Eugenic Austerity

On the 29th of November, members of the British parliament voted in favour of ‘The Terminally Ill Adults (End of Life) Bill 2024-25’, commonly referred to as the ‘Assisted Dying’ Bill. The proposal was put forward by an MP, although not a minister, of the ruling Labour Party. The assent of a majority of MPs does not mean that the Bill and its prescription “to allow adults aged 18 and over, who have mental capacity, are terminally ill and are in the final six months of their life, to request assistance from a doctor to end their life” in England and Wales,^[1] is now law. Rather, the Bill will now pass through subsequent debates in the upper and lower chambers subject to various amendments, and may still be rejected. The most pronounced opposition to the Bill comes from disability rights groups. As it stands, they have united in their stance against it: from the coalition that monitors the implementation of the United Nations Disability Convention, to groups such as Disabled People Against Cuts and Disability Rights UK.^[2] Their opposition to this euthanasia legalisation is indissociable from the historical context of disabled life in Britain and its deadly history of ableism.

To say that the British State has a poor record on the rights and autonomy of disabled people would be an offensively banal understatement. What the United Kingdom has done is so horrifically eugenic in its treatment of the disabled that even a sample from these opening decades of the 21st century would suffice to demonstrate its depravity. Simply put: austerity kills. Cuts to public services such as the provision of safe housing and healthcare kill, and these political decisions lead to the deaths of disabled people. A study from the University of Glasgow highlighted that under the austerity regime first implemented by the New Labour government and then accelerated into overdrive by the Coalition Tory-Liberal Democrat government in 2010 has led to 335,000 excess deaths.^[3]

Austerity kills the poor with an overwhelming disproportionality: half of those in poverty are disabled or living with a disabled person.^[4] During the depths of the ongoing COVID-19 pandemic, Tory minister Matt Hancock oversaw the rapid discharge of people from hospitals to care homes without testing despite the known risk of asymptomatic transmission. As a result, more than 20,000 elderly or disabled care home residents died between the March and June of 2020 in England and Wales.^[5] According to the Office for National Statistics, the 16% of the population who are disabled accounted for 69% of the deaths.^[6]

It is important to stress the point that these deaths are not the result of a pre-political, somehow ‘purely’ biological susceptibility to a disease at the height of pandemic, but the result of a regime which sees the provisions that would assist the disabled to live as disposable. In turn, the state sees them too as a resource to be done away with when their lives become too expensive for the tastes of their government. The lives of the disabled are subject to the calculations of healthcare economics, where that which is deemed ‘abnormal’ is administered death in favour of a normalized life.

Take another example from the pandemic: consider the cases of imposed Do Not Resuscitate orders on people with learning disabilities hospitalized with COVID.^[7] Such a murderous command was not one issued by any minister, but by the bureaucracy of a local NHS trust, trying to manage its resources in a time of crisis—to ensure its own reproduction and continued operation. One should equally examine John Pring’s excellent work on the cruelty of the ‘Work Capability Assessments” that led to hundreds of people’s starvation and suicide which the Department for Work and Pensions covered up.^[8] The new Labour government—itself factionally controlled by the architects of the New Labour austerian regime under Blair and Brown—are already briefing the press about their enthusiasm for ‘reforming’ (cutting) disability and sickness benefits, essentially continuing Sunak’s war on “sick note culture”.^[9] With this, they have been throwing red meat to the newspapers with their hatred for purported parasitic ‘scroungers’. As such, it would be ludicrously naive to believe that this is anything other than a continuity of governance and dominant political narrative, regardless of the party in government.

This governance manifests for the majority of the disabled people in England and Wales, if not Britain entirely, as a vast propensity for social murder. This term, first formulated—fittingly—by Friedrich Engels in his work The Condition of the Working Class in England, deserves substantial quotation for its definition:

When one individual inflicts bodily injury upon another such that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder. But when society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet; when it deprives thousands of the necessaries of life, places them under conditions in which they cannot live – forces them, through the strong arm of the law, to remain in such conditions until that death ensues which is the inevitable consequence – knows that these thousands of victims must perish, and yet permits these conditions to remain, its deed is murder just as surely as the deed of the single individual; disguised, malicious murder, murder against which none can defend himself, which does not seem what it is, because no man sees the murderer, because the death of the victim seems a natural one, since the offence is more one of omission than of commission. But murder it remains. I have now to prove that society in England daily and hourly commits what the working-men's organs, with perfect correctness, characterise as social murder, that it has placed the workers under conditions in which they can neither retain health nor live long; that it undermines the vital force of these workers gradually, little by little, and so hurries them to the grave before their time. I have further to prove that society knows how injurious such conditions are to the health and the life of the workers, and yet does nothing to improve these conditions. That it knows the consequences of its deeds; that its act is, therefore, not mere manslaughter, but murder, I shall have proved, when I cite official documents, reports of Parliament and of the Government, in substantiation of my charge.^[10]

