Assisted Dying: A Backdoor to Convenience Amid Government Failures
How withholding life-saving treatments turns supposed compassion into systemic coercion.
The Growing Normalisation of Assisted Dying
The debate around assisted dying is often framed as a compassionate alternative for individuals with terminal illnesses, providing autonomy over the end of life. However, evidence suggests it also serves as a grim shortcut for governments and healthcare systems that are either unable or unwilling to provide adequate treatment and palliative care for life-threatening conditions. The lack of sufficient palliative care and access to treatment will effectively coerce vulnerable individuals into considering assisted dying if the Adult Terminally Ill legislation, also referred to as the Death Wish Bill, passes. This transforms what should be a voluntary choice into a forced decision born out of desperation. When access to critical drugs is withheld or rejected due to cost, patients are left with few alternatives, making the state and government complicit in coercing individuals towards assisted dying. In this context, assisted dying ceases to be a genuine choice and instead becomes a systemic failure masquerading as compassion.
The Rejection of Life-Saving Treatments
The National Health Service (NHS), guided by the National Institute for Health and Care Excellence (NICE), operates within stringent budget constraints that often necessitate difficult choices regarding treatment approvals. NICE, responsible for evaluating the cost-effectiveness and clinical benefit of new treatments, frequently denies access to cutting-edge medications deemed too expensive for NHS budgets. This relationship means that NHS funding decisions are directly influenced by NICE's assessments, which are constrained by the limited resources available to the healthcare system.
To illustrate this critical issue, consider the following concrete examples that reveal how economic priorities have overshadowed the health needs of vulnerable individuals. The lack of adequate palliative care, combined with the rejection of effective treatments, highlights a systemic form of coercion by the state. This coercion is enabled by government policy and the complicity of MPs, who are failing to allocate the necessary resources for comprehensive care. Vulnerable patients are effectively left with no choice but to consider assisted dying, as their access to crucial medical support is systematically denied.
Lecanemab and Donanemab (Alzheimer’s drugs):
Lecanemab and Donanemab are monoclonal antibody drugs developed to treat Alzheimer's disease. They work by targeting and reducing amyloid plaques in the brain, which are thought to contribute to the progression of Alzheimer’s. These drugs are significant because they offer one of the few available options to slow cognitive decline in patients with early-stage Alzheimer’s. While they are not a cure, they can delay the worsening of symptoms, potentially allowing patients to maintain independence and quality of life for a longer period. Given that dementia, including Alzheimer's, is the leading cause of death in England and Wales, these drugs could play a crucial role in improving outcomes for thousands of individuals.
Rejected Dates: August and October 2024.
Reason: High costs (~£30,000 annually per patient) outweighed the perceived modest benefits.
Impact: These drugs could slow progression in the 135,000–180,000 UK patients eligible for treatment. Without them, dementia remains the leading cause of death in England and Wales, accounting for 66,876 deaths in 2023 (11.5% of all deaths).
Enhertu (trastuzumab deruxtecan) (Breast Cancer):
Enhertu is a targeted cancer drug used to treat HER2-positive breast cancer, particularly in advanced or metastatic stages. It is an antibody-drug conjugate that combines a monoclonal antibody with chemotherapy, specifically targeting cancer cells that overexpress the HER2 protein. Enhertu works by delivering chemotherapy directly to these cancer cells, which helps to limit damage to healthy cells. This drug is particularly important because it offers a treatment option for patients with HER2-low breast cancer, a subtype that previously had limited targeted therapies. Enhertu has shown the potential to extend survival and improve quality of life for individuals facing advanced stages of the disease.
Rejected Date: August 2024.
Reason: High cost (~£117,857 per treatment) deemed disproportionate to clinical benefit.
Impact: Could extend survival for around 1,000 women annually with HER2-low breast cancer. Breast cancer remains the most common cancer in women, with over 11,500 deaths annually.
Orkambi (Cystic Fibrosis):
Orkambi is a combination drug used to treat cystic fibrosis, a genetic disorder that causes severe damage to the lungs and digestive system. It works by targeting the underlying genetic defect in cystic fibrosis patients with two copies of the F508del mutation. The drug helps improve lung function, reduce the frequency of lung infections, and slow the decline in overall health. Orkambi is particularly important because it addresses the root cause of cystic fibrosis rather than just alleviating symptoms, offering patients the possibility of a significantly improved quality of life and extended survival.
Rejected Date: Initially rejected in 2015, approved in 2019 after years of negotiation.
Reason: Prohibitively high annual cost (~£104,000 per patient).
Impact: Delays in approval left thousands of patients suffering without access to this life-extending treatment. An estimated 100 patients die from cystic fibrosis annually in the UK, many of whom might have lived longer with timely treatment.
Fruquintinib (Colorectal Cancer):
Fruquintinib is an oral anti-cancer drug used to treat metastatic colorectal cancer, particularly in patients who have already undergone multiple prior treatments. It works by inhibiting the vascular endothelial growth factor receptors (VEGFR), which play a crucial role in tumour blood vessel growth. By blocking these receptors, Fruquintinib can help to restrict the tumour's blood supply, effectively slowing down its growth. This drug is important because it offers a treatment option for patients in advanced stages of colorectal cancer who have limited alternatives. With colorectal cancer causing around 16,600 deaths annually in the UK, Fruquintinib has the potential to improve survival and quality of life for thousands of patients.
Rejected Date: November 2024.
Reason: Uncertainty around its effectiveness and cost.
