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- [00:00]
A
I think assisted death is a Rubicon. It introduces state sanctioned killing into societies which don't even have the death penalty, you know, and that in itself should give us pause. And we need to look properly at all the implications, not just of what happens at the deathbed, but what happens across the system.
- [00:22]
B
And now the good fight with Jasia Monk. I've been thinking about politics for most of my life, and on some subjects I have a strong view. And so when it comes to questions of free speech, for example, I'm pretty convinced that the benefits of a social practice far outweigh its potential costs or risks. In other areas, I feel myself really torn, not because I don't have any principles or don't know how to apply those principles, but because they seem like hard cases in which they pull in two different directions. Assisted suicide is one of those areas. The principle that we should be sovereign over our own bodies and that we should be able to decide ourselves when to end a life of suffering if we have a horrible terminal disease seems very important. But there is also a real risk of abuse, a very real risk of social institutions broadening and broadening that concept. Until you get perfectly medically healthy people committing medically assisted suicide, a risk of them being pressured by doctors or family members to take this step. How do we balance between the interest in having sovereignty over our own body and the dangers of social systems and institutions failing in really consequential ways? Well, to discuss this topic today, I asked Kathleen Stock on the podcast. As you will see, Kathleen does not agree that this is a closed call in do not go the case against assisted death. She argues that all of these supposedly philosophically liberal arguments for the practice are mistaken, that we should reject the social practice of assisted. We have a very interesting debate about that question. In the last part of the conversation, Kathleen and I talk about some of the other issues that have been at the center of her work for the last years. She has written critically about the transgender movement. She has in fact, been forced to resign as a professor of philosophy at the University of South Africa, Sussex, because of backlash on that campus against her public writing on this subject. And we talk about the state of the gender wars in the United States and the United Kingdom, and on the ways in which the sort of lack of trust in institutions that many of us have come to have over the last years makes it really hard to come to reasonable practices in areas from youth gender transition to something like assisted suicide. It is in part, I think, because we can't trust social institutions, all that deeply that we are forced to make suboptimal choices in those areas. Kathleen partially agrees, partially disagrees with that point of view. You to listen to that part of the conversation to get access to all episodes of the Good Fight to support the work we do here, please go to writing.yashamonk.com and become a paying subscriber. And today I'm throwing in a special discount. If you go to writing.yashamonk.com thegoodfight you will get 25% off your first year of subscription, bringing its cost down to about a dollar a week. Writing to dashamonk.com the GoodWight. Kathleen Stock welcome to the podcast.
- [04:13]
A
Nice to be here. Thank you.
- [04:15]
B
I really look forward to this conversation, for the topic is obviously somewhat somber. You've written a book about medically assisted suicide. You end up arguing against it. But I wonder whether before we can get into those arguments, you can lay out the basic liberal argument for the practice. Because I think from a philosophically liberal perspective there are some obvious arguments for empowering people to make their own decisions about the body, their own decisions about how to live and possibly how to die that are quite powerful. What would you put sort of on that end of a ledger?
- [04:53]
A
Well, it's part of the argument of my book that what look like powerful arguments from a liberal perspective actually are pretty incoherent. So it's going to be difficult for me to convincingly lay out the case since I spend so much of the book attacking these so called liberal arguments. But basically there's two different argumentative strains which are not often distinguished and are often sort of ventriloquized together. So people get confused. But one of them is freedom and one of them is mercy. So the freedom one, I guess is the one that you would associate with liberalism, in my view, pretty illegitimately. But the so that would just say something like, look, it's my right as an autonomous human being to do what I want with my body. So it tries to tap into a long tradition within liberalism of having rights over one's body and doing what one wants with it, and tries to justify an argument for state assisted suicide or state assisted euthanasia from that basic liberal right. And for reasons we can go into I don't think that works at all as a justification for state assisted suicide. It's really about that's an argument about non interference and that's not what most people who want assisted dying are asking for. And actually I call it assisted death to make it clearer what we're Talking about the other argument is mercy. And that's. I don't know if you'd call that a particularly liberal argument. I don't think. I think it comes from a Christian tradition of relieving heavy burdens from people of pain and suffering in this case. And everyone can understand that motivation. I do too, and certainly I have those on my side of the fence have no desire to see people in pain or suffering. We just disagree about the best means of organizing the relief of suffering in that way.
