On the brink

In 1993, George Pitcher tried to kill his mother.

At 75, she had just suffered through a brain surgery when her condition deteriorated. Rattling gasps wracked her frame as breathing became more difficult.

Pitcher, a journalist and Anglican priest living in the countryside of East Sussex, England, felt he couldn’t bear to watch her keep suffering. In tears, he begged the attending nurse to increase his mother’s morphine dosage, so she might sail away “on an opiate tide.”

Heartbreaking end-of-life stories like this one are Exhibit A for advocates trying to make assisted suicide legal in the United Kingdom. For decades, England’s Suicide Act 1961 has prohibited any kind of mercy killing, even at a patient’s own request. But a new bill working its way through Parliament could change that. If passed, the Terminally Ill Adults (End of Life) Bill would allow mentally competent patients with a terminal diagnosis to access lethal drugs and kill themselves with the state’s seal of approval.

The United Kingdom is just the latest in a growing number of Western countries reconsidering their laws against assisted suicide. It’s a foundational legal shift that radically redefines what makes life worth living and what it means to die “with dignity.” Supporters argue bills like this are the only compassionate answer to the thorny, age-old problem of human suffering.

But an unlikely alliance of theologians, palliative care doctors, and disability rights advocates contend legalizing assisted suicide threatens society’s most vulnerable and reduces the value of life to a person’s productivity, health, or independence.

A man reads a “dying wish” tied to a tree near the Houses of Parliament by a group supporting the Terminally Ill Adults (End of Life) Bill in 2024. James Manning / Press Association via AP

TODAY’S AFFINITY FOR ASSISTED SUICIDE can be traced back to post-WWII Switzerland. Since the 1940s, the Swiss penal code has included a caveat punishing only those who assist another’s suicide from “selfish motives.” Popular stories glorifying suicide for reasons of family honor or unrequited love inspired the legislation. But the loophole allowed a “death tourism” industry to spring up in Switzerland, with wealthy foreigners traveling to centers such as Dignitas starting in the early 2000s.

For decades, Switzerland was a cultural and legal outlier. Back then, Wesley J. Smith was a high-powered lawyer and author in the United States writing about everything from airline safety to corporate injustice. Smith said it was pretty much a “self-evident truth” for people in his baby boomer generation that “you don’t kill sick people. You take care of them.”

At least, Smith thought it was. But in 1992 he received a photocopied suicide note from a friend named Frances. She had checked herself into a hotel room on her 76th birthday and paid a distant relative $5,000 to keep her company as she killed herself. Among Frances’ belongings? A suicide file crammed with literature from the Hemlock Society. The group, now called Compassion & Choices, advocates for assisted suicide, which it terms “medical aid in dying.”

According to Smith, the dog-eared clippings in Frances’ file were essentially “proselytizing for suicide.” Reading them sent a chill down his spine.

Two years later, Oregon became the first U.S. state to legalize assisted suicide. Compassion & Choices President Barbara Coombs Lee helped draft the law. In 2002, the Netherlands and Belgium followed suit. Today, assisted suicide is authorized in at least some places in 13 different countries. Courts in Italy and Germany have also approved the practice, although they currently have no federal laws governing it. And, in March, the Isle of Man became first in the British Isles to approve it.

After Frances’ death, Smith started volunteering with an anti-euthanasia organization. Eventually, he started working full time fighting what he terms the “culture of death.” Three decades later, Smith pinpoints two primary drivers of the assisted suicide movement. First, a widespread loss of religion. And second, the rise of “individual autonomy” as the supreme virtue of the modern age.

Those underlying principles are the reason the so-called “slippery slope”—the argument that legalizing assisted suicide for some people puts everyone at risk—isn’t a fallacy, Smith said. “Because it’s not about terminal illness,” he said. “It’s about killing as an acceptable answer to human suffering.”

In the U.K., lawmakers and plaintiffs have made over 25 attempts to change the country’s assisted suicide laws since the early 2000s, according to Alistair Thompson of the U.K.-based advocacy alliance Care Not Killing. The most recent vote came in 2015, when members of the House of Commons defeated the measure 330 to 118.

However, the makeup of Parliament has since shifted dramatically. In July 2024, the Labour Party trounced the Conservatives and claimed a 63% majority in the House of Commons. Although Labour is split on assisted suicide, bringing the issue for a vote was a central campaign promise for new Labour Prime Minister Keir Starmer.