Impact: Around 5,000 patients with advanced colorectal cancer could benefit annually, in a condition that causes 16,600 deaths annually in the UK.
These examples illustrate the rationale behind why the NHS and NICE have rejected these treatments for availability to those suffering. Without access to these treatments through the NHS, terminal conditions leave patients with little to no options for improving their life chances. We must not deceive ourselves—these decisions are primarily based on economic criteria, rather than a genuine commitment to improving quality of life and extending survival. The rejection of these drugs by the NHS is a political decision, making MPs complicit in depriving patients of potential life-saving care, with cost considerations overshadowing all but the basic clinical soundness.
Assisted Dying as a Response to Systemic Failures
The NHS operates on constrained budgets, leading to cost-effectiveness thresholds that often undervalue life-extending treatments. NICE typically caps spending at £30,000 per quality-adjusted life year (QALY), meaning expensive but potentially life-saving drugs are frequently rejected. The stark reality is that some patients are denied the opportunity to extend their lives due to financial considerations that prioritise budgetary convenience over individual needs.
The introduction of assisted dying legislation effectively incentivizes a cost-effective alternative to the prolonged healthcare costs that accompany providing proper treatment and palliative care. It shifts the focus from maintaining quality of life to providing a path that appears compassionate but is often influenced by economic considerations. For example, advanced cancer drugs like Enhertu, costing upwards of £117,857, and will be easily dismissed when the alternative of assisted dying is promoted as a legitimate end-of-life option. This convenience for the healthcare system shifts the narrative from empowering individual choice to effectively nudging people towards death when essential resources are withheld.
Coercion Masquerading as Choice
The ethical foundations of assisted dying hinge on the principle of individual choice. However, if the choice is made in the context of denied treatments, the very notion of autonomy is compromised. For a person denied effective medication for Alzheimer’s or advanced cancer, opting for assisted dying becomes a coerced decision—a reluctant submission to circumstances crafted by policy failures rather than genuine personal agency. Consider cystic fibrosis patients who were left waiting for Orkambi until 2019. During that time, many experienced significant health deterioration and faced a bleak outlook. The absence of treatment options inevitably leads patients to consider assisted dying—not as a true choice, but as an escape from suffering prolonged by bureaucratic negligence.
Who is Most Affected?
It is often the economically disadvantaged who bear the heaviest burden of these rejections. Data from the Office for National Statistics (ONS) highlights that individuals from lower-income households are disproportionately impacted by barriers to accessing life-saving healthcare. For example, around 20% of the UK population lives in poverty, with limited ability to afford private treatments, resulting in stark disparities in healthcare outcomes. Those who can afford to pay privately may access life-extending drugs, but the less affluent are left with a dire choice: suffer without treatment or consider assisted dying. This inequality is glaring—according to a 2024 report, approximately 40% of individuals with terminal illnesses who sought assisted dying cited lack of access to adequate treatment and palliative care as a key driver. Instead of representing an equalising choice, assisted dying becomes a byproduct of social and economic disparities, coercing the vulnerable into premature death while wealthier individuals retain options for life-extending care.
Assisted Dying Lobbyists Rejoicing: A Question of Motivation and Expansion
Assisted dying lobbyists are celebrating what they see as a major opportunity to push their mission forward and get assisted dying legislation passed. However, serious questions need to be asked about the motivations and potential consequences of this movement. If the current bill is passed and added to the statute books, will lobbyists stop there, or will they continue to push for expanding the definition of who qualifies for assisted dying? Evidence from other jurisdictions, such as Canada and Belgium, shows that initial legislation is often just the beginning. In those places, the scope of assisted dying has expanded significantly over time, often to include individuals who were not originally intended to qualify. This raises the alarming possibility that, rather than stopping after securing limited access, lobbyists will push for broader criteria, ultimately coercing more individuals—including the vulnerable and those with non-terminal conditions—into considering assisted dying as a seemingly viable option.
The bill must not pass, it is as simple as that. We have been here before, and history shows us the consequences of such decisions. In jurisdictions like Canada and Belgium, what began as narrowly defined assisted dying legislation has expanded significantly over time. Initially meant for terminally ill adults with unbearable suffering, these laws have since broadened to include individuals with non-terminal conditions, and even, in some cases, those experiencing mental health struggles or simply fatigue with life. The risk is real that if this bill passes, lobbyists will continue to push for broader access, incrementally lowering the threshold until the most vulnerable are swept into a system that incentivises premature death over adequate care and support. Serious questions must be asked: will this be the end, or just the beginning of a slippery slope? Evidence suggests that once assisted dying is legislated, expansion follows, often at the cost of those least able to advocate for themselves.
Reclaiming Compassion in Healthcare
The solution is not to allow this bill to pass into law, but rather to direct funding towards improving end-of-life care. This means greater investment in palliative care, expanding palliative support networks, and even providing more subsidies to drug manufacturers upfront in exchange for a stake in the outcomes of treatments, to ultimately reduce costs downstream. There needs to be a complete overhaul of how we view our most vulnerable—not as profit or cost centres, but as individuals deserving of dignity and comprehensive care. This is a failure of successive governments, and we are now allowing some MPs—who are undoubtedly eyeing opportunities for self-enrichment after their time in office—to turn their backs on those most in need. Only by addressing these systemic failures can we reclaim the true meaning of compassion in end-of-life care, ensuring individuals receive the support and treatment they deserve rather than being coerced into assisted dying as a consequence of systemic neglect.