One summer’s evening in 2007, after a medical ethics conference at Oxford university, Charles Foster pushed off to the pub with a group that included the Australian philosopher Julian Savulescu. Foster, a barrister who lived in London and specialised in medical law, had never met Savulescu, a bigwig in medical ethics. They had both presented at the conference, but Foster often disagreed with his ideas and thought him “a bit of a demon figure”. He had even co-written a rejoinder to one of Savulescu’s papers in the British Medical Journal.
In the pub, Foster eagerly drank his beer and soon found the nerve to ask Savulescu what he considered a forthright question. What principles should be used to decide the most difficult problems in medical ethics — intimate and consequential choices on subjects such as abortion, medical research on humans and assisted dying?
“To which his response was, in his very direct, Australian way, ‘Well I think there’s nothing but autonomy, really’,” Foster told me. The idea was “so dramatically dissonant with everything that I understood human decision-making to be about”, that Foster couldn’t think of anything to say in response.
In the days and weeks that followed, what Savulescu had said bothered Foster more and more. He came to see that medicine’s strict deference to “autonomy” — a person’s expressed wishes about what should happen to their body — was more or less the sole basis for the laws that govern life’s most vulnerable moments. Foster thought that was reductionist, a form of straightforward libertarianism. “It didn’t begin to do justice to the complexity and the enormity of humans,” he said. “It occurred to me that what we really value about human life . . . is the fact that it is intrinsically relational. None of my decision-making, if I’m a decent person anyway, happens in a vacuum without taking other people into account.”
Foster had become disenchanted with his work as a barrister. He’d started to see it as a form of “intellectual prostitution”, in which he was hired to argue things he didn’t believe. The world of academia provided a relief from that, which was one reason he’d agreed to speak at the conference. So on his arrival back in London, he persuaded his wife, Mary, a GP who was then on maternity leave with their second child, to decamp to Oxford for a term so that he could take up a visiting fellowship and write a book.
A year or so later, his book Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law was published. It is a fiery, if academic, assault on the presumption that autonomy should be the guiding principle by which we decide on how we live, from conception to death. It marked Foster out as a rare thinker, someone whose political and social views could be described as progressive, but who believes wholeheartedly that legalising assisted dying is a bad idea.
In recent years, as more countries have moved towards changing their laws on assisted death, Foster has been summoned to courtrooms and parliaments across Europe to make the case against it. In England, he has made submissions in some of the country’s most significant legal decisions on euthanasia and assisted suicide, including in the House of Lords and the Supreme Court. Now that the country is once again considering legalising assisted dying (a new bill is tabled for a House of Commons debate later this month), Foster is in high demand. He is speaking at cross-party MP briefings and advising groups that oppose the bill on its compatibility with the European Convention on Human Rights.
Foster concedes that legalising assisted dying might benefit individuals in specific, extreme circumstances. But, for society as a whole, he thinks it would have insidious effects that are probably irreversible. It is hard to think of a social reform that has granted individuals such an awesome or, for some, terrible power than the state-sanctioned and medicalised means to self-obliterate. “It’s precisely because I think life is wonderful that I think [I have] a duty to say that in the legal ways that I can,” Foster told me. “It doesn’t mean to say that life has to be hung on to at all costs. But it does mean that the law has a real function in saying that life is significant and the taking of life is morally important.”
In March, Foster invited me to Oxford for lunch at Exeter College, where he is now a fellow. It was the Easter holidays and in the fellows’ dining room mostly empty chairs encircled a long table. Foster served us soup. He wore brown lace-up shoes and had put a rumpled navy jacket over a knitted jumper. He was only missing elbow patches.
Now 61, Foster has been a member of the Oxford law faculty since 2012. He and Mary never returned to London after he finished the book. Foster got a permanent job at the university and they had two more children. These days, he lectures, supervises doctoral students and publishes prolifically. He also works as a crown and county court judge in order to feel “socially useful”. For an academic, he has “a very low view of thinking”, he told me. Instead, he is convinced that you get to the truth by being immersed in things.
