Assisted dying bill: why fears about coercion may be exaggerated – a philosopher’s view

The UK parliament’s assisted dying bill recently passed its second reading in the House of Commons, with 330 votes in favour and 275 against. But the bill still has several hurdles to overcome before it becomes law. It is currently being scrutinised, line by line, ahead of the next parliamentary vote in April.

Many people oppose the bill on the grounds that the risks of coercion are too high. The bill’s opponents make much of this point. But as an ethical philosopher who researches the values of life and death, I think it’s worth asking what exactly is coercion? Where might we encounter it? And is it as bad as it sounds?

Check a dictionary and it seems that coercion involves force, threats, physical pressure and compulsion. But the widespread concern with assisted dying is about something subtler. It’s about illegitimate influence – effective yet often disguised – on someone’s actions.

Certainly there is a danger that someone might be coerced, pressured or persuaded into ending their life when what they really want – and what is best for them – is to live. But this isn’t one-sided.

Equally, they might be coerced or pressured into continuing with life, when what they really want, and what is best for them, is to die. And I believe – controversial point, this – unwanted life is worse. Die too soon and you merely miss out on pleasure, too late and you suffer more pain.

Does this coercion problem surface only in relation to assisted dying? And can we then avoid it simply by rejecting this bill? Hardly. I might pressure or persuade you into suicide, signing a do-not-resuscitate notice, or refusing further medical treatment, which would be harder to detect than when teams of doctors and lawyers are involved. But no one suggests the dangers of abuse mean these procedures should be made illegal.

Is coercion bad? Of course, it can be. But someone might really want to do what they shouldn’t want to do. And in this case, persuading or pressuring them to do otherwise is surely legitimate.

People might want to die when their dying wouldn’t be in their best interest – or society’s, more broadly. Equally, they might want to live when this similarly wouldn’t be for the best.

Arguably, they should then be pressured or persuaded into doing what they don’t want to do, and so sometimes to fight on, at other times to bring their life to an end.

Let’s agree, though, that there is some risk of coercion and of the bad or illegitimate kind. Should we do everything possible to eliminate this risk – get it down to zero? Well, it depends.

There’s some risk, whenever I get behind the wheel, that I’ll cause an accident. Easily solved – a blanket ban on driving. No one seriously suggests this, as the costs would be intolerably high. There are multiple benefits to society at large in allowing people to drive, even when we know some will proceed carelessly, dangerously, under the influence and cause deaths.

So then we compromise, manage the risk, and bring it to acceptable levels. A big part of this is in making people aware that the penalties for dodgy driving can be considerable. It should be the same with other end-of-life issues and made abundantly clear that suspicious deaths will always be investigated.

So whether you poison your rich and ailing relatives, bully them into suicide, or con doctors into assisting with and accelerating their deaths, you should fear being caught out and punished.

Is better palliative care the solution?

Yet some argue that unless there are real benefits to allowing and, further, assisting someone to die, then the risks of abuse, no matter how low, are ones we shouldn’t tolerate.

All dying, they say, can be painless and distress free. We simply need to ramp up palliative care. And then all this hastening of death will be illegitimate, all efforts to persuade someone, despite their wishes, to live on, legitimate. But not only might we doubt whether pain can always be avoided we can, in addition, think there are many other ways in which life can become intolerable.

So then on both counts the arguments against the assisted dying bill are nothing like as effective as the opponents would have us believe. Coercion isn’t as bad or as problematic as is made out. And nor is palliative care – though certainly it has its place – the solution.

Christopher Belshaw does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.