Why I Support Assisted Suicide

James Esses’ Substack goes out to thousands of subscribers in over 80 countries each week. Become a paid subscriber to support James’ investigative journalism, gain access to his full archive of articles and have the ability to post comments and join the conversation.

---

People are often surprised to learn that, in principle, I support assisted suicide. Here’s why:

As some reading will know, the issues I usually debate are ones I believe to be a fight between good on one side and evil on the other.

This is not one of those issues.

In the years that I have spent reading, researching and reflecting on this, I have generally witnessed good intent and good faith on both sides of the argument. Death unifies us all. I genuinely believe that those on both sides are driven by a desire to alleviate human suffering.

I appreciate that, within the circles I move, I am in a minority. I know many people with whom I agree on every other major issue, except for this. This tells me that this issue stretches beyond party political divides – everyone has their own unique relationship with mortality and dying. I do myself. You might find it odd that I am on this side of the argument when I tell you that, since a young age, I have suffered from extreme death anxiety that has required many years of therapy to address (unsuccessfully, I might add). The thought of dying terrifies me. I have always said that if they found a cure for mortality, I would be the first guinea pig to sign up. But I have been on a bit of a journey. There was a time in which I could not comprehend or condone someone wanting to extinguish their life, no matter how much they were suffering. However, I made a point of speaking to those locked into a life they no longer wished to live, suffering in agony every day, and on a one-way path towards even worse. I realised that their ability to have the right kind of death was more important than my discomfort at the idea of it.

We already sanction suicide. We did this with the passage of the Suicide Act back in 1961, which decriminalised it altogether. Prior to this, anyone who attempted suicide and survived could be prosecuted and imprisoned, while the families of those who died could also be prosecuted.

However, the government created a new offence of ‘encouraging or assisting’ the suicide of another. This means that, in the UK, it is illegal to assist someone to do an act that, in and of itself, is legal. This is a bizarre thing from a legal standpoint and, I believe, the only example of such a thing in our law.

So, if someone, terminally ill or indeed healthy, wishes to die and take a fatal overdose, hang themselves from a light fixture, tape a bag over their head to self-suffocate, handcuff themselves to something immovable and swallow the key, or throw themselves from a multi-story carpark, this is legal, no matter the pain and suffering for themselves and their families. Death, yes. Dignity, no. By the way, these are all case studies of actions sadly taken by terminally ill individuals in this country.

In fact, we go a step further. Not only have we legally sanctioned suicide but we have created provision for people to end their lives, even if actions by medical professionals could save them. Under the Mental Capacity Act 2005, people can put in writing an advance refusal of various forms of life-saving treatment, should the time ever come.

For those who are dependent upon artificial ventilation to stay alive, they can choose to remove the ventilator. That is what Noel Conway, suffering from motor neurone disease, did in 2021. He died by suffocation, while family members looked on. For those who choose to go down this route, it can take hours, sometimes even days, to die. Breathlessness, anxiety, respiratory secretions and a death rattle caused by mucus in the lungs. Death, yes. Dignity, no.

For those who are bedbound and physically unable to kill themselves in one of the lawful and pro-active manners detailed earlier because of their condition, they can choose to starve or dehydrate themselves to death by voluntarily refusing to eat or drink. This is what happened to Tony Nicklinson in 2012 – Tony suffered from locked-in syndrome after having a stroke. He could only move his eyes and described life as a “living nightmare”. Dying in this manner can take days or sometimes even weeks. For the person themselves and their family watching on, they can expect delirium, weakness, extreme hunger and thirst, moaning, rattling and severe breathing difficulties. As hospitals or hospices must continue to offer food and water to patients, they must be constantly teased with life-sustaining provision and then forced to reject it every single time – like some sort of pantomime. Death, yes. Dignity, no.

The individuals I have named spent their final years campaigning for a change in the law. Unfortunately, they died before any such change could take place.

Huge, unimaginable suffering by both the dying individuals and their loved ones. Yet, all completely lawful.

Compare and contrast that with the story of Mavis Eccleston from 2019. Mavis, a woman in her 80’s, helped her husband, terminally ill with bowel cancer, at this pleading, to end his life through an overdose. She was arrested and charged and spent the next 18 months in the grips of the criminal justice system, before being acquitted. Her children watched on as their father was dead and their mother was facing, essentially, life imprisonment.