That conviction has led Foster down some strange paths. For his 2016 book, Being a Beast, he attempted to inhabit the sensory and psychic worlds of different animals, by living, variously, as a badger, an otter, an urban fox, a deer and a swift. The chapter on badgers begins with a critique, from personal experience, of the earthworm as a foodstuff. His “enquiry into how accessible otherness is” continued in a 2021 sequel, Being a Human, for which he spent weeks in a freezing Derbyshire wood embodying an Upper Palaeolithic hunter-gatherer. “The last thing I ate was a hedgehog. That was nine days ago,” he writes.
Foster’s attempts to inhabit other realities are part of his personal and professional investigation into what being alive really means. But he escapes himself only partially. He is the opposite of a sinewy caveman — a tall, heavy-set, bushy-eyebrowed man who likes to tell stories, especially those he finds funny, and who pootles around on a battered yellow bicycle. He is also, as he likes to say, “morbidly overeducated”.
The writer and psychiatrist Iain McGilchrist, who has known Foster for 20 years, recalled once staying at his house in Oxford. He was put up in Foster’s study, which was full of taxidermied animals and masks from remote parts of the world. Perusing the bookshelf for some bedtime reading, he skipped past The Practical Farrier and landed on a copy of Revelations of Divine Love by Julian of Norwich, a mystic from the 12th century who McGilchrist hadn’t read since his teens. “I thought, oh, I’ll have a look at that,” he said. Taking it from the shelf, he realised it wasn’t a bound book, more a bundle of typescript. “I looked inside it and it said ‘translated from Middle English by Charles Foster’. And I thought well, gosh, the things that Charles does and doesn’t do.”
Foster grew up in a Sheffield suburb. His parents, both teachers, were “from very non-middle-class stock”. But they were “intellectually aspirational”, especially his mother, who was barred from taking her place at university because Foster’s grandfather, who worked in a paper mill, thought that women shouldn’t go. Foster’s parents prized material security, but they encouraged him and his younger sister in their idiosyncratic pursuits. He spent a lot of time alone in the woods at the end of his road. “But it never felt like that to me,” he said. “I was
always aware of this pulsating community of life around me.” He also carried a plastic bag in case he found some roadkill, which he would skin and stuff in the garden shed. He once pickled a blackbird brain in formalin and went to sleep holding it, “hoping that some of its wisdom would seep out”.
When he was 13, Foster made a radical decision. He took the bus to the library and looked up a list of British public schools. He saw a scholarship advertised at a boarding school in the south of England and applied without telling his parents. When a letter came inviting Foster for the entrance exam, he asked his father for a lift. After a pause, his father said, “If that’s what you really want.”
Foster was accepted to the school, but he hated it. “My wretchedness was crystallised in a sentimental northern nationalism,” he writes in Being a Human. Each night, he would stand on a toilet so that he could peer through the window down at the road and inhale when a lorry passed by, in the hope that its wheels might be transporting mud from home.
He went on to study veterinary medicine at Cambridge, but found it dry. One evening in the library, he pulled from the shelves a law report, a collection of judicial opinions on various cases. In it, he saw “how these great principles descending from on high sought to regulate what went on in real people’s lives”. He thought that this “collision” was a place where “really intellectually exciting things happened”. At 6am, he realised he’d been reading all night.
In 1988, Foster moved to London and became a barrister, eventually specialising in medical negligence. In chambers, he met his first wife, with whom he has two children. They divorced after a few years. At first, he found work in court thrilling, like being in a “gladiatorial arena”. But as the years passed, certain cases began to trouble him. He worked in litigation involving babies whose brains had been damaged at birth. “Very often, I was working for defendants — health authorities and NHS trusts — and using any clever design I had to try to keep terribly injured children and their parents out of money which would transform their lives,” he said. “You’re supposed to maintain this professional detachment. And increasingly, that seemed to me to be obscene.”
Back in the Exeter college dining room, a server took away our plates. Foster wanted to show me the “best view of Oxford”, so we went outside and walked across the fellows’ garden and up some steps. A bench overlooked Radcliffe Square, where magnolia trees were in bloom and someone was cutting the grass. I asked how being at Oxford has changed him. “I think it’s made me much less dogmatic, much more respectful of doubt and uncertainty,” he said. As a barrister, he had used cross-examination to wring testimony out of people. But he’s since come to believe that confrontation is not necessarily the way to extract the truth. Academia, he said, had made him “much more suspicious of the ability of any one paradigm to rule”.
