UK End of Life Bill: exploring dissensus through discussion
By Tess Johnson, Jamie Hale, Dominic Wilkinson and Mehrunisha Suleman
Debates on what is often termed assisted dying or assisted suicide (AD/AS), whether in the UK or overseas, are often marked by polarisation along political lines, even the terminology is non-neutral, hence our choice to use both terms here. Deeply personal convictions often cannot be raised, and there is little space for constructive conversations that acknowledge the impossibility of ideal solutions and make space for human vulnerability and open-mindedness, because of the charged contexts and complex histories of euthanasia and suicide.
In an event hosted at Reuben College, Oxford, in April, we aimed to move beyond the debate format, beyond conflicting positions, to find shared values and meaning between two speakers with personal experience and professional interest in AD/AS. The event, 'UK End of Life Bill: Exploring Dissensus Through Discussion,' saw speakers Jamie Hale, a multidisciplinary arts creative and researcher whose work explores questions around health, care, and ethics, and Dominic Wilkinson, Director of Medical Ethics at the Uehiro Oxford Institute and neonatal intensive care consultant, modelling a different kind of engagement—one rooted in listening, humility, and a willingness to explore complexity without that needing to be grounded on consensus. They did not seek to persuade each other or the audience of what the right answer would be to the question of whether the bill should be passed, but sought to explore and interrogate the positions they came with, and to find common ground.
Mehrunisha Suleman, Director of Medical Ethics and Law Education at the Ethox Centre, chairing the event, opened with a reflection on the role of moral disagreement in law, and on the importance of overcoming polarisation to develop shared understanding, noting the role of these discussion methods within platforms like ANTITHESES.
Jamie and Dominic then offered candid reflections on their fatigue with the familiar contours of AD/AS debates. Jamie observed that much of the discourse on AD/AS, both pro- and anti- legalisation, seems to be grounded in fear, whether fear of pain, loss of autonomy or an undignified death, or fear of coercion, exploitation, and rising disableism. This, he noted, creates a loaded space for meaningful discussion, where fear-driven narratives drive us toward absolutist views.
Dominic brought in his research on dissensus, underscoring the importance of humility and the moral value of sustained dialogue—even, or especially, when agreement seems impossible. He shared an experience of how extended, good-faith conversation can uncover more common ground than we might initially expect with those ‘on the other side’.
Shared Values and Vulnerabilities
Despite their differing stances on the UK’s End of Life Bill, both Jamie and Dominic shared important values relevant to the issue. Both affirmed a belief in individual autonomy, and the importance of people making decisions about their own lives and deaths, including, potentially, the right for someone to choose to end their own life. They differed, however, as to whether the state and health service should legally support active ending of life for certain people.
They also both acknowledged the reality of “bad deaths”—experiences shaped by a range of factors: intractable physical suffering and underfunded palliative care, for instance, and the impact that witnessing the dying process can have on loved ones. They both agreed that even with improved palliative care, which would reduce the number of bad deaths that occur, these can never be entirely eliminated. They agreed that this meant that, were the Bill not to pass, some people who might have chosen AD/AS, were it available, would instead suffer at the end of their lives. However, even if the bill passes, some people (and their families) will still potentially experience what they consider to be a ‘bad death’.
Another shared concern between the speakers was the cultural taboo surrounding death itself. Dominic noted how our collective unfamiliarity with dying—what it looks like, how it is experienced, and how families make meaning from it—can inhibit us from being able to be present and participate in the last phase of our loved ones’ lives. They discussed how the normal natural processes of dying can be intensely uncomfortable to observe (though are not necessarily uncomfortable for the dying person himself or herself). It may be this fear grounded in unfamiliarity that plays at least some role in arguments on the side of those in favour of AD/AS.
They both agreed that, in a society, we have shared obligations, and that whatever the legal outcome, some people would experience harm. As Jamie noted, opposing the Bill should not mean becoming complicit in the current system’s failures, and it is not enough to oppose it on the grounds that better palliative care should be available, if they were not also working to make it available. Dominic also recognised that if the Bill were passed, others may feel pressure—imposed implicitly or explicitly—into bringing their life to an early end. There is no perfect solution, but this is especially concerning in medical contexts where assumptions about quality of life, particularly for disabled people, can be influenced by ableist attitudes.
For both opponents and advocates for AD/AS, the outcome of this vote would not bring problems to an end. Suffering, and avoidable suffering, would continue. Both sides would share an obligation to work to mitigate the consequences of the outcome for which they were campaigning.
Dissensus as Valuable
Perhaps the most profound takeaway from the event was the tone of the discussion itself. Neither speaker sought to convert the other, and neither declared victory. Instead, the session embodied a kind of intellectual and emotional vulnerability rarely seen in public ethical debates in which an atmosphere of trust and curiosity allowed them to explore the complicated and sometimes unwanted consequences of the outcomes of their own and each other’s arguments, aware that they had similar rooted values. At points during the conversation, they both shared perspectives and reflections that they acknowledged they wouldn’t usually share publicly, testament to the trusted environment that had built up.
For Dominic, the value lay in recognising and acknowledging ethical complexity and limits. Debates often focus on presenting the strongest arguments on one side while attacking the weakest points of the other. In this conversation, it was both possible and important for both speakers to honestly acknowledge the tensions and contradictions of their own arguments, and the validity of the concerns held by one another. For Jamie, trust allowed for a deeper form of engagement: a willingness to enter the conversation with curiosity. As he observed, 'It’s good to be able to rely not on needing to accept the same viewpoint or have the same opinion, but to rely in this space on the power of listening and reflection. It’s very human.'
In a political climate where polarisation shapes discussion, particularly on issues like the UK End of Life Bill, the event offered a vital alternative model of conversation. We were reminded that ethical progress often begins not with consensus, but with the courage to sit in disagreement and still listen.
This event was supported by the Reuben College Ethics and Values Theme and our Wellcome Trust-funded ANTITHESES research platform.