- [06:58]
B
So let's go into each of us a little bit to steel man versus cases. And I really look forward to hearing and engaging with the arguments you give for why those are less coherent men might meet the eye on the first one. At the moment, in most jurisdictions there are two kinds of obstacles, right? The first obstacle is that we can go to often state provided or at least partially publicly funded medical services in various countries in order to get all kinds of health services, but we can't get those services for assisted death. But the second one is that in most jurisdictions a doctor or even a friend or family member who know helps carry out your clearly documented desire to die, you know, at the end of a long disease is going to be put in jail, it's going to be prosecuted by the state. Right? And so that's where the kind of core liberal argument lies. Now you might say that liberal argument shouldn't go so far as to say that taxpayer money should be used in order to facilitate this. And I think that that is an interesting argument to make and we can get into sort of what the particular moral consideration should be to use collectively funded pools of money in order to do something that some people have very strong moral objections to. I'm quite receptive to that though. It has interesting knock on effects on other debates like abortion potentially. But at the very least there seems to be a strong liberal case prima fasa to say, well, we should stop criminalizing this. When somebody has a clearly documented desire to stop their suffering, the state shouldn't be allowed to interfere and say no, you're not allowed to render them that act of mercy.
- [08:43]
A
So that's the best, as far as I can see, the best version of the liberal argument, which basically treats a contract with one other person as if it's an extension of the individual's right to do what he wants with his body. And it says, look, this person has agreed and they know what they're doing and I know what I'm doing. So the sort of right of non interference should come around us both and see off the state from our joint enterprise. So that's an argument for lack of criminalization. It's not an argument for state organized, supplied medically or doctor supplied death through the health system, and particularly the public health system. That's a massive structure for what is being presented as a much smaller problem now in the uk. And as I concede at the end of my book, in 2008, the then director of Public Prosecutions, Keir Starmer, who is now our Prime Minister, basically decriminalized assisted dying, assisted death. I mean, it's now very, very difficult to prosecute it. And I think there's been five prosecutions since 2008. So effectively that's where we are in the UK. And I actually say that's probably okay. I still think that there should be a criminal deterrent. I think that the state should be able to investigate, because obviously if it's completely decriminalized, then that opens up opportunities for coercion, particularly of elderly and vulnerably ill people. But I think that.
- [10:14]
B
And obviously, at the very least, you would want an investigation to make sure that it in fact does assist the death and not just murder.
- [10:20]
A
Right? Yeah. And I have a whole chapter on those sorts of. Sorts of cases, or at least I have a part of a chapter on the cases where it looks like it's supposed to be benevolent, but actually the husband's cut his wife's throat or something. You know, it's really quite. There's something savage going on. But you know, I would not have written an entire book against the decriminalization of private acts of assistance. What. But that's. You have to understand that is really not what is happening. What is happening is bureaucratized, organized, institutionalized assisted suicide and euthanasia, often within the context of public health, free at the point of use, and then filtered into the medical system, the legal system, changing social norms across a country, being advertised as a good thing, feeding into equality law. If this group has it, why can't this group have it? There's all sorts of ramifications there ethically that just do not get covered when you treat it as a private individual act.
- [11:17]
B
So let's dwell for a moment on the second argument for the practice. And I'm excited to hear about all your arguments against it. And that is the argument for mercy, which is an argument that doesn't come in any particular way from the liberal tradition, but it's certainly something that the liberal tradition can also speak to. And that is simply the recognition that A lot of people have horrible diseases. In many cases, it is extremely likely that this disease will lead to death within a clear timeframe. And a lot of the time, some of the worst hours on earth that we spend is in those last days and weeks and months. And so it does seem merciful in some cases to allow people to pass away two weeks, perhaps two months before they would otherwise. But having been spared some of the worst hours on earth, having been spared some of the most extreme suffering, some of the most extreme pain that they're likely to undergo during that time period, what do you make of that argument? Do you see the force of it or do you sort of think that that's confused in some way?
- [12:24]
A
Well, I mean, what I've tried to do and what I think we all should do is talk about the systems we have rather than the ones in our heads. And actually there's no system I know of that says two months. So they all say something like six months at a minimum, if not 12 months. And quite often they say reasonably death is reasonably foreseeable, which that could mean like anything up to three years. So we're not necessarily.
