I was initially pleased to see Tony Akkermans’ reply to my article on why humanists should join their Christian brethren to oppose the legalisation of assisted suicide and euthanasia (ASE). The purpose of my article was to inspire debate and open up a conversation. Akkermans’ reply to me indicates that my article was at least successful in ruffling some feathers. However, I hope that others have engaged more deeply with my article than has Mr Akkermans, who, rather than analysing my points, simply expresses exasperation that anyone could make them.

Akkermans begins by telling us all that a ‘basic humanist principle…is the belief that everybody should have agency over their own body and be able to make choices that are best for them.’ That’s a new one on me. I assumed that what unites us as humanists is that we do not believe in God or that a supreme creator is responsible for the wonderful history of humanity.

Akkermans might see that I agree that everyone should have agency over their own bodies. And if he will forgive me for the religious reference (he appears to think I am a ‘crypto-Christian’ anyway): ‘Fear not: for, behold, I bring you good tidings of great joy, which shall be to all people.’ (Luke 2:10-11). You already DO have control over your own body. No one can stop a determined suicide. No competent and free adult should be force-fed or treated against their will. Even Tony Nicklinson—who had ‘locked-in syndrome’—eventuated his own death by refusing food and drink.

What we are talking about is the choice of someone else about whether we should live or die. That is what is meant by ‘assisted’. In every euthanasia/assisted suicide regime in the world, the choice—our ultimate choice—must be approved by doctors. I argue that we must stop these third parties from deciding which lives are worth living and which are not. And I argue that when someone expresses suicidal wishes, our general position should be to assume that their life is valuable (though some aren’t) and to encourage them to live rather than give a counsel of despair or—worse—offer to push them off the proverbial ledge. That, and not because I’m a crypto-Christian or blind to people’s suffering, is why I’m opposed to legalised ASE.

Mr Akkermans lays into my book, which he admits he hasn’t read, by referencing two critical reviews. This is akin to writing critical accounts of hotels not stayed at or restaurants not eaten at on Tripadvisor. But I wish he would have read it. Had he asked, I would happily have sent him a copy. Instead of flinging terms like ‘despicable’ and ‘highly condescending and offensive’ at me, we might have engaged in real debate.

Mr Akkermans accuses me of making ‘several unsubstantiated allegations’ (without seeming to appreciate the irony, he lists just one). Perhaps I could have explained the point about utility more clearly. How do doctors decide which suicidal wishes should be honoured and which should not when faced with a request for ASE? It is on their assessment of whether a life is worth living. Otherwise, we would have to honour the suicidal wishes of a 24-year-old on the basis of unbearable suffering because of a failed love affair just as we would honour the suicidal wishes of an 86-year-old in the throes of a progressive disease. It is either the person’s choice or it is the doctor’s, and if the latter makes the decision it is based on an assessment of whether that life is worthwhile not only to the person but to the world. That—besides a simple cost-benefit analysis—is what is meant by utility.

Morally, I regard assisting a suicide as equivalent to capital punishment. There are cases where a person is clearly better off dead but that does not make the principle right. The case of a prisoner on death row is subject to intense legal scrutiny and the authorities take years to review it—but that doesn’t make it right. Nor is killing an autistic man because his life is wretched right. There may be nuanced arguments for either, but I think we should retain the principle that it’s wrong in both cases.

Mr Akkermans defends Canada, where I was born and raised (I have also lived in the Netherlands, where Mr Akkermans was born and which he also discusses). First, ASE was not demanded by the people or even by politicians but by a judge. In 2019, another single judge decided that the existing criteria were too narrow to be constitutional and that the law must be expanded to include disabled people. An obedient Canadian parliament passed legislation, though they might have used the ‘notwithstanding clause’ to stop the judge’s decision from becoming law.

What has it done to Canada? It has changed the culture to one that sees death as a solution to social problems. Mr Akkermans cites one statistic showing that 42% of Canadians support ASE for mental illness only; what he doesn’t tell us is that in that same survey, significant numbers agreed that medical assistance in dying should be extended to those living in poverty (27%, with the figure rising to 41% among people aged 18-34), the homeless (28%), and the disabled (50%).

