Go gently: assisted dying and the old

The transformation of Kathleen Stock from battered academic to charismatic public intellectual is one of the wonders of the cancellation age. It points to heroic levels of personal resilience—and quantities of journalistic instinct, besides. Stock seems not just willing to identify the most difficult issues in our public discourse, but to be positively drawn to them, inspired.

She entered the assisted dying debate in late 2024, driven, she said, by disgust at the “childishness” of “simplistically emotive” politicians advocating for the Terminally Ill Adults (End of Life) Bill, sponsored by Kim Leadbeater, which was then sailing through the Commons. The bill has now been sunk, and Stock’s arguments, gathered here, are no small part of that outcome. This rapidly produced polemic, then, can already count itself an exceptional success.

As perhaps polemics must, it has a narrow focus. Stock is solely interested, as she often reminds us, in the possible provision of a legal assisted dying service in the British NHS and not in the many wider issues of the debate. The Leadbeater bill is the occasion for the argument, while Canada’s medical assistance in dying service provides an Aunt Sally of dangerous practice. Stock has become a passionate advocate of palliative care and frequently posits it as an underexplored and underfunded solution to the problems of difficult deaths.

The core of the book, though, harks back to Stock’s roots in philosophy. The tone is pure unbuttoned don: all sweeping statements, “In medieval times, acts of mercy were wildly popular”; waspish asides, “prominent defenders of assisted death services seem—not to put too fine a point on it—quite rich”; and, throughout, satirical quotation marks and insistent italics pointing out fine distinctions in the meanings of words.

For terms are very important here. Assisted “death” will be used rather than dying, both because “dying” sounds too helpful and because it cannot be satisfactorily defined as a distinct physiological stage. She wants us to understand that “terminal” cannot be truly diagnosed of an illness, nor “unbearable” of suffering. A medicine used to kill becomes a “poison”, those administering them may no longer be called “doctors”, nor the recipients “patients”, because the relationship is no longer therapeutic.

Once we accept all these premises, we will also agree that there is no difference between a (not necessarily!) terminally ill person wanting to die and a healthy person with suicidal ideation. It follows that helping either one to die is a morally equivalent act, a killing, and it is to this that the state must not stoop, in the same way that it should not carry out capital punishment.

Individuals, Stock acknowledges, have a right to kill themselves, though it is an antisocial act. We may be justified in extremis in helping another to die, even in occasionally breaking the law to do so, but—and Stock returns to this many times, with emphasis, as if leaning over her lectern—people do not have the “new right” to state or medical assistance in doing so.

Semantics sorted, Stock moves briskly to archetypes. She divides the supporters of assisted dying into hyperliberal “Freedom Lovers” who see the self as a “gated community” over which they demand unquestioned sovereignty and, “in tension” with them, “Merciful Helpers” who wish to help people die for compassionate reasons. The latter “mean it kindly,” but can’t see that they are fatally judgemental: “they believe that certain kinds of lives are so very terrible, their owners are better off dead.” Enabled by both are “Utilitarians” who are “not particularly bothered with prioritising either personal freedom or mercy”, but see assisted dying as a practical measure with wider benefits for society.

Like the three wise monkeys, the Freedom Lovers acknowledge no social connections, the Merciful Helpers see no possibility of coercion or fraud, and the Utilitarians have no sense of humanity, spirituality or hope. Were assisted dying to enter the statute books, the aggregated foolishness of the three Capitalised Archetypes would quickly ensure “changes in the perceived moral order”. The right to assisted dying would morph into a duty felt by the elderly and pressed on the disabled. Women would be especially vulnerable to coercion. No safeguard would be sufficient. Drift would occur across all institutions because “the idiom of the Freedom Lover ends up favouring the approach of the simplistic Merciful Helper, who doesn’t mind the loss of checks and safeguards, lazily assuming that mercy will have been delivered either way”.