- [12:46]
B
Well, death of course is reasonably foreseeable
- [12:47]
A
for all of us. Exactly, exactly. It's one of the major problems with that formulation. But so we're not talking about people necessarily in pain. They need not be in any pain at all. Nearly all the systems I can think of, in fact, all of them talk about psychological suffering or allow the psychological suffering, effectively allow that it's so no pain, just kind of torment. About the prospect of mortality or incapacity or whatever it is, may also be a reason. And when you say death is definitely going to happen, well, if you're saying, if you're trying to give a prognosis in six months, that's actually really quite difficult to do. So there's not necessarily a definite. In these systems there's a prediction which may or may not be correct. But having made those qualifiers. Yes, I mean, basically, once you pursue this kind of argumentative line, then you are saying that assisted suicide is a means to the end of relieving pain and suffering. And also some other stuff that we can get into about so called dignity. But let's just take pain and suffering as the general descriptor. My point at this is that we should not be zooming in and trying to think about the individual person who's in pain and think, well, is it right that this person here or suffering, you know, has a quick death? We need to zoom out and remember Constantly remember that we're talking about a massive system now. The question is not whether this person should have it. The question is whether the government, the state, should try and provide this en masse for people. And at that point I say, well, there's an alternative, and it's called palliative care. It's a technology that few people really know about. It's certainly very imperfectly delivered because it's more expensive than providing death. But technologies and pain control and the secondary effects of pain control, like nausea, have really come on. You know, there's a Britain started the hospice movement, and it should be a jewel in our crown. The idea that you provide places where the goal is not to get better, the goal is to have a good death. And if your aim is to relieve pain and suffering, now you've got two choices. You've got palliative care, you've got killing people. Basically. I think the merciful system is the one that pursues the former, not the latter, for reasons that I go into the effects on the whole. So it's not that I'm unmerciful, but I think I'm particularly merciful. I'm just trying to take a wider view on the effects of bureaucratizing death rather than the one that's traditionally taken by my opponents.
- [15:44]
B
I keep promising you that I'll get to the part where you get to fully make your argument, but I keep
- [15:48]
A
asking, well, I'm making it now.
- [15:50]
B
You are making it now. But I have one more thing I'd love for you to do to situate us in this debate before we really get into the meat of our thoughts on this. What is actually the legal regime around the world? And obviously you're writing this because there's a change of the legal regime that is underway at the moment in the United Kingdom, but a lot of our listeners outside the UK So what is the law of the land in most places in the United States, in Canada, in Britain and continental Europe? What kind of range are we talking about? And how is it that some of the actual developments in countries like Canada and the Netherlands motivate a lot of the concern around this topic?
- [16:31]
A
Okay. Well, my initial impetus for writing was Britain because it looked like we were about very suddenly, over the last year and a half, we were suddenly about to get assisted suicide delivered through our National Health Service. It now actually looks like that threat has been seen off for the moment because the legislation's basically being held up in the House of Lords and the Scottish legislation has just failed. And I'm Relieved, because precisely the things that I'm worried about were the things that objectors talked about across the world. The picture is very diverse, and I really do try to summarize all the different trends, but, you know, people, jurisdictions are coming up pretty much with their own versions. So broadly speaking, you get three kinds of eligibility conditions. The first is you just need a terminal prognosis of some length. Some, in some places it's six months, in some it's 12, and in some it's reasonably foreseeable. Now, in those sorts of regiments, there's no further qualifications. So this applies to Oregon and I think most of the United States. One, the states where they have it, that there's no further requirement of pain or suffering. You just need the terminal prognosis. You need to establish that you're not being coerced in some totally perfunctory way, and then you can get it. Now, that of course, means that you could be chronically depressed, you could have tried to kill yourself several times throughout your life, you could be homeless. You can be doing it for any reason whatsoever. The prognosis is what gets you through the door. After that, no one really cares about why you're doing it or whether it's actually related to your illness at all. And I guess the background rationale there is autonomy, but I have some doubts about that. In other regimes you need both. So for instance, Australia, in some states, you need both a prognosis of the right length and diagnosis of intolerable suffering that cannot be remedied otherwise, or something like that. And then in Canada and in Belgium and the Netherlands, basically this wasn't always the case in Canada, but gradually, as is well known there, the law has extended and become wider in its remit through various legal challenges. All you need to access assisted suicide or euthanasia, is a kind of, I don't know what you call it, a diagnosis of irremediable suffering. You do not need a terminal illness. And that's where you see, particularly in Belgium and the Netherlands at the moment, and actually, indeed in Spain today, there's been a case that's just hit my newsfeed. You see young people with no underlying physical illness that would make them die anytime soon or at all, but with chronic depression, personality disorder and so on, being euthanized by the state. So obviously there's a lot of differences in all of this, but I try and pick out some common themes.
- [19:55]
B
Recently I realized something about my wardrobe, which is that I have some nice clothes to wear to keynotes and panels If I have to go on television, you know, suits and shirts and that kind of stuff. And you know, I have T shirts or athletic wear if I'm going to the gym. But I really don't have a lot of nice, elegant looking clothes for the everyday. And since the weather is getting nicer and I hope to get out a little bit more in the coming weeks and months, I thought I should really spruce up my wardrobe a little bit. So looking around, I came across Quince, which is an online retail store which offers really high quality material at a very nice price. One of the first things I bought, for example, was a very nice cotton mesh stitch sweater polo for a little less than 40 bucks. I'm wearing it right now. It's super comfortable and I have to say it, it looks quite elegant. It looks quite nice on me. The reason why Quince is able to offer really high quality products at a good price is that they work directly with ethical factories, cutting out the middlemen. So if you also want to refresh your wardrobe, try out quince. Go to quince.com Good fight for free shipping and 365 day returns. Now available in Canada too. Go to Quincom. Good fight for free shipping and 365 day returns. Quince.com Good fight. And give us one or two examples of some of those cases which I think try to motivate the kind of liberal case for assisted dying. Some of those individual cases from seemingly perfectly reasonable countries like Canada and the Netherlands and so on, I think helped motivate the case against it. What are some of those?
