Italian actress Sibilla Barbieri recently left her native land in order to leave this world in Switzerland. Italy did not want her to kill herself, but Switzerland was indifferent. Not long after Barbieri’s victory, the parents of baby Indi Gregory tried to leave their native England to attempt to save their daughter’s life in Italy. Indi, only eight months old, had a rare mitochondrial disease and required life support. Prime minister Giorgia Meloni granted Indi Italian citizenship to expedite the emigration. But England judged that it was in Indi’s best interests to die—the courts ruled that nothing could be done for Indi, and thus that it was not worth it for the state to continue paying for life support. She died on November 13, a few hours after her doctors removed life support.
On the surface, death and Italy are the only commonalities between the Barbieri and Gregory cases. But these events taken together grimly foreshadow a world that will become increasingly difficult for opponents of assisted suicide to navigate.
Today, the Hippocratic orthodoxy to do no harm has become optional. In Canada, Holland, and a fifth of American states, doctors are now allowed to kill people who want to be killed. Slippery slope predictions are coming true: not just the terminally ill, but also those with physical disabilities and mental illnesses are choosing to die—and in some cases, being encouraged to die.
As Richard John Neuhaus put it, “where orthodoxy is optional, orthodoxy will sooner or later be proscribed.” Before long, insurance companies will require doctors to recommend “medical aid in dying” (MAID) to patients who pass some quantifiable threshold of suffering. Later, they will refuse to cover life-prolonging and life-improving interventions when patients are past that threshold. Some of these patients won’t be able to leave the hospital, even when they want to (for their own safety). They will be taking up valuable space that could be given to worthier patients. Notice that the old term “medically assisted suicide” has been replaced by “MAID,” which sounds a little nicer at first, until you realize it neither says nor implies anything whatsoever about a patient’s own choices about death and healthcare.
In places with socialized healthcare, like the United Kingdom, agents of the government (“death panels”) rather than insurance companies will determine the threshold at which interventions are impermissible. This is what happened in the case of little Indi. Despite her parents’ wishes, and despite the willingness of Italian doctors and the Italian government to try additional experimental treatments and do their best for her, England said no. Easier to pull the plug and endure bad press coverage for a couple weeks than keep paying for Indi’s care until transportation could be arranged.
Below-replacement fertility will mean fewer workers to fund pensions and services, including medical care. Governments already regulate the retirement age for access to these benefits. Soon they will regulate the age at which one is no longer eligible for these benefits.
But this is not inevitable, at least in the United States. Heartless as the insurance companies may be, they are still accountable to the law and its judges. The laws, of course, may change. So opponents of euthanasia (compulsory or otherwise) also need to be vigilant about electing lawmakers at the local but especially federal level who understand that intentionally killing innocent people is always wrong, who understand the difference between permissible and impermissible forms of letting a person die, and who will refuse to support legislation that legalizes MAID.
I myself do not have much hope. In forty or fifty years I expect many of us will be advised that “it’s time,” and wouldn’t it be better to go painlessly now rather than painfully later? Think of the burden, to your family, your wider community. Our resistance will be met with sterner advice. We will be seen as irrational. We will be treated like anti-vaxxers. The fate of that movement’s reputation—from goofy counter-culture to idiotic menace—is instructive.
Where the decision-making power of doctors is enforceable by the state, the moral opponents of euthanasia will need to form independent communities of medical care. There is a parallel here with homeschool co-ops and start-up classical schools. Members of these communities shoulder a burden for educating their children that is hugely disproportionate to the majority who opt for public education. They take up the burden because the stakes are too high to outsource education to people hostile to their way of life. Similarly, members of independent communities of medical care would shoulder an enormous burden for practicing medicine in ways that are just. But here too, they should take up the burden because the stakes are too high to outsource medical care to people hostile to their very lives—or at least their grandparents’ lives.
Before her suicide, Sibilla Barbieri recorded a protest video. In it, she told of how she had requested MAID in her home country of Italy, but was refused. She called this “discrimination”—since Italy has granted MAID for others with severe illnesses. Thus Barbieri argued for MAID on the grounds of equity. By resting her case on these grounds, Barbieri has made our culture’s one unassailable argument. It is hard to imagine not eventually having access to on-demand, no-questions-asked MAID. As we age, we will see more and more celebrities end their lives like Barbieri. It will become the fashionable thing to do. Then it will be odd and threatening not to do it. Then we won’t be allowed to forego it.
The state, at its best, threatens the sword only for the evildoer. In the case of Indi Gregory and increasingly frequent cases like hers, we see that the modern state now threatens it also for the expensive innocent. MAID activists like Barbieri are forging a world in which many, many more expensive innocents will be in danger.
Thomas M. Ward is associate professor of philosophy at Baylor University.