Sometimes Stock’s argument leans so hard on its own terms that it starts to feel like one of those arduous philosophy puzzles with runaway trolley cars and fat men on footbridges

Would they? Sometimes Stock’s argument leans so hard on its own terms—that passage is part of a 1,200-word stretch without grounding in the real world—that it starts to feel like one of those arduous philosophy puzzles with runaway trolley cars and fat men on footbridges. Even the case studies seem unreal: the television series Yellowstone, the suicide of Kurt Cobain, the death of Dylan Thomas. Stock presents us with the dilemmas of a euthanasia request from a woman with stage-four breast cancer, anorexia nervosa and a 21-week pregnancy; from a homeless man with cancer but “little pain”; and with numerous hard cases from the Netherlands and Canada—but no case study of anyone old.

Yet it is the very old who, where it is allowed, make the majority of assisted dying requests, and whose ordinary, multiple, chronic illnesses surely provide the answer to Stock’s repeated, exasperated question of why people require that “new right” of assistance in dying: it’s because they’re not well.

You don’t need to be “substantially paralysed”, as Stock puts it, to be unable to claim your right to kill yourself: being confined to a hospital bed, as most of us are at the end of our lives, will incapacitate you quite sufficiently. And from those beds, many do look up and wonder if they have to live through every moment of a long illness, for the everyday miracles of modern medicine have lengthened living and slowed dying beyond any previous human experience.

Stock also claims that deep palliative sedation, used to knock out a patient for their last days of life, is an “occasional occurrence” whose ethical complications we can “bypass”. But up to 20 per cent of UK deaths happen this way. The precise number is unclear because the treatment can hasten death, making it a legal grey area. I believe it did so for my father, and we were all very grateful.

I won’t go on about my father. Stock is intolerant of deathbed stories like his, where death is willed and welcome. Sentiment, she says, is “laid on with a trowel”. We should rather, she says, be “cementing the taboo against suicide,” and developing “compelling narratives about psychological resilience in the face of even great suffering”.

So I’ll put down my trowel and tell you about my mother instead. In January 2021, aged 82 and suffering from multiple long-term illnesses, she was taken into hospital for a check-up, necessarily alone because of the pandemic. She disappeared beyond all contact. Fifteen hours later, I was phoned to be told she was going in for a major operation. I said, no, please, she had signed many documents declining such interventions. But all her documents were lost and my words were disregarded. After the operation, she was in intensive care for a spell, where she caught Covid. On the single end-of-life visit allowed, she gave Covid to my father, causing, probably, his final heart attack. She survived a little longer and was put in a ward where she started pulling the tubes from her own throat. She told the nurses she had made advanced decisions and did not want to be fed.

I think that last gesture showed “psychological resilience” and find it offensive—exactly because I agree with Stock about the wickedness of suicide—to have it, or my mother’s many advanced written decisions about dying, in any way confused with suicidality. My mother wasn’t trying to destroy her life; she was struggling to accept that she was at the end of it and looking for the people and rites to help her. She was not asking for a “new right” or “lazily” avoiding pain, but begging for her ancient, natural right to die. She had good reasons to think it was being denied her.

Nor, in my mother’s case, did the “slippery slope” Stock warns of seem so very well greased. Far from urging euthanasia on a frail old lady, the state was willing to go to great lengths to prevent her death. No utilitarianism was manifest: not only was her treatment vastly expensive but it took place in the context of lockdown, surely the largest and most popular anti-utilitarian movement since the Luddites. Nor was any Freedom Loving libertarianism visible: not only did the hospital demand absolute rights on my mother’s body but, at home, Test and Trace called us repeatedly, even after I told them that she had finally been allowed to die alone in a side ward. At the same time, under these same laws, more than 400,000 people of my mother’s age were confined in their care homes, many alone, many confused, lest they should risk their lives.

The social taboo, in short, of talking practically about death seemed, even in the middle of a pandemic, to be not only stuffing my mother’s mouth but possibly governing our national decisions. For me, the most alarming aspect of Stock’s book is that she upholds this taboo and contemptuously attacks arguments from the journalist Matthew Parris “that we should get rid [of it] for the wider social good”. When Stock herself has suffered so much from dictums of “no debate”, it is surprising to find her arguing in favour of silence and even warning that suicides will follow if the wrong words are spoken.

Modern medicine has made a good death hard to find. We need, at least, to keep talking about that. Triumphant as Stock’s polemic is, I hope it is not the last word.