Sadly, though unsurprisingly, Rob Marris’s assisted dying bill has been rejected overwhelmingly by British MPs.

The most widely accepted argument in favour of rejecting the bill seems to have been that doing so would protect the vulnerable.

Which vulnerable people did the proponents of this argument have in mind? Those who would feel under pressure to request assisted dying so as to relieve the burden on their family. These people fall into two categories.

The first would be those who are feeling moral pressure, but not actually being pressured in any way by their family. It would of course be up to the doctors involved in the case to explain to the patient that there is no general expectation of such sacrifice in our society, and also to point out that the patient’s family would probably not be in favour of any such sacrifice. This may of course be insufficient to persuade the patient. But we do not elsewhere protect even the vulnerable from the consequences of moral decisions we think mistaken. Consider, for example, wealth-transfers. Some vulnerable people surrender large amounts of money to their relatives, and suffer a drop in their own well-being as a consequence, believing that this is what they ought to do. If we disagree, as I presume many of us often will, do we think a law justifying all such transfers by those who are very old or ill should be forbidden?

But what if the patient believes that, though assisted dying isn’t her duty, it would nevertheless be a good thing to do? Well, why should such a patient not be permitted to make that sacrifice? It is, as Mill might put it, a choice within her ‘private sphere’, and others are not entitled to interfere with it. Further, if the patient recognizes that her sacrifice is supererogatory, it would be odd for her to regret the fact that she has been given the opportunity. After all, there is nothing blameworthy in not taking it.

Nevertheless, it might be said, she is making herself worse off. The question here is not whether to allow a person to commit assisted suicide in a system where it is permitted, but whether to set up such a system in the first place. If we are concerned about patients’ well-being, especially when they are vulnerable, we should make certain choices unavailable.

This also seems somewhat paternalistic. Consider wealth-transfers again. Should we make them impossible for the vulnerable, when this could make them worse off? And if so, why only for the vulnerable? Any of us could be put under pressure by our relatives or others. If people are competent, should we not allow them to make their own decisions about the shape and direction of their own lives, even if we think those decisions will sometimes be mistaken?

What about those who are actually being pressured by others? Here it would be especially important for the two doctors and the judge involved to assure themselves that the preference expressed by the patient was competent and uncoerced. There might of course be the odd patient who was so good at dissembling that she could pull the wool over the eyes of the doctors and the judge. Again, however, this possibility is something we are inclined to allow elsewhere so as to promote liberty and autonomy in general. Consider wealth-transfers again.

Data from places where assisted dying has been legalized, such as Oregon, suggest that the fears of these opponents of the bill are anyway largely unjustified. It is a matter of numbers. If assisted dying were legalized, there may be one or two people who would be put under unreasonable and unacceptable pressure by their relatives to end their lives, just as now there are some people put under such pressure to transfer their wealth. But the most significant vulnerability in many of the terminally ill is that to agonizing, chronic, and unrelievable pain. Because of the MPs who opposed the bill, thousands of people in the UK will have to continue to bear this pain against their will. For these MPs to describe their vote as protecting the vulnerable is grotesque.