Currently, any UK citizen who wants an assisted death must travel abroad. Critics of the prohibition point to this “outsourcing”, its expense and the potential repercussions for relatives who help an individual travel to places like Switzerland. Under the Suicide Act of 1961, it is an offence for a person to act in a way that is “capable of encouraging or assisting the suicide or attempted suicide of another person”.
In England and Wales, most recent court cases have been attempts to extract guarantees that relatives won’t be penalised for providing assistance. In 2009, Debbie Purdy, a multiple sclerosis sufferer, succeeded in arguing in the House of Lords that it was a breach of her human rights not to know whether her husband would be prosecuted if he went with her to Dignitas in Switzerland. There were no changes to the law, but the Lords did order Keir Starmer, who was the director of public prosecutions at the time, to “clarify what his position is”.
The Crown Prosecution Service subsequently published guidelines, which included a two-part test. First, for a case to proceed to court there must be sufficient evidence to justify a prosecution and, second, it must be in the public interest. Of 187 assisted suicide cases that were referred to the CPS by police between April 2009 and March 2024, 127 did not proceed and 36 were withdrawn. Most cases of encouraging or assisting suicide fail the public interest test, but four have been successfully prosecuted. For relatives asked to travel abroad, being investigated by police on their return is distressing.
Attempts to change the law in England and Wales have mostly come through private member’s bills, which are introduced by backbench MPs and debated in parliament. These have failed, sometimes due to a lack of parliamentary time. This month, the first debate on a new private member’s bill, introduced this week by Labour MP Kim Leadbeater, is due to be held. Prime minister Starmer has said it will be a free vote, meaning members can vote in accordance with their beliefs or conscience, rather than following a party line. Some senior MPs have argued there is not sufficient time to consider the substance of the bill and are calling for a review of palliative care instead.
Assisted dying, as a part of health policy, is a devolved matter in the UK. Other jurisdictions, including Scotland, the Isle of Man and the Channel island of Jersey, are considering similar legislation. If one of these jurisdictions legalises assisted dying, other parts of the British Isles will be pressured to follow suit.
On May 1, I woke at 5.15am and walked through central Oxford, passing Morris men, a bagpiper and a woman cartwheeling in a giant hoop. It was May Day morning and hundreds of people were out on the streets. I had come to watch Foster’s folk-music ensemble play on the steps of the Clarendon building on Broad Street. Among the musicians, Foster was easy to spot. He was stock-still, apparently concentrating on his tin whistle, and wore a hat festooned with sticky weed. “Oh, there’s Charles,” a woman in the crowd said to her companion. “He really does look like he’s come out of a swamp.” Mary was next to him playing the fiddle.
After the spectacle was over, Foster, Mary and I walked back to their house for breakfast with one of Mary’s GP colleagues, Priya Rai. As he opened the front door of their Victorian terraced house, Foster apologised for the “chaos”. The hallway was a sea of shoes. Three-quarters of the kitchen table seemed permanently given over to piles of books, papers and sheet music. We perched at the clear end and Mary put out coffee, croissants and jam. Maps of the world, yellowing children’s art and a number of African masks were tacked to kitchen walls and cupboards.
The conversation turned to the Isle of Man, where Foster was going the following week. He had been asked to speak to the House of Keys, the equivalent of Westminster’s House of Commons, about their assisted dying bill, by a group of island doctors who were against it. In the jurisdictions where it is legal, medical professionals are involved in the assisted dying process in some form. Some worry about the effect on the doctor-patient relationship if doctors, entrusted to heal, start helping to end lives prematurely. Fifty per cent of British Medical Association members who answered a 2020 survey said they supported prescribing lethal drugs for eligible patients to self-administer. But just 36 per cent said they would be willing to administer the drugs themselves.
Rai suggested euthanasia could become a specialism within medicine, in the way that some GPs are also dermatologists, creating an opt-in model. Mary shuddered. “I just couldn’t do it,” she said, shaking her head.