Having cited the intentional activities of government by sources which they themselves recognize, I therefore claim to substantiate Engels’ condemnation, and I stand by it. This is the recent context in which the struggle for disabled life and liberation rages, but it does not exhaust the contextual richness of the horror adequate to the case of euthanasia alone. For that, one must turn to the euthanasia regime implemented in Canada in the midst of its own practice of austerity. To this end, I cite the following report regarding the Medical Assistance in Dying (MAiD) program from the Cambridge journal Pallative and Supportive Care:

For those who are not dying (Track 2), Canada requires that the 2 MAiD assessors (medical doctor or nurse practitioner) conduct detailed assessments of patient eligibility. The timing to die by lethal injection is set at a minimum of 90 days after the first MAiD assessment is completed. To qualify for MAiD, a patient must be in a situation of irreversible decline of capability and experience intolerable psychological or physical suffering. These terms are not further defined by the legislation, and suffering is treated as purely subjective. If the patient says their suffering is intolerable, there is no requirement for further validation or requirement for clinicians to agree that there are no other options to address the suffering. A Canadian disability inclusion analysis report on the impact of the pandemic on disabled persons noted that persons with disabilities were encouraged to explore the option of MAiD for a lack of resources to live when they had not been contemplating this option. The report further highlights that a lack of social, economic, and health support increases the perception of intolerable suffering in persons with disabilities.^[11]

The purpose of a system is what it does, and a system which deprives disabled people with the resources to live—only to offer them death—is a system which socially murders those it impoverishes with an institutionalized and medicalized efficiency. A social cause of mental and physical suffering is also a social cause of the choice to end said suffering, and the current plans of the Canadian government, albeit delayed under review, is to expand its euthanasia program to include those solely suffering from mental distress.^[12] The existence of the austerity regime tells us that our governments are not willing to foot the bill any more. Further, the hegemony of capitalism, which relies on inserting itself between human beings and the realization of their continued existence by withholding the means of producing that which is necessary for their life and its reproduction, maintains that people are only worthwhile insofar as they are able to sell their labour power.^[13] As a consequence, capitalist society will not allow anyone to truly live outside of it, for one of its main methods of compulsion is to impoverish us in order that we will work for them in order to survive.

The governing faction of the Labour Party and its leader, Keir Starmer, voted in favour of the Bill, but that does not mean that they can be considered truly in favour of “death with dignity”. On top of Labour’s declared war on sickness and disability benefits, we should note that on the day the Bill passed, a party whip subsequently vetoed a hearing on a bill for the provision of hospice care for children.^[14] Additionally, it cannot be said that they supported the campaign of Mark Hughes, who was given six months to live from terminal bone cancer in 2010, and his ongoing drive to secure fast-tracked welfare payments for the terminally ill.^[15] Hughes’ case reflects one of the arguments for the insufficiency of the definitions of a condition within the Bill itself as made by Phil Friend, a co-convenor of the disability rights group Not Dead Yet: that the Bill does not take into account the fundamental indeterminacy of such medical predictions.^[16] The Bill in its brevity flattens all ambiguity and epistemological fuzziness into the deceptive simplicity of its terms, and that this allows for medical coercion and the real actuality of a medical unresponsiveness to the disabled body to enter into the allowance for premature death. It is in light of all of this, we can now highlight that the main argument of disability groups is that the legalisation of euthanasia opens up the possibility of a streamlining of the process of social murder, by which disabled people are coerced to be killed by the state. This would occur by means of an intolerable life directly inflicted on them by austerity, be it lack of palliative care for the terminally ill, inadequacy of accessible housing, or poverty everyday support for those who are not dying; or even by the social and/or familial pressure of being a ‘burden’. MP Kim Leadbeater, who proposed the Bill, openly acknowledged this pressure as a “legitimate reason’ for choosing to die.^[17]

