Nick Spencer critiques the idea that ‘dignity of choice’ is the most compelling moral argument in the assisted dying debate. 01/11/2024

Esther Rantzen put it best. Not long after Kim Leadbeater announced her private members’ bill, the former TV star was interviewed by Amol Rajan on BBC Radio 4’s Today programme.  

“All I’m asking for is that we be given the dignity of choice,” she said, using a telling phrase that I have italicised here. “If I decide my own life is not worth living, please may I ask for help to die. It’s a choice.” She continued, “I don’t want to pressure anyone either way…it’s the most personal choice…like whether or not to have a baby… I’m asking for choice.” 

This is a very widespread sentiment. I have had two conversations in the last week alone with people who were indignant, bordering on furious, that I was prepared to argue against the right to choose the manner of death, especially when it came to someone suffering from a painful and incurable illness. 

As noted in a previous blog, I do waver a bit on this issue but, ironically, it is when I hear Esther Rantzen’s words, or words like them, that I am nudged most decisively away from supporting any change in the law.  

On the surface, the argument sounds reasonable, indeed obvious. We have been well trained by decades of consumerism to hear ‘choice’ as not only as axiomatic but as morally momentous. If my sentence begins ‘I choose’, you are going to need a damn good reason to deny me. Moreover, the phrase familiar from the abortion debate – “my body, my choice” – so often repeated, so rarely interrogated, so automatically assumed unanswerable, has softened us up for the assisted dying one. “My life, my choice.” 

A little reflection shows that “my body my choice” is not really a moral argument at all, let alone an inherently persuasive one. “My body my choice” – really? Does that apply to sex selective abortion? To self–harm? To suicide? So it is with the argument from choice in this debate concerning the other end of life.  

Look at Esther Rantzen’s words again. “If I decide my own life is not worth living, please may I ask for help to die. It’s a choice.” Seriously? If you are like me, there will have been a few times in your life that you have felt – deeply felt – that your life is not worth living. I know I am, by nature, a melancholic soul but I doubt whether I am that exceptional in this. I can only thank God that I wasn’t living in Canada at the time where MAiD (Medical Assistance in Dying) is now the fifth commonest cause of death. 

Ah! respond those in favour of the Leadbeater bill. That may be so. But that is not what is on offer in this bill. On the contrary, the Leadbeater regulations are highly restrictive, and will remain so.  

But they will not remain so, because they cannot remain so. If we really do intend to prioritize ‘autonomy’ in the way that advocates of assisted dying do – if we do want to give people like Esther Rantzen the “dignity of choice” – we no longer have any grounds to deny it to people who argue – with great reason, cogency and unassailable self–knowledge – that they have come to the conclusion that their life is not worth living, and do not want to go on living, and that they want the dignity of choice too. If you put all your eggs in that philosophical basket, you have no tools left to argue against that view (and if you come across a more mixed metaphor today, you should treasure it). 

Or, put another way, law is not positivist. It cannot exist solely on the basis of judicial decisions. It needs moral and philosophical ground beneath it. It is all well and good to propose tight restrictions for any incoming legislation, but unless there is an underpinning philosophical logic to them, they will not hold. You will find yourself on a tilting slope – with only the slightest of gradients, perhaps, but tilting nonetheless – without a brake to reach for.  

It is no accident that Leadbeater’s bill has already been criticised by some for being too tight. It is no accident that restrictions have been gradually loosened in Belgium and the Netherlands. It is no accident that Quebec has just this week become the first province in Canada to allow people to make advance requests for medical assistance in dying (MAiD), meaning that “a person with an illness that will eventually leave them unable to grant consent can arrange to receive a medically assisted death when their condition worsens, be it months or years in the future.” 

It is no accident because there is a perfectly consistent, cogent and coherent logic here. If we think dignity means choice, this is where we must end up. However alluring it may sound, however it is dressed up as compassion, and however much it is the de facto basis of a consumerist society like our own, the fact is that choice is not enough. 

Theos’ new report, ’The Meaning of Dignity: what’s beneath the assisted dying debate’ can be read here.

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