Finding itself in a financial hole, Labour looks to the depressed and chronically ill.
Finding itself in a financial hole, Labour looks to the depressed and chronically ill.
T he United Kingdom is moving toward legalizing euthanasia, following in the path of Canada and other countries. Prime Minister Keir Starmer is reportedly fast-tracking legislation, with a vote in the House of Commons now expected before Christmas, possibly within weeks. While he has promised no repercussions against those who vote against his pro-euthanasia line, his massive majority leaves little doubt that his view will prevail. What is curious is that he is in such a rush. The reason, sadly, may be reflective of one of the darkest aspects of universal health care, and of the welfare state as a whole.
Starmer, when cornered in a phone call with an activist in March, did announce that he would change the law to allow euthanasia (“assisted dying”) during this parliamentary term if he were to win the election, as he did. Yet this issue did not come up during the election campaign. Other than this vague promise to legalize euthanasia sometime over the next five years, nothing really suggested that the issue was one Starmer cared more about than did voters, who ranked it 22 out of 23 on their list of priorities. That, however, was then.
To say that Keir Starmer’s first 90 days in his new office have been tough would be an understatement. Elected in a landslide in July, Starmer now finds himself with a net approval rating of negative 30 percent. Mere weeks after taking office, Starmer announced that the U.K.’s fiscal health was far worse than what official numbers had indicated prior to the election. Whether that truly came as a surprise is controversial, but either way, the Treasury has a £22 billion black hole. Instead of shoring up support by picking off items on the progressive wish list, Starmer and Rachael Reeves, his secretary of the Treasury, have had to announce several cutbacks.
Among the most controversial are the introduction of means-testing of the winter fuel allowance for retirees and the scrapping of a planned lifetime cap on the amount one may have to pay for social care.
On top of these unpopular austerity measures, Starmer has had to deal with riots, and he and several of his party colleagues have also been embroiled in an expenses scandal, accused of having accepted gifts, including Taylor Swift tickets for one of his MPs and a new wardrobe for his wife. For those voters hoping for a fresh break from the Tories and their less scrupulous approach to politics, this has been a great disappointment. As with the austerity, those most disappointed are the progressives who form the core of Labour’s support.
On the surface, it may seem that none of this is related to euthanasia. However, despite being a complicated and sensitive ethical subject, euthanasia is, much like abortion, subject to the whims and incentives of politics. Fast-tracking a bill is always risky, and there is reason to think, given the current political and economic climate, that the timing may not be a coincidence.
In the United States, and in particular on the right, Canada’s MAID (Medical Assistance in Dying) system may be the subject of ridicule, but elsewhere perspectives are far more mixed. While the horror stories of young, nonterminal patients being pushed to kill themselves have received a lot of attention, there is no denying that the Canadian system is a money-saver. A substantial share of lifetime expenditures on health care takes place in the last six to twelve months of life. In countries with universal health care, this cost is borne by the public. In most of those countries, that is also true for the cost of nursing homes and other social care for the elderly and disabled.
While policy-makers are hesitant to make the case for euthanasia on economic grounds, in academic circles the argument is not new. Just a few years ago, in a widely publicized study, a group of Scottish researchers argued for euthanasia on the basis of cost savings. They also noted that euthanized patients could provide additional organs available for transplantation. In the middle of the austerity following the financial crisis, Peter Lachmann, the founder of the British Academy of Medical Sciences, made the same argument. More than a decade earlier, yet another British researcher argued that the U.K. could not afford to “ignore euthanasia.” In Japan, a country with an even more dire demographic problem, a member of the government made waves by stating that the elderly should be allowed to “hurry up and die.”
Of course, the economic argument is never used as the sole, or even main, basis for legalizing euthanasia. Yet policy-makers in countries with universal health care will struggle to ignore it. After all, while such countries do not have the infamous “death panels” described by Sarah Palin when Obamacare was being debated, treatment is regularly denied, including to children, because health-care administrators deem them cost-prohibitive. Having few private options, patients frequently find themselves with nowhere to go.
In addition to the stress caused by having to find at least some of the £22 billion needed to plug the gap, Starmer is under pressure also to reduce wait times with the National Health Service. While voters in other countries with taxpayer-funded health care tend to hold their health-care systems in high regard, in the U.K. the NHS has been described as the country’s new national religion. Suggesting cuts to the NHS, or even partial privatization or other reforms, is a political third rail akin to suggesting cutting entitlement spending in the United States. Many governments have been brought down owing in part to dissatisfaction with wait times; before the election in July, 51 percent of voters ranked health care as one of the three most important issues, and 85 percent of voters disapproved of the Sunak government’s handling of it.
While all universal-health-care systems require patients to wait to receive care, strikes by British nurses and doctors in recent years have seen queues lengthen. Today, only 59 percent of patients receive nonurgent treatment within the target of 18 weeks. Starmer is no doubt acutely aware that his political standing and chances of reelection will suffer unless he turns the ship around. Just weeks after he took office, the government caved to the demands of the British Medical Association, ending the strike by approving steep salary increases for junior doctors. Nurses were also offered above-inflation pay hikes, but they are still holding out for more.
While pay hikes may help retain and recruit staff, they are unlikely to have any significant impact in the short to medium term. Arguably the greatest problem for the NHS is that Britain’s population is aging, increasing demand for health care. Last year in Canada, more than 15,000 deaths, almost 5 percent of the total, were the result of euthanasia. The number has grown rapidly since 2017, the first full year of legalization, when only 2,838 Canadians were euthanized. The trend line is similar in European countries with legal euthanasia, with particularly sharp increases since the pandemic year of 2020, which saw many universal-health-care systems overburdened. In addition to freeing up financial resources, euthanasia serves to free up doctors, nurses, and hospital beds. The stark reality is that comprehensive-welfare states such as Canada and the U.K. frequently reduce citizens to numbers on a spreadsheet.
While this aspect of the welfare state is usually ignored by American progressives, it is not lost on British voters. Brits are generally positive toward euthanasia, though a plurality worry that it would incentivize health professionals to encourage patients to take their lives. Given documented cases of doctors in Canada using the economic argument to convince patients to consider euthanasia rather than drain public resources, those fears may not be unjustified. A plurality of voters also worry that euthanasia would lead to a reduction of funding for palliative care.
For Starmer, the political gains of a “quick fix” to reduce wait times are obvious. As are the benefits of changing the conversation and scoring a win on a “culture war” issue that may stop the grumbling of certain progressives, for whom Starmer’s first 90 days in office have been a disappointment. Yet, while less obvious, there are also political reasons why Starmer should reconsider: Any welfare state hinges on a strong social contract, by which the citizens agree to pay sometimes exorbitant taxes with the expectation, if not the legal guarantee, that the government will provide for them in their time of need. If Starmer is perceived to be attempting to “reduce the surplus population” (to quote Charles Dickens’s Ebeneezer Scrooge) instead of caring for it, the sense of betrayal may begin to run deeper. The mere suspicion of such coldness would be enough to undermine support for the government and trust in doctors and the health-care system in general.
There is no reason to doubt that Starmer genuinely believes that euthanasia is ethically justifiable. However, fast-tracking a legalization bill is a strange choice that indicates that the decision is not purely about ethics. Surely, given the Canadian experience and horror stories from European countries that have legalized euthanasia, Starmer would want to take his time and make sure that all the necessary safeguards are in place to prevent this from possibly blowing up in his face later.
That this is not happening suggests that, tragically, economics and politics may be driving decision-making, with lives very much at stake in the outcome.