- [21:48]
A
Oh, well, I mean it basically, it has become assisted death is basically being used for any disease that might have a natural death as its outcome because it will include cases, for instance, where the person is not taking their medication. So a person can get diagnosed from something like diabetes or chemical sensitivity to cigarette smoke, or in one case I can think of deafness, you know, in these, in Canadian cases. And maybe they had a stroke at some point, say a partial mobility. So there's sort of this massive gray area where people are not fully well, but not dying by any means, but the state will has and still, still will consider that their death is reasonably predictable or that they are suffering enough to pass the test. There's also people with learning in the Belgium and the Netherlands, people with learning disorders being euthanized. There's a whole spate of anorexics who basically become so ill through self starvation that they then get the requisite terminal prognosis. Or someone says, well, your Your suffering is clearly intolerable. And either way, they then get euthanized. So these cases strike most people as horrific and not what, you know, you imagine in the paradigm of the person in terrible pain in the last few days of a fatal illness. I mean, that's not what's happening.
- [23:30]
B
Yeah. I mean, just to cite one example that crossed my radar over the last years, a woman called Zoraya Ter beck, who was 29 years old in the Netherlands. She'd been diagnosed with chronic depression, borderline personality disorder and autism, tried numerous treatments which clearly weren't effective, and she was euthanized at her home in May 2024. So this is somebody who clearly was in severe psychological distress, but it was a case in which death was not reasonably foreseeable any more than it is for you and me and for every human. And clearly here, you know, what was a much more restrictive regime earlier on got expanded and expanded in a way that then made assisted dying available to somebody who clearly wasn't in physical pain in the last stretches of a fatal disease, but in a very different kind of context.
- [24:23]
A
That's an interesting case. I mean, I talk about that case in the book. There's also a case that came up today, as I say in Spain, a young woman who was, who seems to be gang raped, who then. I'm not sure at what point she became depressed, whether she was depressed before that, but she certainly was depressed afterwards. She tried to kill herself. She then became paraplegic and she's been euthanized today. So I mean, that's. She's 29 or something like that. And it's in. You can Google that one. I did actually, unexpectedly, I was giving a talk in Berlin last year and I was talking about the Zariah, is it Terbeak case in my talk. And as it happened, a Belgian minister was in the audience because it was a gender conference and he was there to see what Belgium could do about youth gender medicine. And he said, well, I'm a doctor, I have euthanized people and I am partly responsible for the Belgian law. And I said something about 30 year olds being euthanized for mental illness. And he said something like, well, he said this, exactly this. He said, listen, we don't want our young people jumping in front of trains. He said, and you know, the implication is the state will do it more cleanly and the trains will run on time as far as I can see. You know, I said that you can get into that mentality quite quickly once you've got this mechanism. In your system to deal with suicidal ideation basically.
- [25:54]
B
So, you know, we have the argument for some of these practices on the table. You don't find it fully convincing. I have to say that they have a certain amount of moral pull on me. You've started to make some of a case against it. How do we balance between those different considerations? Why is it that rather than trying to restrict the practice or trying to come up with more restrictive terms for them, by and large you conclude that the arguments are just muddled, but they just ultimately don't carry the weight of a burden of proof here?
- [26:36]
A
Well, let me focus on the freedom arguments because they are probably the ones that for some reason seem most attractive to people. Now I think they are fundamentally confused because as I say, we're not talking about a liberal right of non interference, we're talking about assistance and we're talking about assistance from the state, not just from your friend who's agreed, you know, state rep. You want the demand from the pro assisted death lobby is that the state and in the form of doctors should help. And that's what I'm focusing on. So that's not non interference and that's not I want to be left to get on with my own suicide in my own way. Unfortunately, most of us still have that opportunity. I mean not everybody, but most. So we're all, it's a grim fact and one that I do not celebrate. And in fact, I don't even think there's a right to non interference in suicide. As I say in my book, for various reasons, generally we don't act that way. Generally we have suicide prevention, we have suicide watches, you know, so. But we're not talking about someone's individual right to do what they want with their body and particularly not before we've brought the legislation in. So in Britain we don't have it. So now we're in a public conversation about whether to get it. And before we bring it in, it's sort of incoherent to say you should just leave me alone to have what I want. That's not freedom, that's just a demand, a demand that the state do something that I want and it gives us an extra choice, but so does extra breakfast cereals. You know, I mean there's just, it just sounds to me from the perspective of a country which has yet to get it that people going on here about their freedom and their demands that their autonomy be respected are just not making sense. Now if they were genuinely interested in freedom to die for everyone, then why Are they focusing only on the ill? Why not? In a way, the Belgian government might have the best idea if it's really about freedom, which would be anyone who wants to kill themselves should be facilitated by the state. But that's never the argument. The argument is always the suffering, the ill. So that suggests to me it's not really about freedom for that cohort in particular at all. It is about compassion. And that, or at least that's certainly a useful defense that opens the door to this sort of legislation. The freedom legislation on its own really doesn't. I think it just doesn't get anyone anywhere there because of course, once the institutions are in place, someone might be stopped from using them. Maybe that's going to be an inhibition on their freedom. But before the institutions are in place, their freedom is not being curtailed by the lack of them.