Disability rights groups are worried, as Rhian Davies from Disability Wales argues, “that this bill would further devalue disabled lives and undermine their very right to life”. This concern cannot be dismissed simply as a ‘slippery slope’ fallacy. These arguments are not made on the basis of an abstract conception of state power as it would abide by the propositional calculus of analytic philosophy, Aristotelian syllogism, or parliamentary debate. They are made on the basis of an analysis of actual processes of political power, of hegemonic media narratives which demonize the disabled in our contemporary situation, and ultimately upon the bodies of countless thousands of disabled people killed by the austerity regime. The Canadian system did not operate its expansion on the ideal logic of a chain of validity and necessity based on its propositions, but on the logic of contemporary power, which the philosopher of disability Shelley Tremain characterizes as one of Incremental Normalization, by which the legal categories and their spheres of operation on the bodies of the population shifts to an increasing assault on those it deems ‘abnormal’.^[18] On this basis, I hope that the reader can at the very least understand the pressing nature of their concerns.

The position outlined above is not a purely negative one. Against assisted dying comes the rallying cry for an assistance to live, for an autonomy worthy of the name. In its negative mode, the argument is one not just regarding the rights of the disabled, but is also one that is defensive, a call for the reduction of harms against a harmful and harming society. However, the existence of the positive correlate contains the admission that this is not enough on its own. The imperative for the communist, as laid down by Antonio Gramsci, is that we be pessimists of the intellect and optimists of the will. For such a pessimist of the intellect, according to all available evidence regarding the British State at this point in its history, there are two intolerable positions. The first position arrives from the critique of society, that we know help is not coming from the capitalist state, that they no longer fear us enough to buy our civility, and that we are as yet not organized adequately to counter their power. Secondly, we have the moral extremity, the tortuous injustice of the situation itself: that in order to put up any opposition to the social murder of the disabled, we are willing to demand that many dying people be held back from the prospect of a death freed from a long process of pain and suffering. In other words, a death with dignity: not in the sense in which dignity is defined against an indignity of disability (for to be disabled is so often be rendered as an undignified life in an ableist society), but one in which one may choose to end one’s suffering in the face of an imminent death and have that choice respected, as Freud did in the final days of his cancer. Many of those opposed to this Bill recognize death with dignity as a moral right. They oppose this Bill on the basis that it will be the vehicle of further evils, and do not do so lightly.

It is insufficient to let our pessimism of the intellect pervade our will and drag us into despondency. The denial and violation of the good of dignified death and the good of dignified life issues from neither principle, but from the capitalist state and its real historical activity. That this mediation produces such a situation therefore marks the mediator itself as unjust, and the negation of its force and active ableist power is therefore the only argument one can make for justice, the only moral demand. If we accept that this state will never do right by us, but can only be pleaded to for lesser wrongs which it may well ignore, then this only speaks to the greater necessity of its overcoming, that which we call communism.

As Marx and Engels wrote in The German Ideology, “Communism is for us not a state of affairs which is to be established, an ideal to which reality [will] have to adjust itself. We call communism the real movement which abolishes the present state of things. The conditions of this movement result from the premises now in existence.”^[19] There is no communism that does not contain a component of the ethical, because a movement in its conscious charge and direction is not a social critique arising from material conditions, but also contains a motivating sense of indignation against that which it aims to abolish. The ethical does not sit at the end nor the beginning, but as Gillian Rose once put it, in the middle, in the midst of our situation; with “the difficulty that cannot rest with either perfection or repugnance—with the ‘scandal’ of the ethical”.^[20] It is in the injustice of our position that justice becomes clear before thought, which even in the absence of immediate practical prescription, nonetheless illuminates the possibility of its realization.^[21] That this is a state of affairs in which society mediates two moral goods into conflict by means of its own hegemony, in which we can no longer expect concessions from them to remedy such moral violation, means that the enemy has been marked by its actual existence. Our order is a moral blight both within this world and of its cosmos.

The ethical injunction which is the most realistic, in the face of a state power that will not provide us with anything otherwise and will not stop until it is stopped, is as clear as day. They must be fought, not only because they are already being fought, but because they ought to be fought. Eugenic mass death is not a novelty in the advent of euthanasia, it is already here. The social war on the disabled has been waged for centuries, and it is ultimately a war on the body itself—on all of us. The only course, no matter how abstract, utopian, or impossible it seems, is nonetheless the only course available for a new world within a situation in which we are already in an active conflict.

The call to ‘organize, resist, fight’ is a tired and tiring refrain, but it is only tiring in the sense of a literary trope, at which one stands at the limits of writing at the border of the practical. Nonetheless, it remains the only imperative, whether we fail, founder, or falter. Fight like hell for the dying. Fight like hell for the living.