I am certainly not the only atheist to look upon what is happening in Canada and elsewhere with horror. Readers might be interested in a film made by another atheist, recently shown on the BBC, which gives an often-ignored perspective from a disability point of view: Liz Carr’s Better Off Dead?

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I am in a minority. As an atheist who supports the aims of the National Secular Society and Humanists UK in almost every other area, including abortion, I find I am at odds with most of my fellow humanists on the issue of legalising assisted suicide and euthanasia (ASE). But there are excellent secular reasons for opposing ASE.

Assisted suicide—or, as some euphemistically call it, ‘assisted dying’—is in the news again, thanks (among other things) to the tabling of an ‘assisted dying’ bill in the Scottish Parliament and the publication in February of a Health and Social Care Committee on Assisted Dying/Assisted Suicide report. Countless legislative attempts have taken place in this and other countries to legalise ASE. Keir Starmer, who favours legalisation, may well dedicate government time to the issue, should he become Prime Minister.

First, we need to be clear about what we are discussing. Euthanasia (from the Greek ‘good death’) is where the doctor acts to end life. It can be voluntary or involuntary. Passive euthanasia is death by omission, i.e. when doctors, either of their own volition or at the request of the patient, purposefully end medical treatment, leading to death. Passive euthanasia might also include a patient refusing food and drink but still being kept comfortable by medical attendants. Such acts are legal. Assisted suicide is when the doctor provides the means but the patient takes the final action. ‘Assisted dying’, or ‘Medical assistance in death’ (MAiD), appears to be a compendium term that might or might not include some of the above. It does not bring clarity to the issue. In fact, as we shall see, it confuses people.

We should also be clear in our language—and humanists should be suspicious of a campaign that uses comforting but vague terms like ‘assisted dying’ to market its ideas. We atheists reject mythology and face facts, yet this term is used uncritically. If a doctor hands you a gun and you shoot yourself, that’s assisted suicide. If she hands you a rope and you hang yourself, that’s assisted suicide. But if she hands you poison and you ingest it knowingly and with the intention of ending your life, we are meant to believe that it is not suicide but ‘assisted dying’? It is no good substituting comforting new myths for old ones.

Moreover, the term ‘assisted dying’ does not help public understanding. In a UK poll conducted in 2021, when asked ‘What do you understand by the term “assisted dying”?’, 42% of Brits polled thought it meant ‘Giving people who are dying the right to stop life-prolonging treatment’. As noted above, this is a right that they already have. When proponents of ASE argue that the majority of Brits support the legalisation of ‘assisted dying’, it is useful to remember that much of what they support is already legal.

I am against a change in the 1961 Suicide Act, not to the rare situations where death is hastened as a byproduct of preventing suffering. Assisting a suicide should remain a crime, as should giving someone a lethal injection, even at their request. I am not against someone hastening their own death by refusing medical treatment or refusing food and water, which is already legal, because individual freedom from unwanted physical intervention trumps our need as a society to save lives.

There are four basic reasons why humanists should join with religious folk in opposing legalized assisted suicide and euthanasia. First, it is not necessary, being built on an irrational fear of a bad death. Second, though many who support the campaign do so out of compassion, utility is the real force behind campaigns; some citizens—particularly those who are disabled or elderly—are inevitably valued less than others. Third, where it has been legalized, real harms have occurred. Fourth, one need not believe in God to conclude that we, as a society, should strive to prevent rather than assist or encourage suicide. Let’s take these arguments in turn.

A fear-mongering campaign

The campaign to legalise assisted dying often plays on people’s fears of how they and their relatives might die. Indeed, many of us have witnessed difficult deaths. But organizations like Dignity in Dying play on our fears. In 2019, the CEO of Hospice UK, a charity that works with those experiencing death, dying, and bereavement, publicly chastised Dignity in Dying for the ‘sensationalist and inaccurate’ portrayal of death in a video to accompany its ‘The Inescapable Truth’ campaign.