- [29:26]
B
So that's a really interesting argument and I want to deal with the connection between the freedom and the compassion argument in a moment. But to stick with a freedom argument within the very specific context of the United Kingdom and the law that was being discussed there. I think you have a point. But there is a way for liberals to restate the argument in slightly broader terms, which is to say that at the moment there's for good reason, a prohibition on murder. And we often use the prohibition on murder in order to restrict every form of assisted dying as well. And obviously, again, this is a very complicated issue because in many cases there's going to be gray zones where we don't know whether somebody really did was in a state where they could request to die, whether somebody is using this as a cover to commit murder. We obviously want to tread very, very carefully so that this doesn't just become an end run around the most vile crime there is, which is murder. Right? But as long as we fulfill those conditions, there could be lots of circumstances where we do want various forms of assisted dying to be permissible on freedom grounds. Now this could just be being allowed to access the kind of medication that you can take yourself. So it should just be that in general, the state needs a reason to prohibit me buying all kinds of things, and the state's reason to prohibit me from buying some kind of cyanide capsule or whatever it might be that'll have the intended effect of killing me if I take it shouldn't be there. It may be saying, why shouldn't I be able to entrust my friend or my relative with helping me die if that's what I wish? They need to be free from criminal prosecution if it's obvious that there really was an agreement between us to do that, and in places where the medical services aren't necessarily state funded, you know, private insurance should be free to offer insurance plans which include as part of its provisions financing for those forms of assisted death. None of that would sort of fall under your concerns about, you know, why is it a responsibility for the state to provide this, which I take seriously. They would all do an end run around that and do, I think, fall more cleanly into the zone of non interference?
- [31:54]
A
I mean, I don't. I think we can sort of get into the arguments about whether it's freedom or not freedom. It doesn't. It's not freedom to die anyway. You already had it. It's freedom to make contracts with people who are going to help you to die and it's freedom to help others without going to jail. I mean, if you're successful, you're not going to jail. So, you know, it's. Let's just say we're now talking about a different kind of freedom to the one commonly used by the pro assisted death lobby, which is freedom from pain or freedom from the burden of your life or freedom to choose. You know, those are, I think that's just misleading rhetoric. Some of the, you know, neither here nor there. Because if there, there's probably other arguments for the things that you're saying. I think, like I say, yeah, and
- [32:39]
B
I'm not, I'm not part of the, you know, pro assist, the deaf lobby. I'm just. No, I know, but I rooted in liberal values trying to puzzle this through. Right.
- [32:48]
A
So it's the way that I would
- [32:49]
B
puzzle it through this perspective of non interference.
- [32:51]
A
In my experience, people really, really want this and they'll find any argument that works for them to get it, you know, for this and that. And maybe we need to really, instead of thinking about the arguments, we also need, or at least need to be thinking about the sort of deep fears and unconscious motivations that are making this seem such an attractive option. And that's part of the book too. But generally speaking, like I say, I wouldn't have written a book against mere decriminalization, but some of the arrangements that you've just described would still need to be carefully handled, extremely carefully handled. And they start to shade into some of the worrying areas that I go through. For instance, about coercion. So there is a huge worry about coercion as soon as you have suicide pills floating around. Elderly, vulnerable and disempowered ill people with carers who have financial interests in freeing up their own time or getting their hands on a house or whatever. I mean, the courts are extremely familiar with the kinds of motives that lead to murder or manslaughter in this area. And whatever arrangements were put in place, it would have to be the right kind of investigation, which would be expensive. So for instance, in Switzerland, I believe every death through assisted suicide has to have an associated investigation. And that's enormously expensive for the Swiss state. In fact, it's becoming so expensive that they can't really deal with the expense anymore. So whatever arrangements were put in place, they would never just affect, and this is the big message, they never just affect the person who wants it and the person who's helping them. They have knock on effects for other people who want to carry on living potentially.
