What does a good death look like?
Scotland's decision on assisted dying is an opportunity to expand personal autonomy at the end of life.
I have watched two people I love die in Britain’s end-of-life care system in the last five years.
Both my parents died in hospices in England – and what I witnessed is a system that is fraying at the edges. Too few staff, too little time, too many compromises. And ultimately, final days and hours that were often fraught, panicked and desperate.
Later tonight, Scotland could become the first nation in the UK to legalise assisted dying. Right now, the final vote by the Scottish Parliament is too close to call. On both sides of the argument, people are passionate and determined. But at the heart of this debate is a central, recurring question – what does a ‘good death’ look like?
This is, of course an ethical puzzle, but it is also a practical question.
A ‘good death’ is often spoken about in soft, almost poetic language. But in practice, it comes down to concrete details. Is pain managed in time? Are there enough nurses on shift? Can a patient remain where they want to be, and are their wishes respected when they can no longer articulate them? These are not philosophical ideals, but logistical realities, shaped by funding decisions, staffing levels and the limits of the system itself.
Hospices embody the ideal of a ‘good death’ – and the incredible staff give their all to make this a possibility for as many patients as possible. But these institutions are chronically underfunded, relying heavily on charity and donations, and as demand grows, their resources are increasingly stretched. Two in five hospices are planning to make cuts this year, and 380 beds are already out of use due to financial strain.
There are valid concerns about the assisted dying bill, and they apply differently depending on how the law is designed. In Scotland, the proposed bill is tightly focused on mentally competent adults with terminal illness, with multiple layers of medical oversight built in. Proposals debated in England and Wales have at times been broader, which has heightened fears about where boundaries might ultimately lie.
Across both contexts, critics worry about the risks of subtle pressure – “internalised coercion” – for the most vulnerable, people who could be made to feel a burden. Disability rights groups have argued legalisation could send a dangerous signal about which lives are considered worth living.
Critics of the Scottish bill say MSPs should focus instead on improving end-of-life care, warning that offering assisted dying in a strained system risks turning a failure of care into a reason to end life. But with the need for hospice admission in England projected to rise by 25 per cent by 2048, it is more realistic and practical to plan for a future in which both things could work alongside each other – a palliative care system that is properly funded by the government, and safe, rigorously legislated assisted dying for those who would choose that.
This decision is not just about Scotland, but the UK’s direction as a whole. If this bill is passed, it will force a reckoning across England and Wales. This is an opportunity to expand personal autonomy at the end of life.
I don’t know what my parents would have chosen if there had been more options for them. They were young, they were hopeful. I imagine they would have wanted to stay as long as humanly possible. But I can’t be sure. And the choice is the point.
Their version of a ‘good death’ was autonomy, comfort and dignity. None of it played out exactly as we hoped. There is an inevitability to this; death is messy and unpredictable and can’t always be smoothed at the edges. But where the failings are systemic – a lack of beds, delays administering pain relief, no one to answer calls from family members – these preventable calamities in our most vulnerable moments are unforgivable.
You don’t get a second chance at a good death. The answer is both better care and greater choice, not one or the other.■
About the author: Natalie Morris is our National Editor here at The Lead. Elsewhere, she is a freelance writer, author, and host covering social justice, inequality, health and community.
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