The Perverse Economics of Assisted Suicide

Opinion|The Perverse Economics of Assisted Suicide

In June, lawmakers in my native country, Britain, approved plans to legalize assisted suicide. If the bill becomes law, England and Wales will join more than a dozen countries and 11 U.S. states in permitting medically assisted dying.

Every one of these jurisdictions has a total fertility rate below the replacement threshold. I do not think this is a coincidence.

About 30 years ago, P.D. James’s prescient novel “The Children of Men” imagined that a birthrate crisis would induce governments to facilitate the suicides of the elderly in a ritual known as “the Quietus.” Looking at the rush among some low fertility countries to legalize assisted suicide, I fear that Ms. James’s vision is already being realized.

Our fertility predicament is not as extreme as that imagined in “The Children of Men,” but it is nonetheless very real. The global total fertility rate has more than halved since 1950, with those of most countries already below replacement level. The population pyramid is increasingly inverted, not just in the wealthiest Western nations but also in most places outside Africa.

This poses an existential threat to welfare systems, which rely on young workers to fund entitlements and health care for older adults. Those who hope that liberal immigration policies will solve this problem forget that immigrants themselves get old, and their birthrates tend to converge with those of the greater population over time.

If birthrates do not recover — and at present, they show no real signs of doing so — eventually we will be forced to revert to the system that prevailed for all of human history up until recently: Older people will be cared for privately, typically by their children and grandchildren, and those without families will have to rely on charities, such as they are. In the meantime, we are in a period of transition. Welfare states limp on, but in conditions of increasing stress.