After breakfast, we retreated to the living room, which was strewn with music stands and instruments. Foster plays the tin whistle despite missing the end of a middle finger — he lost it after skiing to the North Pole — because it’s a version of the oldest instrument archaeologists think humans played. He has researched why we are captivated by music and believes that as a means of communication it predates talking. “And it speaks to much deeper parts of us,” he said. When you play music with others, “there is a sort of telepathic connection, which we are all capable of feeling all the time”. It is the experience of knowing what your partner is thinking, or going to say next, for example.
To Foster, the problem with medical law as currently practised is the way this fundamental aspect of human nature, our “relationality”, is being sidelined. By overemphasising the importance of bodily autonomy, Foster believes we create an “atomistic picture” of the individual, declaring, “I’m an island, I need consider no interests other than my own.” He traces this picture of humanity to the work of Immanuel Kant. It is the philosophy of the selfish brat. “I don’t think humans are like that,” he said. Instead, he believes that in making decisions about ourselves we do habitually take into account the fallout on the people around us.
It is a nuance absent from the assisted dying debate, he said. “An assisted dying law sounds nice . . . It’s a classic example of something that sounds good until you start to think seriously about it.” The question, for Foster, is whether legalising assisted dying is the best way to minimise the amount of suffering in the world. He has concluded it is not. On the pro-assisted dying side, there is “an understandable but fairly narrow focus on the individual patient, the patient with motor neurone disease, or the patient with cancer,” he said. “But there are other stakeholders. And, ultimately, those stakeholders include everyone in society.”
In all the jurisdictions where assisted dying or suicide is legal, the number of people ending their lives that way has steadily increased over time. In Oregon, the US state that in 1997 became the first jurisdiction to allow assisted suicides, 367 people chose to end their life by that method in 2023, a 21 per cent increase on the year before, which was itself a record year. In a report to the House of Commons, David Albert Jones, director of the Anscombe Bioethics Centre at Oxford, stated that such increases “do not themselves demonstrate that the practice is malign, but they show that the practice cannot be limited to a small number of people. Over time it will be ‘normalised’.”
As assisted death becomes more commonplace, Foster worries about people being coerced, either by a malicious party with an interest such as inheritance, or by subtler means. In 2022, 36 per cent of Canadian patients who had an assisted death said “perceived burden on family, friends or caregivers” was one of their reasons for choosing to die and 17 per cent cited “isolation or loneliness” (the survey permitted more than one answer). In Oregon, 125 people who had an assisted suicide since 1998 cited financial issues.
People pursue an assisted death for many reasons. Eighty-six per cent of patients in the Canadian survey said it was the loss of ability to engage in meaningful activities. But Foster thinks that being a burden, loneliness and financial worries are tragic reasons that reveal a failure of society and state. If health systems provided better palliative care that ameliorated both the physical and psychic pain a terminal diagnosis can bring there would be fewer calls for assisted deaths, he believes. “We’ve got to start valuing and giving appropriate status to palliative care physicians and giving them money for it.”
The next week, Foster flew to the Isle of Man, a windswept rock with 80,000 residents in the middle of the Irish Sea. The island is a crown dependency meaning it is self-governing. Within an hour of landing Foster was warned never to refer to the UK as “the mainland”. Outside the parliament building, known as the “wedding cake” for its white three-tiered facade, a line of protesters from Campaign for Dignity in Dying held placards. The Isle of Man’s assisted dying bill applies to terminally ill adults with capacity and a “clear and settled intention” to end their lives. That day, the 24 members of the House of Keys were meeting to debate its clauses.
Foster was one of a trio of expert witnesses invited to speak. His topic was the potential “legal jeopardy”. He was dressed more smartly than usual in a navy suit and a tie decorated in Amharic script. It had been his father’s. When he entered the wood-panelled chamber hung with portraits of bewigged dignitaries, he greeted me warmly, but he seemed tense. Sitting right next to him were the two witnesses for the “pro” side of the debate: Sam Ahmedzai, a palliative care specialist, and Jacky Davis, a consultant radiologist and assisted dying campaigner.
One of the members of the house stood to introduce Foster, and he launched into a technical explanation of the risks of legalisation in the context of the European Court of Human Rights.
