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Giles Fraser recently wrote that "assisted dying is the final triumph of market capitalism" and concluded, "When the moral history of the 21st century comes to be written, I predict we will look back with horror at how the word choice became a sort of cuckoo in the nest, driving out all other values…The moral language of the supermarket has become the only moral currency that is accepted."
His piece, however, largely addressed the emotional aspects of the issue. He persuasively argued that giving people a choice as to when and how they died would place them in a lonely dilemma. They may feel obliged to spare their loved ones the ordeal of watching them suffer, and opt for assisted dying not because they wanted to, but because they felt it would be best for their nearest and dearest: "It presents the dying with the option of giving their loved ones the gift of their simple swift end."
Perhaps we also need to look much more carefully at the economic and social pressures which may surround such decisions. All the main political parties are now signed up to austerity. We are constantly told that the NHS is becoming unsustainable. The Independent Living Fund is being abolished, and the budgets set for social care are insufficient to meet demand. Increasingly, ill and disabled people are being made aware of what they cost the taxpayer, and fear that they are becoming too expensive.
Perhaps the most disturbing development in this area is the introduction of Personal Health Budgets (PHB). NHS England says: "A personal health budget is an amount of money to support the identified healthcare and wellbeing needs of an individual, which is planned and agreed between the individual, or their representative, and the local clinical commissioning group (CCG)."
For the first time since the establishment of the NHS, patients can be made fully aware of what their care will cost. I cannot imagine anything more likely to make a person feel a financial burden. PHBs are, at the moment, optional, but they seem designed to break a taboo. They introduce the concept that NHS care is not an unlimited public service to which we are all entitled on the basis of need, but a taxpayer funded commodity to which we have to negotiate access. If that is not the case, why is it a health budget and not a health plan?
It is one thing to be terminally ill or severely disabled and have all the support you need. It is another thing entirely to be terminally ill or severely disabled and fear that you may not get that help. Only last week, a coroner ruled that concerns about losing care and support were a factor when Lorraine Andrews, a 44 year old disabled woman from Bristol, took her own life.
The Coroner said, "It struck me that was an issue of real concern to her, for whatever reason." We also know that some terminally ill people are now struggling to get the benefits they need and spend their last weeks worrying about money. In this context, assisted dying may be considered an option for all the wrong reasons.
And of course, as with all such issues, this does not affect the wealthy. For those who can afford private medical and personal care, none of this is a worry. They will never feel they are a financial burden because they are footing the bill. They will never fear losing care because they can buy what they need. If they choose assisted dying it is unlikely to be for lack of care or medical attention.
The moral, religious and ethical arguments around assisted dying are taking place in public and that is a good thing. But the economic and financial aspects of the issue which must be a significant factor are not being rehearsed so publicly.
If we lived in a society where we had economic equality, we could arrive at a decision based on reason, humanity, and compassion. In a society as unequal as ours, we may risk bringing about a situation where we eventually have assisted living for the wealthy, and assisted dying for the rest.
© Bernadette Meaden has written about political, religious and social issues for some years, and is strongly influenced by Christian Socialism, liberation theology and the Catholic Worker movement. She is an Ekklesia associate and regular contributor. You can follow her on Twitter: @BernaMeadenTweet