- [34:48]
B
But something similar is true in lots of cases of non interference where we still think that there is a compelling case for erring on the side of liberty. I mean, certainly alcohol consumption has all kinds of downstream costs for society. But I think we rightly reject the prohibitionist argument that because somebody who's drunk is then more likely to lead to other kinds of social cost, from diseases they might suffer to behaviors that might impose other kinds of costs on society, we should just ban alcohol altogether. So if you allow any kind of claim to non interference, any claim to this is something that I'm choosing for myself, for my own life, for my own body, the fact that it might have certain kinds of downstream harmful social consequences shouldn't be allowed to trump that liberty interest. Otherwise we should be able to coerce people to go to university and we should be able to coerce people to make wise choices and not get a divorce and, you know, all kinds of other things. Right.
- [35:50]
A
My argument doesn't depend on just the general shape of some things that we allow people to do have some bad consequences. My argument completely depends on the specific bad consequences of this thing. And they are far greater, I can tell you, than allowing people to drink alcohol. And we also do not let 18 year olds, under 18 year olds in most countries drink alcohol. You know, so I certainly shouldn't have. I'd rather we just honed in on the actual implications for society rather than sort of say, oh, well, in these other cases we let you do things that are bad for you. No, this is, we're letting people die, but we're not just letting them die, we're helping them. We're putting deliberately bringing about death into a health system. We're making the very same doctor who in the morning gives you pain control, in the afternoon give you poison. You know, we are changing the attitude of a population to their health care providers, potentially particularly people who are already frightened of going to the doctor. Now that some of them will be terrified. No matter how often you tell them it's all fine, they are still going to be frightened. We are placing a burden on every single person with a terminal diagnosis because now they have to make a choice that they couldn't. It was socially unacceptable to think about before, but now it's there, it's in the waiting rooms, it's on the posters, it's in the news. And they have to explain to themselves or others why they're not taking that choice. None of this applies to alcohol, you know, so let's just, let's focus on this, the problems that this would bring and is bringing in countries where they have it right.
- [37:22]
B
I mean, the shape of the argument I'm making is not that these specific bad consequences are there, but there's lots of other circumstances where individuals making choices, some of which might be bad choices, has harmful downstream social consequences. I'm just nervous about saying in any case in which there's harmful downstream social consequences, that justifies us in interfering with the liberty of the individual.
- [37:46]
A
And so we agree. So we agree.
- [37:48]
B
Well, I'm not sure we do because I just worry that when we're talking about a case in which an individual makes a decision that's primarily about their own life, but there's a secondary and tertiary consequence for society that are complicated. And you're saying because of those secondary and tertiary consequences that liberty interest should be superseded. And I'm saying that if we acknowledge that principle in general, I worry that we're going to be able to limit all kinds of other freedoms that we take for granted in a liberal society.
- [38:26]
A
But my principle is not the general one, it's the specific one in this case. And I think it's perfectly acceptable for some attempts to instigate legislation to say, no, we're not going to bring this in, not because of the, necessarily just because of the bad effects on the people it would directly affect, but also because of secondary effects. It's perfectly fine to take those initiatives on a case by case basis. And we do already. So I just don't see. I guess I'm just not getting it. I think in this, my argument is entirely directed to this particular case. I think assisted death is a Rubicon. It introduces state sanctioned killing into societies which don't even have the death penalty. You know, and that in itself should give us pause and to look at. And we need to look properly at all the implications, not just at what happens at the deathbed, but what happens across the system. So the book is an attempt to get people to think about those things and to think, is it worth it? Is it going to be worth it? Particularly when you have palliative care that could be funded that would achieve many of the same ends, perhaps even better, is it worth it? And there's a range of problems, from the potential for coercion to the changing attitudes towards medicine towards. And the slippery slope problems. There's also what we do with people who are probably will get mental capacity or will be judged to have mental capacity, but won't necessarily. We might not feel comfortable about that. Like learning disabled people, are they going to get it? Pregnant women, are they going to get it? You know, there's just so many issues here to be thought through carefully, and they're not going to be solved by a quick liberal. Oh, people should be free to do what they want.