James Mildred, spokesman for the U.K. group Christian Action, Research and Education (CARE), suspects most of these newly elected Labour members of Parliament (MPs) took their cues from Starmer in the first vote on the issue in November. Almost 60% of Labour MPs supported the measure, compared to only 20% of Conservatives.

But that doesn’t mean it’s a done deal. Many MPs voted “aye” at this first stage of debate simply because they wanted to “continue the conversation,” according to James Eglinton, a senior lecturer at Edinburgh University and outspoken critic of assisted suicide. Only 28 MPs would have to change their minds in the final vote to defeat the measure. And that means, the decision is “on a knife’s edge.”

GEORGE PITCHER wasn’t thinking about personal autonomy or slippery slopes as he sat by his mother’s bedside in 1993. Pitcher just wanted her pain to end. But the attending nurse took him by the hand and told him “quietly, but firmly” she couldn’t increase his mother’s morphine drip—but that everything would be alright soon.

Later that day, Pitcher’s mother became lucid again for a final quarter of an hour. Enough time for him and his sister to say goodbye. By then, their mother couldn’t speak. “But she could see us,” he said. “And in a sense, comfort us with her eyes.” Pitcher read in her expression all the tenderness of a mother more worried about her children’s welfare than her own.

It was a farewell Pitcher said he wouldn’t have traded for anything. And he feels the nurse’s gentle action that day “saved me from myself.” It’s one of the reasons Pitcher opposes his country’s attempt to legalize assisted suicide. “The law, as it stands, is protective of the vulnerable, the disabled, indeed the terminally ill,” he said.

Pitcher recognizes his mother’s situation isn’t exactly the same as what’s authorized under the current bill. She was in no state to give her consent to anything by that final day. But he points out she could easily have qualified earlier in her illness, and Pitcher believes she might have chosen assisted suicide just to spare her children the pain of watching her die.

STUDIES SHOW MOST PEOPLE OPT for assisted suicide for emotional reasons, like loss of autonomy, impaired quality of life, and loss of dignity—not physical pain. One small 2009 study in Oregon found all surveyed patients ranked pain as “unimportant.” Instead, they listed wanting to control the circumstances of death and concerns over future pain as deciding factors. Fear over being a burden is now also cited in 46% of Oregon cases.

It’s a crucial point often overlooked in media hype over end-of-life horror stories. Bios Centre ethicist Anthony McCarthy said pain can often become a red herring of sorts in the U.K.’s assisted suicide debate. “Pain is not actually in the bill,” McCarthy pointed out. Anyone with a terminal diagnosis and an uncoerced death wish can qualify, regardless of whether or not they are suffering physically.

Lucy Honeysett is an experienced hospice nurse and lead coordinator of the support group Christians in Care. She said most end-of-life pain can be alleviated given proper care, and that many people actually die “very comfortably.” Honeysett witnessed that firsthand when she started working in a Christian care home as a 17-year-old in the 1990s. She cared for an elderly woman named Bessie who spent her days quietly resting in a room adorned with embroidered Bible verses.

Over time, Bessie’s mind and body started to “slow up.” She spent more time sleeping in her chair or dozing under her floral bedspread. Eventually, she just stopped eating and slipped into a “deep sleep.” “She died incredibly peacefully without any medication and just faded away and drifted from here to eternity, almost unrecognizably,” Honeysett said.

That experience had a profound effect on the teenage Honeysett. After that, all she wanted to do was work in the “sacred space” of end-of-life care. Since then, Honeysett has cared for countless dying patients. For these people, she said, the pain of death isn’t merely physical. It’s tied up with the “existential stuff”—emotional and spiritual anguish at life’s end.

“The pain of a 31-year-old mum who isn’t going to see her baby grow up … that pain doesn’t get soothed by medication,” Honeysett said. Treating this kind of “total pain” takes “skill and compassion.” “We’re not just an aching arm or a poorly lung,” she said. “We are beings with so many different parts of us.”

IRONICALLY, THE U.K. IS REALLY GOOD at caring for people at the end of life. For at least 15 years, the country has topped the charts for quality palliative care. One 2021 report ranked the U.K. first out of 79 countries worldwide—giving it a more than 20 point lead over the United States. In the 1960s, Britain’s Dame Cicely Saunders started the modern hospice movement from a Christian conviction to care for the sick and dying. Saunders viewed assisted suicide as diametrically opposed to her cause. “You matter because you are you,” Saunders wrote. “And you matter to the end of your life.”