Dignity in Dying removed that particular video but it continues to claim that 17 people will suffer as they die every day. What it does not say is that that number is about 1% of an estimated 1,700 people who die every day in the UK. Moreover, ASE will not help those at the end of life. In the Netherlands, where it is legal, up to 42.8% of people experience pain and/or restlessness in their last hours of life. And tellingly, in Oregon, one of the supposed success stories of ‘assisted dying’ legalisation, pain does not feature in the top reasons why people opt for death. This is about existential, not physical, pain.

The (relative) value of lives

ASE’s progressive image is undeserved. Euthanasia was but a branch of the campaign for eugenics when it was first raised as an idea. As the German zoologist Robby Kossmann put it in 1880, ‘the human state . . . must reach an even higher state of perfection, if the possibility exists in it, through the destruction of the less well-endowed individual . . .’

In 1920 Karl Binding and Alfred Hoche published a pamphlet entitled Permitting the Destruction of Life Unworthy of Living. They argued that ‘there are indeed human lives in whose continued preservation all rational interest has permanently vanished’. The German psychiatrist and neurologist Robert Gaupp targeted mentally disabled people when he said that it was time to remove ‘the burden of the parasites’. In this context, we need to remember that Canada today is considering extending euthanasia to those who suffer only from mental illness.

The utility reasoning also exists today, though proponents of ASE are shyer about mentioning it than their predecessors. A Canadian government report entitled Cost Estimate for Bill C-7 “Medical Assistance in Dying” sees savings of up to $53,264 per patient with ASE. Are we meant to believe it when the report’s authors demur that ‘this report should in no way be interpreted as suggesting that MAID be used to reduce health care costs’?

Let’s look at the evidence from countries where ASE is legal. Though every country where it is legal justified changing the law with reference to cases involving the terminally ill, the use of death as a solution for medical and social problems followed. Thirty-nine people suffering only from autism and/or other intellectual disabilities—nearly half of them under fifty—have been euthanized in the Netherlands, where assisted suicide and euthanasia have been legal since 2002. One was an autistic man in his twenties. His record said that he was a victim of regular bullying, that he ‘had felt unhappy since childhood’, and that he ‘longed for social contacts but was unable to connect with others’. On this basis, and at his request, his doctor euthanized him.

Across the Low Countries (Belgium legalized euthanasia in 2003), prisoners, children, those suffering only from dementia, and young people with clinical depression have been euthanized.

Given that, in one large study, over half of the patients predicted to die within a particular period of time lived longer than expected, it is likely that thousands of people who have died from euthanasia have had their lives cut short. Those who, like me, oppose capital punishment worry that innocent people will be killed by an imperfect system, yet few seem to use the same reasoning when it comes to ASE.

Should we prevent suicides?

Perhaps the biggest harms, however, are intangible. There are signs, particularly with the COVID-19 crisis, that some no longer adhere to the principle that human lives—whether rich or poor, black or white, young or old—are equally worthy of protection. We view suicide as generally negative because we value our fellow human beings, even if they do not value themselves. Not all suicides are wrong, but it should be our basic position that we prevent suicides when we can.

As the humanist sociologist and pioneering author of Suicide, Emile Durkheim, remarked over a hundred years ago:

‘. . . [S]uicide must be classed among immoral acts; for in its main principle it denies [the] religion of humanity. . . . No matter that the guilty person and the victim are one and the same . . . If violent destruction of a human life revolts us as a sacrilege, in itself and generally, we cannot tolerate it under any circumstances.’

Of course, many who favour legalised ASE support suicide prevention. But how do they differentiate the two? As Not Dead Yet, an organization of disabled people opposed to ASE, points out, it is assumed that those with fewer years left and those with disabilities lead less valuable lives and, thus, are directed towards ASE—while others are strenuously prevented from killing themselves. Legalising assisted dying would be a huge step in the wrong direction. It will lead to some people’s lives—on physical, or sometimes mental grounds—being deemed as not worth living. That would be a dire and dangerous situation. There is wisdom yet in the famous old Christian precept, Thou shalt not kill.

More on the assisted dying debate

National Secular Society podcast on the 2021 Assisted Dying Bill: Emma Park interviews A.C. Grayling and Molly Meacher, Baroness Meacher

Bishops in the Lords: Why are they still there? by Emma Park

Assisted dying: will the final freedom be legalised in France? by Jean-Luc Romero-Michel

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