- [40:16]
B
Yeah. I mean, again, I feel very torn about this issue, and I don't know what I actually think about it. I just think that clearly, I think there's a reason why a lot of people feel so torn about this issue. Right. And that is that on the one side, it does feel like if you suffer from a terrible disease, being able to decide what happens to you, being able to decide whether you want to go through that suffering or be able to cut that short, is an important form of choice that we should have available to us. And at the moment, in many jurisdictions, there's all kinds of things that are actively keeping us from being able to make that choice, such as being able to contact with somebody to buy a pill that I myself wouldn't take that would put me out of my misery. And the second is you alluded to a fear that pervades this discussion or to some kind of. And I think that's right. Right. I mean, I thankfully am in very good health, but I'm very afraid of having some kind of disease that is going to impose horrible suffering on me. And so the thought that in such a circumstance I might not be able to make the choice to free myself from that suffering does induce fear. Now, on the other hand, of course, there are all of those very real concerns that I take seriously. When I read about some of those cases of assisted death for people who don't have a mortal disease. When I read about older people who might feel pressured by their families, I Read an interesting account recently that I came across randomly by a priest who said he was in favor of his sister dying until he, in his service spoke to a family that said, well, but can't we try and do this by Sunday because we're flying off on a skiing holiday on Monday. And that changed their minds, right? I mean, a lot of people have the interests of their loved ones at heart, and some people don't, and that's obviously a problem here. So I feel very, very torn about this. But I guess to me, the way to get to the bottom of it is to try and size up those competing circumstances. And one way that I think about this, and I wonder how you respond to this, is that the main way in which I've changed my mind about the world over the last 10 years is that I'm much less confident about institutions. I think 10 or so years ago, I just had a relatively high level of confidence that in countries like the United Kingdom and the United States and Germany, where I grew up, by and large, our social institutions are relatively functioning, relatively functional, work relatively well, have the interests of people at heart, don't get captured by extreme ideologies, don't have deep forms of internal dysfunction. And in that kind of world, I think I would be much more open to legislation introducing something like assisted death, because I would assume that the doctors and others who make those decisions would act in a reasonable way. And so one of the reasons why I'm much more sympathetic to your argument than I would have been 10 years ago is that both from seeing some of those actual examples in the Netherlands and Canada and elsewhere, and in my general assessment of these institutions, I'm now much more worried that there might be extreme ideologues in charge of some of those decisions that don't take seriously the case for the other side, that just straightforward financial incentives may drive some of those decisions, with doctors realizing may really be helpful to free up that hospital bed. So perhaps we kind of have a conversation with a patient again, and so on and so on and so forth. I mean, one way of asking this is for you, is part of what's driving this fundamental distrust of our institutions. Do you think in a place that had much more functional institutions, you would be more open to this case? Or is that not a big part of what's driving you?
- [44:07]
A
No, no, it's definitely a big part of what's driving. I mean, in fact, it's part of the point. I keep saying in this book, you know, let's stop thinking of utopias. And let's look at the systems we actually have because that's the, the where. That's where we're going to get assisted death now. Absolutely. In the uk, for numerous reasons, I've become more distrustful of institutions. Perhaps eventually you'll get to ask me about it. But you know, my. In my previous book I talked about a total catastrophic failure of the medical and psychiatric professions towards the bodies of teenagers and young people. So yes, I'm very aware of how institutions can be captured by glamorous moral precepts that are totally shallow and as soon as they become bureaucratized they just become not fit for purpose. But I'm also highly aware of the collapsing health system we have in the uk. Absolutely collapsing. You know, I mean, people on trolleys, in corridors for hours and hours and hours, can't get an appointment with your gp. Care homes not being inspected for years and years. Hospices closing because they haven't got enough funding. We don't have publicly funded hospices, rather they're only 30% funded, the rest is charity donations. They're falling, the birth rate is declining, people are living longer. That pension system is going to collapse soon. So put death, you know, deliberate assisted death into a system like this and you will effectively have an outlet for many social problems that's cheap and quick and the people involved will not be complaining about it afterwards because they won't be here. You will funnel people effectively inadvertently towards taking this option because as soon as assisted death is in a system there is less momentum towards palliative care. So that will actually speed things up. So yeah, I'm extremely skeptical. Can I just go back for a second to the first part of your question there, which was about fear. I just want to add something because we haven't covered it yet and I do think it's really important. The fear that able bodied people have about terminal illness is often about pain, incapacity, loss of bodily function, inability to move around, things like that. Things that disabled people have now, you know, and who are not terminal necessarily. Again, as soon as you say those things are undignified, fundamentally undignified. They're so undignified that if the person wants it, we'll kill them to get them out of that position. It is impossible, as far as I can see, to take that attitude and just inject it in a way that's sequestered from the rest of society without having knock on effect for disabled people. Effectively you are saying you are in a fundamentally undignified position here. Great. That you want to carry on there, but lots of people don't. So we're going to kill them or help kill them. That's just a terrible message to send to the disabled. So, yes, I understand the fear, I do. Of course I do. I'm human and I also have experiences that are relevant to this. But I just don't think personally the cost is going to be worth it. We'll end up with a society that many of us now just will not recognize in about 50 years time. That's my biggest fear.