But while palliative care in the U.K. excels—accessing that quality care is a vastly different matter. The hospice charity Marie Curie found 1 in 4 Brits—150,000 people a year—lack the palliative care they need. And it’s a problem expected to grow 26% as the U.K.’s population ages over the next two decades.

While many Brits remain staunchly loyal to their National Health Service (NHS), the agency has long been in crisis. Widespread staffing shortages plague the NHS, and the British Medical Association found there were over 6 million patients waiting for NHS care in December 2024. Among those most affected by these system failings are the country’s disabled citizens. They have proved some of the most formidable opponents of assisted suicide in the country. At least 350 disability groups have banded together to fight the proposed bill.

One of these advocates is Phil Friend, a ­disability consultant and campaigner with the group Not Dead Yet UK. Friend has used a wheelchair ever since he contracted polio as a 3-year-old in 1949. He said at one point during his childhood, doctors suggested taking him off a respirator—telling his mother her son’s quality of life would be “abysmal.”

That early brush with death has shaped Friend’s skepticism about doctors’ ability to make impartial care decisions. Friend said even though the proposed bill only applies to terminal illness, it’s an easy step from there to including people deemed to be suffering “unbearably.” Already, Canada has changed its law from covering only people with “reasonably foreseeable” deaths to those with chronic conditions—including disabilities.

That opens the door for coercion, Friend said. And he fears some disabled people might end their lives because they feel like a “burden” to their friends and families.

George Fielding is another Not Dead Yet UK campaigner who formerly led a social care company. He said it already takes an average of two years to get a wheelchair from the NHS. And things will only get worse if assisted suicide becomes law. “You are trying to free up space within your care home,” Fielding said. “Please don’t tell me that it won’t be a harder fight for … people like myself to say, ‘Actually, I deserve treatment, too.’”

Although disabled activists are often accused of parroting the “religious lobby,” long-time advocate Mike Smith said that’s far from the truth. Many are atheists who approach the issue from a secular human rights framework. He pointed out there is no “right to die” in any of the UN Conventions. “An individual’s right to choose their own way of dying—if it exists—does not in any way supersede someone else’s right to be kept free from harm and to live,” he said.

And that’s exactly what assisted suicide does, Smith argued. Once the government has power over life and death, “You turn the state into a killing machine.”

Sources: World Population Review, Life Issues Institute, World Federation of Right to Die Societies

ALREADY, PHYSICIANS AND CAREGIVERS are seeing the debate’s trickle-down effect. Mark Taubert is a hospital consultant and clinical director providing palliative care in Wales. At a Bios Centre panel in January, Taubert said his staff has already seen a significant uptick in patients and family members asking about assisted suicide options since November: “We’ve had a number of relatives say, ‘Well, couldn’t you hasten my sister or my mother’s death?’”

It’s a shift Taubert would once have celebrated. While in medical school, he supported assisted suicide. But years of experience raised some alarms and turned him “skeptical.” For one thing, Taubert said, it’s actually very difficult for doctors to predict when someone only has six more months to live.

One woman Taubert treated recently told him she’d had the same end-stage lung condition listed in her doctor’s notes for the last 15 years. That condition would qualify the woman for an assisted suicide under the proposed legislation, and Taubert said she might well have ended her life during an episode of depression, had such an option been available. Instead, she’s been able to return home and spend time with her family again.

Taubert said that’s “not uncommon” among the patients at his palliative care outpatient clinic. Some of them he treats for over a decade, or even ends up discharging. But in countries where assisted suicide is legal, more and more of these patients are choosing to end their lives early. In Canada, data from 2023 showed assisted suicides now account for almost 1 in 20 deaths.

And, contrary to many claims, studies suggest legalizing assisted suicide doesn’t lead to a drop in general suicide rates. In some countries, suicide numbers have actually risen. The Discovery Institute’s Wesley J. Smith said that’s because legalizing assisted suicide normalizes a “culture of death” and promotes an “anti-hope agenda.” Even if someone only has three weeks left to live, “you don’t know what kind of wonderful thing can happen to somebody during those three weeks.”

Smith urges Christians and others who oppose assisted suicide to band together to care for the sick and dying, regardless of the law. “The work continues,” Smith said. “And every life saved is an important life.”