The battle over legalization of assisted suicide in the United Kingdom continues to intensify. As previously reported here, the crucial first stage in this fight, where underlying legislation was approved 330-275, has moved on to the committee stage in Parliament where amendments to provide more safeguards for vulnerable patients under the bill have been offered and considered. If the past few weeks are any indication, adoption of major protections for patients, even those with conditions ordinarily considered nonfatal, will not happen. Whether this fact will spur more rethinking of assisted suicide on the merits is open to question, as members of Parliament appear to maintain their overall stances on the bill along party lines, with the ruling Labour Party most solidly behind the measure.

The truth is that prior to considering the vulnerability of the very poor or the very ill, there is another kind of upstream vulnerability to consider, one that is endemic to modern secular societies. Great Britain, like the United States, faces a host of difficult challenges with life and death implications in the midst of a loss of faith that now exhibits itself in a loss of hope. The national budget deficit in the last completed fiscal year in the United Kingdom, for example, was 131 billion pounds, not enormous by American standards and not unusual by British ones, but the government is now under enormous pressure to invest heavily in defense with respect to the ongoing war in Ukraine.

Like the United States, the country is experiencing an historic drop in childbearing, with a total fertility rate of 1.44 children per woman in 2023, roughly one third below replacement level fertility. Budgetary pressures on the National Health Services in the U.K. are also significant, with an analysis by the NHS Confederation finding that “the major barriers to improving productivity continue to be lack of capacity in social care and a lack of capital investment, as well as the likely impact of having to cut non-clinical staff who would otherwise play a key role in helping to reform services.”

Unspoken for the most part or denied completely, the combination of these factors feeds the temptation to save money over the short term through such measures as expansive abortion and suicide among the elderly and disabled. In the United States, physician and commentator Ezekiel Emanuel, who supports legalization of euthanasia and assisted suicide, specifically rejected the idea that these practices would reap significant health care savings and argued against this idea as grounds for proceeding.

A 2017 study published in the Canadian Medical Association Journal took an entirely different tack, however, and estimated that the implementation of assisted suicide could save Canada as much as $136.8 million a year. Canada now reports that MAiD — the disarming acronym for Medical Aid in Dying — was the cause of one-in-20 deaths in Canada in 2023, with pressures to expand the range of individuals who can be exposed to death by this means.

The possibility of expansive federal legislation legalizing assisted suicide in America seems slim, despite the prevalence of perhaps even more harrowing social statistics. The welcome barriers include the continuing resistance of medical societies like the American Medical Association, social groups like the Center for Disability Rights, and the Supreme Court’s unanimous 9-0 decision in Washington v. Glucksberg in 1997, which upheld the state of Washington’s then-existing ban on assisted suicide, finding that the practice “has been, and continues to be, offensive to our national traditions and practices.”

But pressures in American states have not ceased and likely will not, as the annual federal budget deficit hovers around $1.83 trillion and the U.S. total fertility rate sank in 2022 to 1.66 children per woman (Canada’s by the way is 1.33). More debt and fewer people to deal with it are deadly pincers on a society struggling to restore its core beliefs.

In fact, though it is strictly speaking a correlation, the onslaught of assisted suicide is an embrace of a culture of death that limitless abortion also epitomizes. The chart below illustrates the phenomenon. In the United States, 10 states and the District of Columbia (D.C.) have legalized assisted suicide in the past three decades. One state, Montana, did so via indirection, a court ruling in 2009 that created protection for assisted suicide and for physicians who prescribe the means to administer it. The other nine states and D.C. adopted assisted suicide by legislation or referendum.

Note how these measures correlate with some of the most permissive abortion laws not only in the United States but around the world. Of the 10 states and D.C., seven have virtually no limits on abortion at any stage of gestation, and four have laws that permit unfettered abortion until “viability’ coupled with permission for abortion when the mother’s “life or health” (LOH) is threatened until birth. These laws are a fig leaf and the only real protection for babies this late in pregnancy in these states (and some others) is the scarcity of doctors willing to commit such horrific crimes.

With respect to the difference such laws make, it is clear that states with liberal abortion laws, not to mention other progressive policies on issues like sex education, parental rights, and other regulatory approaches, have among the highest abortion rates in the country. Four of these states rank in the top 10 states for abortion, seven are in the top 20, and all are in the top half.

Consider where assisted suicide is on the agenda in the 2025 state legislative sessions. The three states that pose the most imminent threats are Illinois, Maryland, and Delaware. Illinois had a hearing last Friday and more hearings are planned before votes can be held on the End-of-Life Options for Terminally Ill Patients Act in both chambers of the legislature. A similarly named bill is advancing in Maryland, where assisted suicide measures have failed since 1996. Current Democratic Governor Wes Moore, a rumored presidential hopeful down the road, has said he will sign the bill if it reaches his desk. The Delaware bill came closest to passage last year when then-Governor John Carney vetoed it last September, but new Governor Matt Meyer, also a Democrat, indicated shortly after his inauguration that he will approve it if it reaches his desk. In addition to these states, Oregon, Vermont, and Washington are considering further liberalization intended to make it easier to obtain lethal drugs for assisted suicide, including by ending the physician requirement and allowing delivery by nurse practitioners and physician assistants.

In terms of the overall posture on life and death in the new states considering PAS or MAiD:

Certainly, collapsing ethics at both edges of life, to borrow Paul Ramsey’s phrase, is an affliction of Western nations that once upheld the Hippocratic Oath which explicitly condemns both abortion and euthanasia as betrayals of medicine. It is no wonder that, even as the House of Commons moves toward ratifying an unamended bill on suicide, the abortion rate in the United Kingdom has nearly tripled since 1969 and is now significantly higher than that of the United States. In 2022, more than a quarter million abortions (252,122) occurred in the U.K., most of them in England and Wales, with high percentages happening by chemical means as is the case in the United States.

All told to date, review committee members in the House of Commons, led by Danny Kruger, Conservative MP for East Wiltshire, have exposed the grave gaps in the Leadbetter bill via over 80 amendments that have gone down to defeat. The amendments are substantive and address such questions as whether someone can obtain assisted suicide when they are experiencing a disability or mental illness and are not terminally ill, if they have stopped eating or drinking, or if they have a condition that can be stabilized or treated. Kruger is pleased that amendments passed that protect the conscience rights of physicians who do not wish to refer for AS and that appropriate palliative care is offered. “Worst of all,” Kruger notes, the bill’s champions rejected an amendment “that would require a patient to see a palliative care doctor so they can discuss alternatives to AS with an expert.”

Several more steps remain before a final version of the Leadbeater bill is ready and final votes occur, now scheduled for April. Will reason, sound medicine, and morality prevail against such a blood-dimmed tide? If not, it will not be for lack of evidence or of heroism on the part of the bill’s many opponents.