Assisted Dying logic makes perfect sense but imposes a dreadful dilemma

The case for assisted dying appeals to choice and autonomy, yet not all choices are good. It means vast numbers of people will face a terrible choice as their life nears its end.

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A black and white picture shows a woman head and shoulders, she is looking up and to the side in an unsure way.

Anastasiya Badun on Unsplash.

Two broad cultural trends have led us to our current debate over assisted suicide.

One is the way consumer choice has come to be seen as the engine of successful economies. Emerging from Adam Smith’s theories of rational choice based on self-interest, given a boost by Reaganomics and Thatcherite thinking in the 1990s, the provision of a range of choice to the consumer is usually argued, with some logic, as key to the growth of western economies and the expansion of freedom.

The other is the notion of individual autonomy. Articulated especially in the past by figures such as John Locke and John Stuart Mill, the idea that individuals should be free to choose to dispose of their property, their time and their talents as they choose, as long as they don’t harm anyone else, has become standard moral fare in the modern world.

Put these two together, and the logic of assisted dying makes perfect sense. What can be wrong with offering someone a choice? Why should the state restrict individual freedom to end your life in the way you might decide to do so?

Yet expanding choice is not always good. Forcing an employee to choose between betraying a colleague or losing their job is not a fair choice. There are some choices that are unfair to impose upon people.

Assisted dying will lead us to this kind of choice. Imagine a woman in her eighties, living in a home which is her main financial asset, and which she hopes to leave to her children when she dies. She contracts Parkinson’s or dementia, which will not kill her for some time, but will severely limit her ability to live independently (and remember about of third of the UK population will need some kind of longer-term care assistance as we get older). At present, her only options are to be cared for by her children, or to sell her house to pay for professional care.

With the assisted suicide bill, a third option comes into play – to end it all early and save the family the hassle - and the money. If the bill passes, numerous elderly people will be faced with an awful dilemma. Do I stay alive, watch the kids’ inheritance disappear in childcare costs, or land myself on them for years, restricting their freedom by needing to care for me? Or do I call up the man with the tablets to finish it soon? Do I have a moral duty to end it all? At present, that is not a choice any old person has to make. If the bill passes, it will be one faced by numerous elderly, or disabled people across the country.

Even though the idea may have Christian roots, you don’t have to be religious to believe the vulnerable need to be protected

Of course, supporters of the bill will say that the proposed plan only covers those who will die within six months, suffering from an “inevitably progressive condition which cannot be reversed by treatment.” Yet do we really think it will stay this way? Evidence from most other countries that have taken this route suggests that once the train leaves the station, the journey doesn’t end at the first stop - it usually carries on to the next. And the next. So, in Canada, a bill that initially allowed for something similar was changed within five years to simply requiring the patient to state they lived with an intolerable condition. From this year, there is a proposal on the table that says a doctor’s note saying you have a mental illness is enough. In the same time frame, 1,000 deaths by assisted dying in the first year has become 10,000 within five years, accounting for around 1 in 20 of all deaths in Canada right now. Some MPs in the UK are already arguing for a bill based on ‘unbearable suffering’ as the criterion. Once the train starts, there is no stopping it. The logic of individual choice and personal autonomy leads inexorably in that direction.

Of course, some people face severe pain and distress as they die, and everything within us cries out to relieve their suffering. Yet the question is what kind of society do we want to become? One where we deem some lives worth living and others not? Where we make numerous elderly people feel a burden to their families and feel a responsibility to die? In Oregon, where Assisted Dying is legal, almost half of those who opted for assisted dying cited fear of being a burden as a factor in their decision. Or would we prefer one where the common good is ultimately more important than individual choice, and where to protect the vulnerable, we find other ways to manage end of life pain, putting resources into developing palliative care and supporting families with dependent members – none of which will happen if the option of assisted dying is available.

Even though the idea may have Christian roots, you don’t have to be religious to believe the vulnerable need to be protected. Changing the law might seem a small step. After all, doctors routinely administer higher doses of morphine which alleviate pain and allow a natural death to take its course. Yet that is a humane and compassionate step to take. To confront numerous people, elderly, disabled and sick with a dreadful dilemma is one we should not impose upon them.

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21 October 2024

2 min read

Do we feel guilt for Liam Payne’s death?

We want the celebrity world to exist, but it returns terrible violence.

Jack Chisnall

Jack Chisnall is a former gag teller and Oxford Theology graduate, combining the two at Holy Fooling.

A crowd of teenagers gather by a Peter Pan statue to mourn a dead pop star

A fan vigil beside a Peter Pan Statue, London.

Sky News.

It’s no secret that fame is a poisoned chalice. Those reading about Liam Payne, the former One Direction star who died last week, will have noticed the theme: denied privacy, loaded with unbearable expectations, in a milieu where illegal substances were too much to hand - what chance did he have? The word ‘tragedy’ is scattered across multiple headlines.

One young Telegraph writer sees it as a generational trauma: “our first celebrity-induced reminder that life can be cruel, and fleeting”. Formerly Elvis, or John Lennon, now Payne; plus ça change. But what really haunts our society about Payne’s death is not a feeling it was unavoidable. It is, rather, our guilt: did we do this? Our rapacious appetites, consumer needs, and reckless licensing of rock-’n-roll form - did we tie this teen idol to the sacrificial altar?

Religious language is not inappropriate: thousands in cities around the world are holding vigils to Payne’s memory, and these shrines would have interested René Girard, who had a theory about how society works. While staying “a few pages ahead of the students” in French novels at Indiana University during the late 1950s, Girard noticed that humans want things, but not because of innate desires. We want things because other humans want them. There is always this undercurrent of rivalry to our world, even amongst close friends - in fact, especially for those whose goals are most similar.

What becomes of this collective aggression? It has to be banished through scapegoating. It’s everyone against one; a victim is butchered. For Girard, culture is what happens when a group achieves temporary peace in the wake of a sacrificial death. The bubble of built-up tension has burst, and an epoch of nonviolence means we get on with civilisation. We raise the kids, build some structures, or write a poem.

Religious mourning for Payne reveals these sacrificial contours of our culture. We want the celebrity world to exist, for its fantasies, desirable bodies, and danger. But it returns terrible violence - exploitation, harassment, and rejection (Payne’s own solo career had not kept him at the thrilling toppermost of the chart). The death of a victim sobers us up, momentarily, from our intoxication. But how long until we repeat it again?

Girard converted to Catholicism in 1959, after he encountered in the Gospels a religion that acknowledged these human trends, and offered a solution. It still required imitation - of Jesus Christ - but without the threat of rivalry. But in the crucifixion was a scapegoating that did not seem to leave things open to repetition. It had finished something, for good. Sunday morning yielded a new kind of peace.