Many of you will have heard the New Years Day interview that Baroness Jane Campbell had with Matthew Parris when she was guest editor for the BBC Radio 4 Today programme. Our supporters expressed considerable anger around Parris’s central assertion that the economy could not sustain the high costs of looking after dependent older and disabled people. In this thoughtful article, Don Brand questions Parris’s assertion.
An Immodest proposal
Dean Swift and the Scandal of Poverty in Ireland
In 1729, Jonathan Swift, Dean of St Patrick’s, Dublin, published a pamphlet he called “A Modest Proposal”. In reasoned tones, he set out his novel solution to the problems of extreme poverty in Ireland. The pamphlet’s full title is A Modest Proposal for Preventing the Children of Poor People From Being a Burthen to Their Parents or Country, and for Making Them Beneficial to the Publick.
Swift’s proposal is that the impoverished Irish might ease their economic troubles by selling their children as food for rich gentlemen and ladies. “A young healthy child well nursed, is, at a year old, a most delicious nourishing and wholesome food, whether stewed, roasted, baked, or boiled; and I make no doubt that it will equally serve in a fricassee, or a ragout.”
Swift knew his proposal would give offence to his readers. He intended to shock them into recognising the severe effects of grinding poverty on the Irish people among whom he lived: the desperate measures it provoked, the evil consequences in blighted lives, starvation and criminality.
But Swift also managed to convey, to those with ears to hear, sustained irony. Alongside his savage case for refined cannibalism, he follows the style of the Roman satirist Juvenal in purporting to dismiss the solutions he really believes in.
Therefore let no man talk to me of other expedients: Of taxing our absentees at five shillings a pound: Of using neither clothes, nor household furniture, except what is of our own growth and manufacture: Of curing the expensiveness of pride, vanity, idleness, and gaming in our women: Of introducing a vein of parsimony, prudence and temperance: Of learning to love our country, Of being a little cautious not to sell our country and consciences for nothing: Of teaching landlords to have at least one degree of mercy towards their tenants. Lastly, of putting a spirit of honesty, industry, and skill into our shop-keepers………
Therefore I repeat, let no man talk to me of these and the like expedients, ’till he hath at least some glympse of hope, that there will ever be some hearty and sincere attempt to put them into practice.
Matthew Parris and “Useless People” leading “Fruitless Lives”
Before Christmas, the commentator Matthew Parris published an article in the Spectator, setting out his own proposal for tackling a central problem of an ageing population: the rising costs of meeting their health and care needs, placing a growing burden on the economically active. His article appeared under the title Some day soon we’ll all accept that useless lives should be ended. When interviewed by Baroness Campbell on the Today programme on New Year’s Day, Parris’s attempt to defend his views was a fine example of the comedy of embarrassment.
It would be reassuring to think Matthew Parris sees himself as a latter-day Dean Swift, making his own Modest Proposal for our contemporary times. For Parris has looked into his crystal ball, foreseen rapidly rising numbers of disabled and older people, concluded the cost of their care will bankrupt the country, and come up with a radical solution.
He argues that the rising cost of health and care services for this growing number is well on the way to becoming unaffordable:
There are 11 million disabled people in Britain. As the proportion of our population disabled by old age increases, the figure can only rise. The result — we see it already as our health service struggles — is that an ever heavier burden falls on proportionately ever fewer wage-earning shoulders.
The mention of “wage-earning shoulders” blithely ignores the £17.5 billion income tax paid by pensioners. With the same reasoned tone as Swift, Parris walks us step by step towards his Modest Proposal. First, Kipling-like, he invokes the well-being of the tribe:
Tribes that handicap themselves will not prosper. As medical science advances, the cost of prolonging human life way past human usefulness will impose an ever heavier burden on the community for an ever longer proportion of its members’ lives. Already we are keeping people alive in a near-vegetative state. ………..Like socialist economics, this will place a handicap on our tribe. Already the cost of medical provision in Britain eats into our economic competitiveness against less socially generous nations.
