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.

Article

Comment

Music

Sustainability

17 October 2024

4 min read

What’s the point of celebrating the harvest?

We reap what we sow: a once young man’s guide.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A soot stained burnt-out harvester sits in a recently harvested field.

A burnt-out harvester, Lonesome Farm, Oxfordshire.

Nick Jones.

I plan next week to visit a small nursery school, called Young Haymakers, for their Harvest celebration where toddlers to five-year-olds will sing songs about tractor wheels going round and round, with vigorous manual actions as they shake, shake, shake the apple tree.

We’ll have a Harvest snack at tiny tables, a prayer and then they’ll give me the Harvest gifts from their families for those who may be hungry.

It is, of course, a delight, one of the happiest duties of a parish priest and I’ll miss it terribly as I hand it over to a new Rector. But, while I take nothing away from the sheer joy of thanksgiving of these children for the fruits (and vegetables) of this harvest and for those who farm them, I can’t help but wonder what Harvest, as a festival, really means for grown-ups.

The metaphor has been just too rich to avoid this season. We reap what we sow – and we witness that from Ukraine to Gaza and Lebanon, from Sudan to a United States that teeters on the brink of self-destruction as the world’s beacon of democratic values.

One might add to this sorry list the longer-term grim gathering-in from the world’s reliance on fossil fuels, a failed harvest of biblical-scale abomination as we destroy our planet’s natural capacity to host us. Truly, we have sown a wind and, in so many areas of human endeavour, we look like we reap a whirlwind (literally, in the case of weather crises such as Hurricane Milton).

There are prophetic voices that cry out in our human wilderness, from those who foresee the demise of the US at the hands of a shallow nationalism to those few on the political stage who predict an all-out war in the Middle East as the only possible conclusion to the escalation of revenge attacks between Israel and its neighbours.

The ancients saw famine and failed harvests as judgments for their sin, their divergence from the divine will. It’s unlikely that our world is going to accept such culpability any time soon. To do so would require a humility that we have lost, along with losing our religion.

We need to be careful of ascribing too much of a prophetic voice to Young. This was, after all, a fairly bombed-out singer-songwriter of the start of the Boomer generation.

Setting aside the reaping of whirlwinds from millennia ago, I’m going to invoke a popular folk song from a little over half a century ago. I do so because, in 1972, we lived in a more innocent world, before we knew how industrialisation could destroy our human species and when a western hegemony in democracy was taken for granted. Little did we know the precipice on which we were perched.

The song is by the folk-rock colossus Neil Young and is called, appropriately enough, Harvest. It is, lyrically, one of his more obscure works and to listen to it now is to struggle to get past a strangulated hippy voice that verges on self-parody.

But it repays the effort. Young’s lyrics are infused with religious reference and imagery, but no claim should be made for his affirmation of the Christian faith. Nonetheless, we’re entitled to view art through the prism of what informs us and, as such, Harvest yields its fruits. Young may well be singing about his lover, but it’s in love that all truth is explored.

Listen to it. Young’s Harvest opens with the lines “Did I see you down in a young girl’s town/ with your mother in so much pain?” Through a scriptural lens, this sounds like the pain of incarnation, the sharing of Mother Mary’s agony in visceral human experience.

It continues: “Will I see you give more than I can take”; for the confessing faithful, we’re at the foot of the cross here. “Will I only harvest some?”; we can, all of us, only harvest a little of the mystery of that event. “As the days fly past, will we lose our grasp?”; of course we will – time is finite. “Or fuse it in the sun?”; an uncanny pre-echo of climate change worthy of Nostradamus.

We need to be careful of ascribing too much of a prophetic voice to Young. This was, after all, a fairly bombed-out singer-songwriter of the start of the Boomer generation. But it’s also true that we should be careful of where we look for prophetic voices.

For Young, the Harvest is indeed a cruel and painful event, which we can only understand in part. We do indeed reap what we sow, but there may be purpose to be found in that. And the Harvest is indeed bitter, but in it we may glimpse a plan: “Dream up, dream up, let me fill your cup/ With the promise of a man”.

Or, okay, it’s just a song, harvesting a good deal of cash for its writer and singer. I’m no big fan of Young. But it might just have told me more about the Harvest than singing All Things Bright and Beautiful.