Foster thinks that assisted dying isn’t entirely compatible with the European Convention on Human Rights, which protects people in the 46 countries belonging to the Council of Europe. The UK made these rights part of its domestic law in 1998. Article 2 of the convention prohibits the taking of life and Article 8 gives an individual the right to live their life the way they want. Some claimants have argued that laws preventing people from ending their lives when they wish inhibit their rights under Article 8. “Lots of the litigation about assisted dying relates to a stand-off between Article 2, on the one hand, and Article 8 on the other,” Foster told the house. Until this stand-off had been resolved, he added, it might be imprudent of members to pass a bill that could expose them to litigation in one of Europe’s highest courts.
In closing, he gave some of his other reasons for caution, including the impact on the doctor-patient relationship, coercion and so on. Then he shared his view that legalising assisted dying isn’t necessary. “If palliative care is properly in place, the worries which are expressed on all the placards of unbearable suffering at the end of life just don’t happen,” he said. If all goes badly wrong, he continued, patients can be sedated to unconsciousness and life-sustaining fluids can be withdrawn. This kind of palliative practice, he said, is not in conflict with either Article of the convention. “It vindicates personal autonomy rights in the way advocated for in this bill. And it doesn’t affect in a deleterious way any of the other constituencies whose interests you are required to consider.”
For much of Foster’s speech, Davis appeared to be struggling to contain her disdain, often regarding him with a mix of incredulity and contempt. When it was her turn to speak, she used her opening remarks to rebut Foster’s reasoning. Legalisation could improve the doctor-patient relationship, she said, by spurring “better conversations” about the end of life. And palliative care was not the panacea presented. “I have seen patients in situations that I would not want my family to be in, I would not want to be in myself.”
One member asked Davis how she became involved in campaigning. “How much time have you got?” she replied. She had started looking into assisted dying when the British Medical Association asked her to speak about it at an annual meeting, but her beliefs were solidified when her brother, at the age of 60, threw himself down some stone steps and died. He had been diagnosed with terminal cancer and was paralysed from the waist down. He had wanted an assisted death but couldn’t get one. Davis had promised him she would use his story. “We’re still living with that memory from my brother,” she said. “I’m looking around this chamber, I bet everybody can put up a hand to a bad death. If we can avoid that, why wouldn’t we?”
The house adjourned, and Foster left the building. We walked down the hill towards the seafront in the direction of my hotel, where he had arranged a lift to the airport for me. After the dimness of the chamber, the late afternoon sun seemed especially bright. The air smelt of brine. “I hate being here,” he said. “I hate this whole business. I find it very depressing. I’d rather not do it.”
I asked how he thought the day had gone. He didn’t think anyone in the chamber had changed their mind that day. “People are really entrenched, aren’t they?” He seemed to be reflecting on what Davis had said. “The argument for the other side is a very simple one and very immediately appealing. Here are [patients] who are suffering . . . there’s an easy way to abolish that suffering. Why wouldn’t you do it?”
We continued down the hill. The answer, he said, requires a more holistic view. Foster thinks that if we begin to offer people premature artificial deaths, that means we are saying, directly or indirectly, that some lives are not worth living. If death is permitted for the alleviation of suffering, where should we draw the line? Some jurisdictions already provide assisted deaths for unbearable mental suffering. In May, the Netherlands approved the application of a 29-year-old woman with chronic depression among other mood and personality disorders.
We arrived at the seafront. The tide was out, exposing a muddy crescent. Seagulls, joggers, dogs, elderly amblers and a little girl pushing a toy pram passed by on the promenade. “People overwhelmingly want to die looking out at an open space or at the sea,” Foster said. “People pay vast amounts of money to die in a nursing home on the esplanade.” He thought it a reflection of our deep yearning for wildness, for our roots as a species. It reminded me of a passage in Being a Human in which Foster writes about his father’s cremation. His family had “hired strangers to put on black suits and solemn expressions and to drive him from a breeze-block garage in a shiny car . . . We should have stripped off his old tweed suit and carried him in procession to a platform at the top of the moor, laid him down and let the crows take him.”
I asked if he would like that kind of burial for himself. “I think that has a great deal more dignity than being incinerated in a municipal crematorium on the other side of the ring road,” he said. “You get a certain sort of immortality, I guess, from knowing that lots of your cells are being grafted into the bodies of the crows.”
Nicola Davison is assistant analysis editor
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