The sleight of hand embodied in that last sentence – how much is Britain’s economic competitiveness “eaten into” by medical costs, compared with, say, our low productivity rate? With which “less socially generous nations” is Parris comparing us? – continues in the next paragraph:
As costs rise, there will be a point at which our culture (and any culture) will begin to call for a restraining hand. I believe that when it comes to the cost of keeping very enfeebled people alive when life has become wretched for them, we’re close to that point.
So the case for euthanasia as a solution to excessive costs to the Exchequer is dressed up as a kindness to “very enfeebled people” whose life has become “wretched for them”. And the drastic shift of culture this entails is now presented with almost Marxist historical inevitability:
I don’t even say we should look more benignly upon the termination of life when life is fruitless. I say we will. We may not be aware that our moral attitudes are being driven by the Darwinian struggle for survival, but in part they will be. And just as we feel ourselves looking more sympathetically at those who wish to end it all, so we shall be (unconsciously) looking at ourselves in the same way. The stigma will fade, and in its place will come a new description of selfishness, according to which it may be thought selfish of some individuals (including potentially ourselves) to want to carry on.
Parris and Malthus
Parris evidently believes he is saying something new, observing a phenomenon others have failed to perceive. But his basic argument is the same as that of Thomas Malthus more than 2 centuries ago about over-population. Malthus argued that unchecked population growth would outstrip the ability to feed people, and the solution lay in preventive or positive checks of one form or another. He believed in “positive checks”, which lead to ‘premature’ death: disease, starvation, war, resulting in what is called a “Malthusian catastrophe”. The catastrophe would return population to a lower, more “sustainable”, level.
Parris has simply created a special case of this general theory, arguing that unchecked growth of disabled and older people is already outstripping the means to treat, support and care for them. He’s not brought the food supply into the debate yet, but presumably his grotesque dystopian vision of large-scale euthanasia would be carried through “humanely” by gradually restricting the intake of food and drink allowed to the “useless” people. This system has already been piloted in The Liverpool Care Pathway.
Implementing the Parris Solution
It is said that every crisis represents an opportunity. How would Parris’s drastic solution be implemented? A process would be needed for selecting the people who are going to be shunted into this particular siding. One obvious mechanism would be application of NICE’s methodology of QALYs, but with a much lower tariff. NICE regards annual treatment costs of £30k per person as a reasonable value to put on a life. For “useless people” Parris would presumably want a much lower figure, preferably well below £10k.
The processing could be put out to tender. Several of the big-name firms versed in delivering public services for profit could make a good case for having the necessary skills (and friends in high places). Proper appeals machinery would also be required at several points in the process, perhaps through a Useless People’s Tribunal Service. As Parris evidently thinks other developed nations with ageing populations will see the logic of his argument and the attractiveness of his proposals, the Tribunal could quickly go international. Its Chair might well be willing to let the UK have the service at below cost, if it acts as a loss-leader for business with other rich nations.
Is there an alternative?
None of this might be necessary, of course, if instead of trying to eliminate the excess of people using the NHS and social care, we pursued greatly increased productivity and efficiency. This would involve producing better, more effective health and social care at significantly lower unit cost.
This could be helped by tackling three of the big dysfunctional features of the NHS: its inability to control the drugs bill, and blatant exploitation by the drugs companies; its toleration of entrenched protectionism by the main health professions; and its lack of a coherent research investment strategy. The allocation of research funding is based on a beauty contest of health conditions. The gross discrepancy between the NHS and social care in the levels of state research funding they receive is just one symptom of this lack of a strategy.
Lip service is regularly paid to these objectives; and Parris might echo the ironic doubts expressed by Swift about whether “there will ever be some hearty and sincere attempt to put them into practice.” But promoting them would surely be a better use of his genuine talents than continuing with his wrong-headed and nihilistic campaign to foster a climate in which mass euthanasia becomes a social good.
The intelligent man who spouts nonsense is a sad spectacle. The commentator who fails to connect the elimination of “useless” people with events in Europe 75 years ago has lost his moral compass. The normally astute journalist, frustrated that a slightly-built disabled woman consistently has better arguments than he does, makes a fool of himself as he blunders from one mistaken point to another untruth. Isn’t it time the referee stopped the fight?