Mavis is not alone. Between 2009 and 2024, just under 200 cases of assisting suicide have been referred to the CPS by the police – only 4 have been successfully prosecuted, with the vast majority being dropped, withdrawn or resulting in an acquittal. This is in part because of CPS guidance, which, controversially, uses the term ‘victim’ to describe the person wanting to end their life, even though many of them would say that it is the state keeping them as perpetual victims by not allowing them the dignified end they seek.

Yet, the uncertainty that exists as to whether loved ones may face prosecution, means that many choose to fight on until the bitter end, even if it means dying without dignity. Uncontrollably vomiting black bile, faecal matter pouring out of the mouth, fungating wounds from breast cancer that has broken through the skin. All real-life examples of the types of suffering experienced by those with terminal illnesses in the UK in their final days on earth.

What all of this means is that, in this country, for those who are terminally ill, they are allowed to kill themselves, but only through suffering and indignity. But for those who want to take prescribed medication, to enable them to die as comfortably and peacefully as possible, with their family by their side, such a thing is illegal.

That is why the law needs to change.

What are some of the main arguments against a change in law?

1. That we should focus our attention and resources on providing better palliative care, psychotherapeutic support, etc. Firstly, these things aren’t mutually exclusive. Secondly, this argument views these people as suicidal and seeks to address it as we do any other form of suicidality. I don’t agree – dying people are not suicidal – they don’t want to die but they do not have the choice to live either. There is a world of difference between someone who wants to die because a voice in their head tells them to kill themselves (an irrational delusion) and someone already dying who wants to die with dignity (a rational desire). If you successfully treat someone for a mental health condition, they will stop wanting to die. However, for someone already dying, they will never stop wanting to die with dignity.

2. That hospitals wanting to free up beds and family members wanting inheritance will apply pressure on people to choose this route. Firstly, the proposed law in the UK creates a new offence around coercion, dishonesty or pressure. Secondly, I am a natural cynic, but this takes an extraordinarily pessimistic view of human nature. Those who go into medicine do so because they want to help alleviate human suffering. And, when it comes to relatives, we know that, so often, it is desperate family members who push for more diagnostics, more treatment options, more second opinions – anything to keep their loved ones alive.

3. That there are insufficient safeguards. I agree that safeguards must be robust, in order to prevent bad actors or irreversible regret. I was saddened to see that, in the Bill currently before Parliament, the requirement for approval by the High Court has been removed. This should be added back in. However, it is also worth highlighting the safeguards that do exist: Strict, immovable eligibility criteria. No obligation on medical practitioners to partake. Two declarations with independent witnesses. Two medical assessments, including an independent practitioner. Mandatory, lengthy periods of reflection. Self-administration of the medication. Continuous monitoring by Chief Medical Officers.

4. That this is euthanasia - This is not euthanasia, whereby some individual or State institution makes a decision as to the worth of another’s life. This is assisted dying, for people who are already dying.

Back in 2011, the then Lord Chief Justice said “the problems of assisted suicide should be decided by Parliament, which, should be reflective of the conscience of the nation”. The time to enact this collective conscience is now. Polling shows that the vast majority of the public support a change in law (and now, even a majority of doctors support it too).

Those who are terminally ill should not be forced to endure a torturous end. They should be able to die in comfort and peace, before illness ravages their mind and body.

The irony is that, by giving these people death, it frees them to live. Instead of constant pre-occupation and anxiety over their demise, or indeed making a premature journey to Dignitas while they are fit to travel, they can spend their final few months on this earth amongst family and friends, safe in the knowledge that they will die with dignity.

I would like to finish with a quote by philosopher, Leonard Peiikoff - “Suicide is justified when man's life, owing to circumstances outside of a person's control, is no longer possible; an example might be a person with a painful terminal illness, or a prisoner in a concentration camp who sees no chance of escape. In cases such as these, suicide is not necessarily a philosophic rejection of life or of reality. On the contrary, it may very well be their tragic reaffirmation. Self-destruction in such contexts may amount to the tortured cry: "Man's life means so much to me that I will not settle for anything less. I will not accept a living death as a substitute."