We have previously featured a guest contribution that looked more closely at the details of the Bill. The following thoughts from Vital Signs group are of a more general nature. As health workers and concerned working class people we have to discuss together when the state introduces fundamental changes in the health sector – changes that decide how we work and how we relate to patients.

The following points for debate are written from two angles. The first angle relates to a historical and structural view of the current social system. Crisis in capitalism means that the grip on working class lives tightens and that more pressure is piled on to ‘costs’, such as wages, pensions or benefits. The second angle relates to our concrete experiences of caring for seriously ill or dying patients on the wards.

 

1) The Bill is a drastic change in the trajectory of health work

It is not enough to primarily discuss the technicalities of this bill. Even if the bill itself is not ‘far-reaching’, it is nevertheless an important shift: so far the health system was supposed to sustain health and life, now it also becomes responsible for actively ending life. As our health system is hierarchical, we on the ‘frontline’ might be asked to assist with dying without having much knowledge about the wider circumstances – only the doctors and the judge will know more and have a say in the case. This would put us in a very alienated position. 

In wider social terms the Bill changes the discourse. Since it has been passed, groups have lobbied to expand its reach and include patients with dementia or Parkinsons. Currently the public debate circles around the question of ‘who has the right to die’, which opens up the question of ‘what kind of life is worth living?’, and potentially to ‘what kind of life is worth sustaining?’.

2) In capitalism the focus on ‘individual choice or freedom’ often disguises underlying material forces that curb both choice and freedom

Why should it be a problem that individuals have the freedom to choose to end their lives and ask for assistance if they cannot do so themselves? Seen from an individual point of rights there is no problem. The problem arises once we see the wider reality, the social context within which individuals ‘choose’ to do something. An individual might ‘choose’ to join the army, because there are no other jobs around. An individual might ‘choose’ to take drugs, because of previous abuse and lack of hope for a good future. Similarly, an individual might ‘choose’ to end their lives, because there is no adequate palliative care, because they feel isolated or a ‘burden’ on family and society.

3) Working class people have less material scope ‘to choose’ than middle class people

We assume that the people who mobilised for the assisted dying bill are people who tend to feel in control of their lives in general and now want more control over how to end it – we assume that a middle or upper class background facilitates this wish for wanting more choice. Our concern is that a lot of people, in particular working class people, don’t feel that they have much control over their lives. We often end up in jobs where we don’t have much of a say and cannot control our environment. Accordingly, many working class patients tend to develop a certain fatalism towards life and death. There have been many sociological studies that showed that working class patients with substance abuse issues have a much smaller chance to overcome their addiction than middle or upper class patients – because in the end they are all too aware that there is less chance that a good life is waiting for them in recovery. 

There is also the fact that working class patients often feel that they cannot interact with consultants and medical professionals in an equal way, which expresses itself in mistrust or by becoming passive and handing over of responsibility. Taking all this into account we can assume that while middle-class people fight for their ‘right to choose to end their lives’, for working class people this ‘individual choice’ is much more vulnerable to outside structural pressures and open to manipulations. 

4) Many working class patients are made to feel that they are a burden on family and society

From our experience of caring for very ill working class patients on hospital wards we know that many feel like a burden, both to the ‘health system’ and to their families. Facing situations of understaffing and lack of beds and resources, they are made to feel apologetic. We are also often confronted with safeguarding issues, where situations of social isolation and poverty lead to relatives trying to take advantage of patients, e.g. by getting access to their money, property or making decisions over their heads. Given the work stress and the under-funded community care we actually know very little about the vulnerable conditions of working class patients beyond the hospital. Again, all these pressures work on the ill individual and their ‘choice’. It is not far-fetched to think that under these conditions, terminally ill patients might feel forced to ‘alleviate’ the perceived burden.

5) The ‘wish to die’ is influenced by the degree of social loneliness and the quality of palliative care

Caring for dying patients we know that in particular patients who feel alone express the wish to die. To see a patient die alone or with only a few, not too warm relationships around them is a devastatingly sad thing to witness. To see a close group of family and friends saying goodbye is both sad and beautiful – and our hospitals lack space and time to enable this. Crisis and austerity undermine family ties, friendships and adequate palliative care. Unless we can give a warm and collective environment for our dying, we should question our wish to die quicker. 

