will make some coercive relationships even more dangerous than before
None of this is to say that I don’t agree it would be wonderful to avoid agonising, drawn-out deaths, or even unremitting, unbearable long-term suffering. Nonetheless, I am beyond sick of the false dichotomy between “people who’ve seen a parent die of cancer and now understand why assisted dying is compassionate” and “total bastards who evidently have immortal parents but would like other people’s to suffer untold agonies because they’re religious fundamentalists, a bit funny about death and / or have some weird need to control other people’s bodies”. In a piece on his excellent Substack, the political philosopher Paul Sagar — who has written repeatedly about assisted dying in relation to his own experiences following a catastrophic climbing accident — describes the need to “just acknowledge that complex social policies have winners and losers — and that in cases like this, the losers will be forced to suffer (sometimes severely)”:
It may well be the case that even people with terminal illnesses in agonising pain should not be entitled to medically assisted suicide […] All I ask, however, is that if those who want help to die ahead of time are told that they cannot have it, then society at least looks them in the eye and admits that they are the political losers, being sacrificed accordingly.
I think this is perfectly fair. I’d ask at the same time that those who take the opposing position could at least admit that the very existence of assisted dying as an option will make some coercive relationships even more dangerous than before. A refusal to admit the costs and complexities of your own position does not make it a strong one.
As someone who supports a woman’s right to end an unwanted pregnancy, I’ve long considered “if you don’t like abortion, don’t have one” to be a terrible slogan — one which wilfully avoids the fact that many of those who oppose abortion take a different moral position on the relationship between foetus and gravida and are not just obsessed with controlling women’s bodies. Similarly, “if you don’t like assisted deaths, don’t have one” is a way of denying the social, economic and relational context in which lives are understood to have value (or not). I’m relatively confident no one will convince me personally that my life is no longer worth living — that if I make that decision, it will be on my terms. That I don’t think this is necessarily true of others isn’t because I think I’m more intelligent. It’s because I appreciate the safety I have right now (but know that could change). Horowitz’s claim that people like me are worrying about “pensioners less intelligent than themselves” is another way of casting concern for others as disrespecting agency or free choice, as if everyone lives on their own personal island.
Horowitz himself is writing “in glorious Crete”, where he muses on the injustice of Dignitas being an option for the wealthy but not the poor. There is no class of people untouched by the deaths of loved ones — or by the approach of their own mortality — so it’s good of him to check his privilege. What’s clear to me, however, is that there is another privileged class, one with many members, who clearly haven’t encountered or noticed how abuse and coercion can operate in seemingly loving relationships, or how sex, disability, illness and social class can make the dynamics even more corrosive. I’m increasingly of the view that if you haven’t noticed this — indeed, if you think it’s all a bit made up — then you do not have the insight into what is at stake in this debate that you think you do. I’m not asking you to change your mind. Just be honest about what it is you’re asking. None of this is fiction.
