When the right to die becomes the duty to die, who will step in to save those most at risk?

It’s rare to get a politician who openly admits they are torn on an issue, but in recent days there have been two striking examples. First, Wes Streeting, Labour’s shadow health secretary, admitted that though he voted to legalise assisted dying a few years ago, he feels conflicted. Then Nicola Sturgeon, former Scottish first minister, wrote a piece saying that, with new Scottish legislation on the table, the reservations she expected to subside are becoming stronger.

I wrote last year about my own trajectory in relation to proposals to legalise doctor-assisted suicide for the terminally ill. A decade ago, I would have supported assisted dying out of a respect for personal autonomy and a desire to alleviate suffering. Today, I understand these objectives are not standalone but need to be weighed against the impact on those for whom an abstract liberal notion like autonomy is highly simplistic, and the state-sanctioned wrongful deaths that seem to me impossible to avoid.

The first prompt for my reappraisal has been my evolving understanding of the complexity of relationships. We are not all autonomous islands floating in a sea of humanity; we are highly influenced by each other and by cultural norms. Writing about domestic abuse has opened my eyes to the extent that coercively controlling relationships drive people to do things because others want them to. Of course there will be women who get a terminal diagnosis, whose partners have been emotionally abusive to them for years – telling them their life isn’t worth living – who will come under intolerable pressure to opt for assisted dying. How can we ignore that around a third of female suicides are thought to be related to intimate partner abuse? Or that some men who violently kill their sick wives rely on defences such as “mercy killing” and “suicide pacts”, sometimes very effectively? Even the fact that men are much more likely than women to leave their partners after a terminal diagnosis feels salient to understanding the gendered implications.

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