By Liam Gibson

The opening lines of the Universal Declaration of Human Rights proclaim: “Recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.” Preeminent among these rights is: “The right to life, liberty and security of person.”[1]

At present, there are two bills in the United Kingdom that specifically seek to legalise physician-assisted suicide: the Assisted Dying Bill, introduced to the House of Lords by Baroness Meacher, and the Assisted Dying for Terminally Ill Adults (Scotland) Bill, introduced to Holyrood by Liam McArthur, a Liberal Democrat MSP. These Bills not only endanger the lives of vulnerable people, but also threaten to undermine the foundation on which all human rights are based – human dignity.

Both the Meacher and McArthur Bills are supported by the organisation that was known for 70 years as the Voluntary Euthanasia Society. In 2006, however, this group changed its name to Dignity in Dying. In terms of public relations, this rebranding was hugely successful. The new name not only avoids the unpleasant association with the killing of the sick and disabled – in Hitler’s Germany, for example – but it also cleverly implies that laws that prohibit voluntary euthanasia deprive the terminally ill of their dignity.

During the House of Lords debate on 22 October 2021, Lord Michael Grade, the former television executive and a self-described liberal, drew attention to one of the ways in which the notion of dignity has been distorted by the advocates of “assisted dying”, when he said:

I reject one key argument: that assisted dying restores an individual’s dignity. I cannot accept that it is undignified to succumb to nature, however inevitable or distressing. Dignity and indignity in the dying process depend entirely on the treatment and care afforded to the patient. To be the involuntary victim of fatal illness cannot be regarded as undignified.

On the other side, I was not persuaded that to vote against the Bill and deny choice means that you must be uncaring, content to stand idly by and allow individuals to suffer unimaginable pain and despair.[2]

Rather than win public opinion with rational arguments, the campaign for assisted suicide has relied heavily on emotional manipulation, playing on people’s fears of suffering and their compassion for the terminally ill. And while Lord Grade’s remarks are accurate, there is a far more serious attack on dignity with potentially far-reaching consequences.

In its legal battles, the assisted suicide lobby and its allies in the medical profession have presented human dignity as synonymous with personal autonomy.

In 2003, Ruth Macklin, at the time a professor of medical ethics at Albert Einstein College of Medicine in New York, wrote an article in the British Medical Journal with the title “Dignity is a useless concept. It means no more than respect for persons or their autonomy.” She concluded that as a concept in medical ethics it “can be eliminated without any loss of content”.[3]

The reverse expression of this equation is the view that someone incapable of exercising autonomy is devoid of dignity. Individuals like Tony Bland, Terry Schiavo and Vincent Lambert can have food and fluids withdrawn and their human rights denied on the pretext that their lives are without dignity. The same disregard is shown for the rights of unborn children.

On 26 February 2020, the German Constitutional Court struck down legislation prohibiting commercial assisted suicide services for breaching the country’s Basic Law. The judges found that the free development of personality, guaranteed by Article 2(1) of the Constitution in conjunction with Article 1, which declares human dignity to be inviolable, created a right to commit suicide. While the legislation did not forbid assisted suicide completely, the court found that it made it difficult to obtain for individuals whose doctors would not facilitate requests for lethal drugs. It concluded, therefore, that it was unconstitutional to prevent businesses from offering the necessary assistance based on payment, stating that:

The right to a self-determined death is not limited to situations defined by external causes like serious or incurable illnesses, nor does it only apply in certain stages of life or illness. Rather, this right is guaranteed in all stages of a person’s existence. Restricting the scope of protection to specific causes or motives would essentially amount to a substantive evaluation, and thereby predetermination, of the motives of the person seeking to end their own life, which is alien to the Basic Law’s notion of freedom.[4]

The German state’s “respect” for human dignity, therefore, requires that the law should facilitate an individual’s wish to end his or her life. And despite the court’s assertion that assisted suicide services are not required solely for the ill, infirm or disabled, its discussion is framed in terms of the compliance of the medical profession, palliative care, access to controlled drugs, and so on.

The underlying assumption is that assisted suicide is a medical issue. This ruling, “in its majestic equality”, illustrates Anatole France’s ironic aphorism about the unequal impact of ostensibly equal laws.[5]

There is also growing evidence that this interpretation of human dignity is too susceptible to external influences to provide robust protection for vulnerable groups such as the seriously disabled. In Geronticide: Killing the Elderly, Mike Brogden shows that, in practice, personal autonomy is not a decisive factor for Dutch physicians when they euthanise their patients. 

This is supported by the finding that 1000 people actually had their lives terminated without an explicit request. In many cases, it is the condition of the patient, not the request, which is the real ground for euthanasia.[6]

This has been the experience of the Netherlands. As one author, writing in the Journal of Medicine and Philosophy, notes:

Paradoxically, the jurisprudential ‘legality’ of euthanasia that was fought for by advocates of voluntary euthanasia on the basis of the principle of autonomy and self-determination of patients, actually has increased the paternalistic power of the medical profession above its last limit, above the law.[7]

This paradox has arisen, at least in part, from the increasing medicalisation of our society. One example of this is government policy on teenage pregnancy. As Robert Ebert points out: “Teenage pregnancy is primarily a social problem, but a social problem is more difficult to analyse, to talk about, to do something about, so that it becomes easier to make it a medical problem.”[8] 

In the UK, the NHS supplies contraceptives and abortion drugs to underage girls, not to remedy illness, but to advance social and economic objectives under the cover of medicine. Once framed as a medical concern, patient autonomy and confidentiality can be invoked to reject any demand for parental oversight. Similarly, suicide becomes medicalised through the prescription of lethal drugs to suicidal individuals, not as a treatment for illness, we should note, but to facilitate acts of self-destruction on the grounds of personal autonomy. And since it, too, is shielded by patient confidentiality, the regulation of physician-assisted suicide “must, in the end, be physician self-regulated”.[9]

It is not possible to claim that the legalisation of assisted suicide will only affect the individuals involved and not human beings collectively. As with the right to liberty, the voluntary renunciation of the right to life means it ceases to be inalienable. The understanding of a human right once altered, is altered for everyone.