Assisted Dying: What Should We Think? LSE: Public Lectures and Events Podcast Series Hosted by London School of Economics and Political Science Release Date: March 13, 2025

Introduction

In the March 13, 2025 episode of the London School of Economics and Political Science (LSE) Public Lectures and Events podcast, the topic of Assisted Dying is explored in depth. Hosted by Dr. Lewis Ross, a member of the philosophy department and director of the Centre for the Philosophy of Natural and Social Sciences, the discussion brings together an esteemed panel to dissect the complexities surrounding assisted dying legislation in the UK and its implications globally.

Panel Introduction

• Father Hugh MacKenzie: A Catholic priest and hospice chaplain with over a decade of involvement in the Catholic Medical Association.
• Kenneth Chamber: Professor at Ghent University, specialized in end-of-life care research, particularly assisted dying since 2006.
• Alex Voorhoeven: Philosophy professor with experience in bioethics from the U.S. National Institutes of Health and Erasmus University Rotterdam, drawing from personal experience in caring for terminally ill relatives.
• Emily Jackson: Law professor at LSE, advisor to various bioethics councils, and seasoned participant in public debates on assisted dying.

Overview of the UK Assisted Dying Bill

Speaker: Emily Jackson (06:36)

Emily Jackson provides a comprehensive overview of the Terminal Adults End of Life Bill, currently at the committee stage in the UK Parliament. The bill aims to legalize assisted dying under stringent conditions:

• Eligibility:

  • Adult patients (18+) with a terminal illness expected to result in death within six months.
  • Must have mental capacity and a clear, voluntary, and informed wish to end their life.
  • Excludes individuals with mental disorders or disabilities as sole reasons for seeking assisted dying.

• Procedural Safeguards:

  • Requires approval from two independent doctors.
  • Mandates discussions about palliative and hospice care options.
  • Introduces a reflection period: seven days between doctor assessments and an additional 14-day period (shortened to 48 hours if death is imminent) after panel approval.

• Legal Protections:

  • Coercion or pressure to undertake assisted dying is a serious criminal offense, punishable by up to 14 years in prison.
  • Physicians are not obligated to participate in the assisted dying process.

Emily emphasizes the bill's characterization as "the toughest regime in the world, with safeguards upon safeguards" but acknowledges ongoing debates about its sufficiency.

Philosophical Perspectives on Assisted Dying

Speaker: Alex Voorhoeven (17:17)

Alex Voorhoeven delves into the philosophical underpinnings of assisted dying, highlighting three core principles:

1. Reduction of Suffering: Alleviating unbearable suffering with no prospect of improvement.
2. Self-Determination: Empowering competent individuals to make autonomous decisions about their own lives and deaths.
3. Societal Assurance: Providing a "comfort blanket" that reassures individuals facing potential suffering, enhancing overall capacity to endure life's burdens.

Alex references the Epicurean philosophy, suggesting that the option to end life can mitigate the fear of suffering, aligning with historical perspectives on death and autonomy.

Religious and Ethical Considerations

Speaker: Father Hugh MacKenzie (26:07)

Father Hugh MacKenzie presents the Catholic Church's stance on assisted dying, emphasizing three primary areas:

1. Religious Doctrine: Asserts the intrinsic dignity of human life, arguing that assisted dying undermines the inherent value bestowed by God.
2. Role of Reason and Community: Advocates that true freedom and autonomy are realized through relationships and community, not isolation or self-determination detached from social bonds.
3. Practical Implications: Critiques the bill for potentially eroding societal values and the intrinsic worth of life, arguing that formalizing assisted dying sends a message that devalues human existence.

He states, “We believe any physical suffering actually will get us through,” underscoring the belief in the resilience and enduring nature of the human spirit against suffering.

Practical Lessons from Belgium and the Netherlands

Speaker: Kenneth Chamber (39:42)

Kenneth Chamber shares insights from Belgium's and the Netherlands' experiences with assisted dying:

• Belgium's Approach:

  • Legalized euthanasia and physician-assisted suicide in 2002, with provisions extending beyond terminal illnesses to include mental and non-physical ailments.
  • Decision-making is primarily the physician-patient relationship, with minimal external oversight, fostering trust but leading to challenges in cases involving mental health.
  • Over two decades, euthanasia accounts for 4-5% of deaths, predominantly among terminal cancer patients.

• Challenges Identified:

  • Physician Reluctance: A significant percentage of physicians object to participating in assisted dying.
  • Scope Creep: Initial restrictions have gradually expanded, raising concerns about boundary erosion.
  • Implementation Issues: Cases involving psychiatric conditions or dementia pose complex ethical and procedural dilemmas.

Kenneth emphasizes the importance of social learning and adapting legislative frameworks to ensure responsible implementation, noting, “We are opening the door,” reflecting on the initial step's irreversible implications.

Audience Interaction and Panel Debate

Slippery Slope Concern

Speaker: Father Hugh MacKenzie (48:33)

Father Hugh challenges the notion of a "slippery slope," arguing that the current bill represents a direct pathway toward broader acceptance akin to Belgium and the Netherlands. He states, “By taking this first step in the current bill, what we're doing is exactly that. We're opening the door.”

Response: Kenneth Chamber (49:04)

Kenneth counters by advocating for a progressive, evidence-based approach. He notes that initial strict criteria can prevent immediate overreach and provide time to observe and adjust laws based on empirical evidence from established jurisdictions.

Age Limits in Assisted Dying Legislation

Question by Audience Member (75:00)

An audience member raised concerns about the UK bill proposing an age limit of 12 years for assisted dying, questioning why not lower the age if identical reasons apply across ages.

Response: Kenneth Chamber (75:44)

Kenneth explains differences between Belgian and Dutch frameworks, highlighting Belgium's removal of age limits in 2014 to focus solely on the individual's suffering rather than age. He underscores the stringent requirements, including parental consent and comprehensive psychiatric evaluations, to mitigate risks associated with lower age brackets.

Final Thoughts and Conclusion

Speaker: Dr. Lewis Ross (85:51)

Dr. Lewis Ross wraps up the discussion by urging listeners to engage in the political process, emphasizing the critical nature of the assisted dying debate and the importance of informed participation in shaping future legislation.

Closing Remarks (86:24)

The panel acknowledges the complexity of the issue, recognizing the balance between ethical principles, practical implementation, and societal values. They underscore the necessity of robust safeguards, comprehensive palliative care, and ongoing dialogue to navigate the morally charged landscape of assisted dying.

Notable Quotes

• Emily Jackson (06:51): “There are just three other points I wanted to make before stopping that, I think, matter.”
• Alex Voorhoeven (17:17): “The core claim about self determination is not really an empirical claim. It's an essentially normative moral claim...”
• Father Hugh MacKenzie (26:13): “Human freedom or autonomy is not an absolute thing... It’s manifestly ordered to fostering friendship.”
• Kenneth Chamber (39:42): “We are opening the door,” reflecting the initial step towards broader assisted dying acceptance.
• Alex Voorhoeven (59:33): “There is no regime in which this is intended to be an encouragement or pressure put on individuals by a physician.”
• Father Hugh MacKenzie (57:30): “We believe there's a meaning to freedom, a pattern to its full use, which is relationship with others.”

Conclusion

The LSE podcast episode on assisted dying presents a multifaceted examination of the topic, balancing legal, philosophical, religious, and practical perspectives. The discussion underscores the profound ethical dilemmas and societal implications of legalizing assisted dying, highlighting the need for careful consideration, robust safeguards, and empathetic dialogue to navigate this sensitive issue.

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