AS THE government considers the issue of assisted dying with a view to legislation, the question of who frames the debate, and how, should be of real concern for working-class people and the labour and trade union movement, which cannot afford to be a bystander in the discussion.

The case for legalising assisted dying will be championed by the liberal political class and personalities as a “human right,” a matter of personal autonomy and “choice,” even a social justice issue and a progressive moral principle, elevated above and distinct from other factors, including class interest.

When liberals demand a “human right” it invariably means the moral right of the individual abstracted above that of the collective, with scant regard or consideration of the potential consequences for wider society, and certainly not of the working class.

Morality, even when expressed as a “human right,” is not ordained in Heaven, nor dictated by some eternal human verity or imperative — it is rooted in, and reflective of, prevailing economic conditions — in other words, class interest.

In a capitalist society, profit comes before people. Every decision, no matter how “humane” the motivation may be, will be distorted and conditioned by that fact. For Marxists, there can be no unfettered right of individual “choice.” Consideration of potential societal consequences, not least for the working class itself, is very much a class issue, not a moral one.

Few in our largely secular society would argue idealist notions of the “sanctity of life” should supersede the natural instinct that springs from human compassion to alleviate extreme, irresolvable suffering and distress. No action, even ending a life, is in itself either “good” or “bad.” It can only be judged in terms of concrete circumstances and consequences.

To end a person’s life in order to end untreatable suffering is one thing, to end the life of a person because they believe they have become a burden to their family or on society is another. The same action, ending a human life, in one instance, is an act of human compassion and solidarity: the other is an act of social murder.

Rich and poor all die, but only the former has any genuine “choice” in the conditions they do so.

Assisted dying has been legal in Oregon in the United States since 1997 under its Death with Dignity Act and is often hailed as an exemplar. With a population of roughly 4.25 million 2,454 people, average age 72, have experienced assisted death between 1998 to 2022.

In 1998, 24 prescriptions were issued for lethal drugs, with 16 assisted deaths as a result. Prescription issue increased year-on-year by 13 per cent and assisted deaths by 16 per cent. In 2022, 431 prescriptions were issued with 278 deaths.

We can see the issue of class hidden within these figures. Assisted deaths of those with private health insurance dropped over 25 years from 65 per cent to 20 per cent.

Some 80 per cent of deaths in 2022 were covered by government (Medicare or Medicaid) health insurance. Most concerningly, in the first five years after legislation 30 per cent cited “being a burden” as a factor in their decision, since 2017 around half, with 46 per cent in 2022.

Cancer diagnosis formed 80 per cent was cited as a reason in the first five years of legislation, falling to 64 per cent by 2022, and since 2010 other non-terminal conditions have been qualifying factors, including arthritis, complications from falls, hernia and anorexia nervosa.

The process of doctor-patient interaction has fallen from 18 weeks in 2010 to five weeks in 2022, and psychiatric referrals have fallen from an average of 28 per cent in the first three years of the legislation to 5 per cent in 2010 and 1 per cent in 2022.

Multiple concerns arise from all this. Reduction in doctor-patient interaction could have made it harder to identify “treatable factors influencing the wish to die.”

There is a lack of data on how many people had treatable depression, an influential factor in decision-making. Why didn’t people take the drugs they were prescribed for assisted death — is this related to the advice and counselling they received? And why is there a lack of data on complications around assisted death, including regaining consciousness?

Extending the criteria for assisted dying beyond circumstances of extreme and irreversible suffering is not an unrealised fear. Psychological distress, disability, homelessness and poverty are seriously considered, legally and morally, as valid reasons in those countries where assisted dying is allowed. Even in Canada, that Valhalla of “progressive” and authoritarian liberalism, such concerns have resulted in a pause in legislation.

It is not just a question of what legislation may be proposed, but who is legislating and who will administer it, and in whose interests: who will set the qualification criteria and is it possible to put in place regulations and safeguards that can prevent abuse, profiteering and extensions of qualification criteria for assisted dying.

The same liberal political elite, of all political parties, will frame and direct the debate on their terms. Parliamentarians will make heart-rending and sincere speeches about human suffering that will emanate from the depths of their empathetic humanitarian or religious souls.

But the same people support “fiscal rules” austerity, drive privatisation of the NHS and are also complicit in the genocide in Gaza. Let’s remind ourselves that New Labour, along with the coalition and subsequent Tory governments, waged an unremitting class war against the disabled and the poor. Remember “there’s more to life than moving from the bedroom to the sofa”?

Such language is where “moral” justification for the social cleansing of those unable to compete in the “rat race” begins. The same people who made such statements would not bat an eyelid if the criteria for assisted dying included the disabled, homeless and the poor.

Never forget, never forgive. And most of all — never trust them.

The politicians’ “moral” case for assisted dying would be more credible if they were as keen on reversing the cuts to maternity services that endanger the lives of women, and the children they bring into the world, as they claim to be about easing the passage of those leaving it.

The labour and trade union movement, and particularly the left, must not enter the public debate on terms set by the politicians, but from an independent class position.

The real issue in discussion is not whether assisted dying is “right or wrong” but how our movement can intervene to frame demands on specific issues around safeguards, qualification criteria, administration, democratic accountability, scrutiny and control.

And also those wider class demands that are legitimate and necessary elements of the debate: an end to privatisation, services brought back in-house, the provision of properly resourced and financed services, with well-trained workers and adequate staffing levels, funding for research and resources for end-of-life palliative care, and the best possible care, free at the point of need, for those in physical and mental pain and distress.

Follow John McInally on X @JohnMcInally13.