- [47:26]
B
Speaking of some of these institutional failures, you know, to what extent are there safeguards in place to make sure that, you know, when patients say that they actually agree to die in this manner, that is the case, that doctors don't try and pressure them because they could really use that hospital bed, that families don't pressure the medical staff because perhaps they would like to go on that holiday. Or in one horrible case I read about because the inheritance tax was going to go up on January 1st, and therefore it wouldn't be useful if my relative dies by December 31st. Obviously, if I have one fee on one side, which is that suffering at the end that perhaps might be avoidable, those are the things that activate the fear on the other side that these systems can get so out of control that you get these horrible cases. Do you think that this is an argument I've heard from people who defend assisted death that as long as the laws are drafted in a smart way and as long as they're sufficiently robust to introduce genuine safeguards, those kind of cases can be avoided? What would you respond to somebody making that argument?
- [48:49]
A
Well, I'd like to see what they think these laws would look like, because as far as I can see, having looked extensively, they're not like that at all. There's very little attention paid to background circumstances of the applicant. Ideally, in order to eliminate the possibility of coercion, you would want to know, if you had ultimate access, you'd want to know what is the financial status of this person or what is the family situation of this person. You would want to know whether there's been any domestic abuse in this woman's background, if there's been any convictions, stuff that all you'd want to know is their history of chronic depression. None of that you're allowed to know. You're not. It's again, so this is the influence of the specter of freedom and autonomy coming in to hollow out the safeguarding process Every time someone tries to make an appropriate safeguard, saying, for instance, look, we should have a reasonable time of reflection before we administer the poison. Or maybe we should look into whether there's any domestic abuse charges against her husband or whatever it is, someone will come in and say, no, it's none of our business. They should be, you know, it's not. We need to, we don't need to look into that because it's basically. That would be an infringement of their autonomy. And really, we need to just speed this thing up. So, in fact, what you get is rate reflection times reduced systematically through various challenges. And then, you know, starts off by being administered by doctors, ends up being nurses or pharmacists, you know, ends up. So it becomes access gets wider, safeguards get smaller because they are presented as obstacles to freedom. And that's the case in the. All the systems I've looked at in various ways. So. And then if you add into that the basic lack of money floating around most systems and the fact that doctors really don't know whether to say yes or whether to say no. I mean, they've got no idea. Somebody comes in and says, say that they're, you know, they're, they're homeless or they're alcoholic, but they've got cancer. They're also dyslexic. They can't fill out the forms to get social housing. They say, I want to die. The doctor's not going to try and argue them out of it. The doctor has no idea. It doesn't seem right. You know, they've got several months of life ahead, but, you know, they're not, they're just not going to look for a reason to say no. And what you do get in Canada, perversely, is doctors feeling pressured to say yes because if they don't immediately get the maid team in when somebody starts saying, oh, I can't live like this anymore, relatives may start accusing them of holding the process up. So I don't know what, like, things are like in America, but in Britain at the moment, doctors sign off, I think, 10 million sick notes a year or something like that. Doctors don't seem to be able to say no to people who want things. And I suspect that there'll be no incentive on doctors to say no to people who say they want things, death. They will just think, well, okay, I'm just part of a bigger system. I'll just sign it off. And we will not know whether that person was being coerced financially, physically, or maybe they just want to get out of their horrible life. And this is a very easy way for them to do it. And I don't mean horrible because of illness. I mean horrible because someone's beating them up at home or whatever. So none of that is going to come to light. And I don't know that I can. I just don't think there's systems that are financially well resourced enough to establish it.
- [52:28]
B
Thank you so much for listening to this episode of the Good Fight in the rest of this conversation, Kathleen and I talk about a subject she's written about a lot in the last years, which is the gender wars in the United Kingdom. There has been significant changes in this area. The Travestock Clinic, which facilitated genital transitions for minors, has been closed down. The guidance from the National Health Service about, for example, how early and under what circumstances to prescribe puberty blockers and cross gender hormones has been significantly changed after the CAS inquiry. We discuss whether or not that is a permanent change, or whether some of those changes may end up being rolled back. We also discuss about whether the United Kingdom is ahead of the United States here and shows where the road is going in the United States as well, or whether America may end up being different if, for example, Democrats take back the White House in 2028. We also talk more broadly about the role of trust in social institutions. Is it partially because social institutions are malfunctioning, but you end up with a kind of excesses in the case of medically assisted suicide or perhaps in some cases of youth gender transitions that then make it impossible to govern these spaces in a sensible case by case basis? As in the rest of the conversation, we agree on some things and we also disagree on some important things in that part of a conversation to get full access to it to support the work we do here. To get all episodes of this podcast into your favorite podcasting app twice a week, Please go to writing.yashamunk.com and become a paying subscriber. This week we are throwing in a special discount. If you go to writing.yashamon.com thegoodfight you will get 25% off your first year of subscription writing for yashammonk.com the Good Fight. Thank you for your support.
- [54:26]
A
Sa.