The assisted dying bill has been rejected by Parliament. But the debate exposed a much bigger problem: who should look after us when we are old or dying, and who should pay for it?
Much of the opposition centred on palliative care. If good end of life care isn’t available everywhere, opponents argued, can someone really make a free choice to die? It is a reasonable question. A choice between excellent palliative care and an assisted death is very different from a choice influenced allegedly by pain, loneliness or inadequate support. There is; however, an uncomfortable issue underneath all this. Care is extraordinarily expensive, Britain is getting older, and we increasingly expect the state to pay people to perform activities that were once simply part of family life.
We have effectively monetised caring. Looking after children cooking for an elderly parent cleaning their house, taking them shopping, helping them wash and dress, having Granny living in the spare bedroom. None of this was ever genuinely free. It required somebody’s time and effort. But it didn’t necessarily require somebody to send an invoice. We now routinely call it ‘unpaid care’. Even the phrase is revealing. It puts an economic value on something previous generations often regarded simply as part of belonging to a family.
There are good reasons why things have changed. People live longer, sometimes with extremely complex medical needs. Families are smaller and more geographically dispersed. Both partners often work. And it would be wrong to romanticise a past in which much of the burden fell automatically upon women. But those explanations can also become convenient excuses. Not every elderly person needs 24-hour nursing care. Plenty need something much more ordinary: meals, shopping, company, a lift to an appointment, help around the house or simply somebody being there.
Perhaps we should be prepared to ask ourselves an uncomfortable question; have our parents really become impossible for us to care for, or have we simply become less willing to allow caring for them to inconvenience our own lives? We are fiercely protective of our independence. We want our careers, holidays, spare bedrooms, weekends and freedom to be ours alone. None of those things are wrong. But family cannot mean very much if it imposes obligations only when they are convenient.
There is something peculiar about a society wealthy enough to have more bedrooms, cars and leisure than almost any generation before it, yet increasingly convinced that looking after our own relatives is somebody else’s responsibility. I was reminded of this while travelling in Sri Lanka. My wife and I were staying at a homestay and talking to the family who owned it. The wife’s father had died and her mother had subsequently moved into their home. What struck me wasn’t that she lived with them, It was the way they spoke about it. They were actually proud that she had chosen to live with them. There was no sense that they had reluctantly inherited a social-care problem. When an elderly member of their family needed somewhere to spend the next stage of her life, they regarded being the household she chose as something to be proud of.
One family in Sri Lanka cannot represent an entire country, nor should we pretend that family care is always wonderful. Sometimes professional care is essential, and sometimes caring for somebody with severe dementia, disability or complex medical needs is simply beyond what a family can reasonably provide, but perhaps we have allowed those difficult cases to obscure all the ordinary ones. If Granny doesn’t live with her daughter, somebody still has to cook her dinner. If her son doesn’t take her shopping, somebody else must. If nobody in the family has time to check on her each day, we eventually pay somebody who does. And then we are surprised by the enormous cost of social care.
Once activities previously undertaken within families become professional services, their financial cost becomes painfully apparent. Perhaps we have spent several decades enjoying greater individual freedom without fully confronting the cost of replacing the obligations that once accompanied family life.
The state certainly has responsibilities and so do the NHS, councils and hospices, but somewhere along the way we seem to have become much better at discussing what government owes us than what we owe each other and that brings us back to assisted dying. One of the strongest objections is that a terminally ill person might choose death because they feel themselves to be a burden. Nobody should find themselves thinking, ‘my care is costing my children too much’ or ‘the NHS would be better off without me.’ That is precisely why safeguards matter.
But there is another side to the word burden. Perhaps rather than only ensuring that elderly and dying people never feel like one, the rest of us should occasionally examine why we have become so frightened of carrying one. Families have always involved burdens. Children certainly do. Marriage sometimes does. Illness does. Ageing does. We accept many of those burdens because caring for other people is part of the bargain of loving them. That doesn’t mean sacrificing your entire life to become a full-time nurse. But neither should every inconvenience created by an ageing parent automatically become somebody else’s paid employment.
If Parliament believes assisted dying cannot safely be introduced because palliative care is inadequate, then Parliament has a responsibility to improve it. It cannot argue that excellent end-of-life care is the alternative while accepting a system in which access to that care can depend upon geography and charitable fundraising.
But government cannot solve everything. Perhaps we also need to rediscover a little of what that Sri Lankan family seemed to understand instinctively: looking after someone you love can be an obligation without being an imposition, and sometimes it can even be something in which to take pride. The assisted dying debate will return. When it does, there should be more evidence from countries that have recently introduced it France (2026), Australia (2019 – 2025), New Zealand (2021), Spain (2021), and less need for either side to rely upon predictions of what might happen.
In the meantime, Britain needs a broader conversation about ageing, dying and responsibility — not merely what the state owes us, but what we owe one another.
Assisted dying has been postponed, not buried. And before it returns to Parliament, Britain might need to decide who we expect to care for us when we are alive before we ask who we allow to help us die.