6) The main organisations that lobby for the Assisted Dying Bill are not grassroots organisations, but have problematic links to the Labour Party and the private sector

On the surface it looks like the main organisations that have been lobbying for the Bill, such as ‘Dignity in Dying’, are grassroots organisations of concerned patients and family members or people with a liberal humanist outlook. Actually, ‘Dignity in Dying’ seems to be based in the neoliberal swamp that exists around Labour Party politicians and their activities in the private commercial sector. A few examples:

• In Scotland, ‘Dignity in Dying’ gave Lib Dem MP Liam McArthur thousands of pounds to fund a member of staff to work on his right-to-die bill. ‘Dignity in Dying’s sister charity ‘Compassion in Dying’ in turn received £300,000 from Church Street Trustees, a tax haven company. US Securities Exchange Commission filings show that Church Street Trustees is linked to a number of senior business figures and American big pharma interests including NovoCure and Channel Islands firm Volati.
• Days after the Starmer government took power, ‘Dignity in Dying’ appointed Paul Blomfield as director and chair of the board. Blomfield has been working closely with Starmer as the Labour shadow Brexit minister between 2016 and 2020.
• Jo Gibbons has been a trustee for ‘Compassion in Dying’ since 2016, and was previously a board member for ‘Dignity in Dying’ between 2015 and 2021. Her ‘Compassion in Dying’ bio says that she worked as a senior adviser for Tony Blair in Downing Street. For a year from 2004, she was a general election coordinator for former health secretary Alan Milburn, who is currently lead non-executive director of the Department of Health and Social Care (DHSC).
• Alan Milburn joined the neoliberal think tank Demos in 2010, at the time when Demos hosted the launch for the lord Falconer-led Commission on Assisted Dying. The think tank was heavily funded by the Bernard Lewis Family Trust, owned by textile industrialists.
• Various Labour Party staffers, amongst them Jo Gibbons, launched private advisory and media companies, such as Blackstock Communications and Story Network. One of the clients of these enterprises is ‘Dignity in Dying’.

The Labour Party has been one of the major forces that combined their party network with NGOs, think tanks and consulting firms in order to drive the process of privatisation, e.g. through ‘private public partnerships’ in health or housing. When it comes to the passing of the Assisted Dying Bill the Labour Party has mobilised the same neoliberal forces to push it through.

7) Historically, times of crisis and austerity meant that the state has to create an atmosphere where working class lives seem dispensable (‘wars’) or an unnecessary cost

The guest article is right in saying that the bill will not save money, but rather cost the health system more. Our concern is that with the global economic and political crisis there is a mounting pressure to ‘save money’ and to ‘get the economy going again’. In this sense the Bill is a potentially slippery slope, a first acceptance of a moral shift that, under mounting financial pressure, can take on a different dynamic. The first ‘victim of austerity’ within the Assisted Dying Bill are the High Court Judges, who were supposed to decide on assisted dying cases. As there are not enough of them and cases in family courts are piling up, MPs plan to issue an amendment that will replace them with a cheaper and more available ‘expert panel’, that has to include a ‘senior lawyer’.

Historically deep crises such as the one we are facing today produced situations where states put more and more pressure on those sections of the working class that they deem as ‘unproductive’: the unemployed, the foreign, the sick, the elderly. The current discourse of ‘individual choice to die’ takes place within a much louder debate about ‘demographic time bombs’ and the ‘financial costs’ that sick and old people inflict on society. The media is full of propaganda, telling us that our societies are ‘getting too old’ and that we cannot afford this. At the same time the state is looking for external enemies again and wants people to get ‘war ready’. ‘Life’ becomes cheap again, both ‘at home’ and at the various frontlines. As long as this absurd system, which puts money above humans, prevails, we have to defend lives at all costs. Let’s show our elderly or terminally sick patients that we have their back and fight with them for the best and most dignified conditions possible.

In relation to the actual scope of the current Bill our concerns might seem over the top – but we think that both the historic cases of mass euthanasia and the current ‘calculated’ and somehow accepted early deaths of elderly people (underfunded health system, cut in winter fuel allowance for pensioners) should ring our alarm bells. Under the brutal conditions of this system, ‘individual freedom’ for some (‘the land of the free’ etc.) has often been mobilised against the anonymous masses of the poor.  

We are not in favour of criminalising anyone who wants to end their lives and seeks help for that – but we want to focus our fight on better care, more time and space for meaningful relationships and dignified deaths.