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

Mental Health

Poetry

15 October 2024

4 min read

Auden and our anxious age

While the tropes of trauma are still with us, how to not die in our dread?

Jack Nicholson

Jack is a graduate of Peterhouse, University of Cambridge and Blackfriars, University of Oxford. He works in local government.

An outdoor vigil is lit by people holding up mobile phone lights.

Oxford's peace vigil.

BBC News.

Faces along the bar

Cling to their average day:

The lights must never go out,

The music must always play . . .

Lest we should see where we are,

Lost in a haunted wood,

Children afraid of the night

Who have never been happy or good.

This week, we mark the 85th birthday of W. H. Auden’s poem ‘September 1st, 1939’. He describes four solitary drinkers in New York on the cusp of the Second World War. September 1st, 1939: Hitler invades Poland. Those four faces struggle to find meaning in their lives.

In a later, much longer poem of 1947 (first UK edition, 1948) Auden built on this theme, having lived through the War, to identify an ‘Age of Anxiety’. He wrote, ‘We would rather be ruined than changed / We would rather die in our dread / Than climb the cross of the moment / And let our illusions die.’

I have been reflecting on this of late, especially in light of a recent night vigil for peace, remembrance, and unity at Bonn Square, Oxford, where I live. This took place on 7 October, the anniversary of the Hamas attack on Israel in 2023: the darkest day in Jewish history since the time that Auden wrote his poems.

In an Age of Anxiety, Auden wrote, ‘the world needs a wash, and a week off’. The gathering in Oxford was especially poignant because some 250 people chose to go out in the rain, on their Sunday-evening time off, and in the darkness, to hear prayers and readings from different communities. It was as if the world was awash with people coming together.

The Bishop of Oxford the Rt Rev’d Dr Steven Croft said, ‘Our purpose is simply to be together.’ People simply had to do ‘something in the face of the helplessness that we all feel, in the face of these terrible events’. Louise Gordon, co vice president of the Oxford Jewish Congregation, described people ‘clinging to hope’. Imam Monawar Husain stressed that togetherness as such is a ‘symbol’, a symbol of hope.

Symbols abounded. Candles were lit. In ‘September 1st, 1939’, Auden described ‘Ironic points of light’ which

Flash out wherever the Just

Exchange their messages:

May I, composed like them

Of Eros and of dust,

Beleaguered by the same

Negation and despair,

Show an affirming flame.

The crowd spontaneously joined in with the protest song ‘Where Have All the Flowers Gone’, which was first sung in 1955.

It is striking that so many of the tropes and themes concerning what has gone wrong with the world, from our perspective, were already apparent and received clear expression from 1939 through to the mid- to late-1950s, in terrible events, then in thought, poetry, and protest song, in an age of anxiety.

If there are similarities between Auden’s age and our own, then we should be encouraged by that.

Sociologists described the ‘lonely crowd’ in 1950. This suggests that people seek more approval and acceptance from others as the physical distance between them diminishes and society becomes increasingly geared toward consumption. The capacity to come together for peace, remembrance, and unity becomes far less likely.

Philosopher Max Picard lamented the loss of the ’World of Silence’ in 1952: the capacity to be still. And later, in 1958, the word ‘meritocracy’ was first used to describe a dystopian world in which merit (IQ + effort) reigns, replacing previous relational bonds, a sense of togetherness, exemplified in the gathering in Oxford in 2024.

C. S. Lewis, in Oxford in the late 1950s, identified friendship as a kind of love which is regarded 'in the modern world' as 'quite marginal; not a main course in life's banquet', which is especially true if we bypass the banquet and spend our time at the bar (or, worse, online, at home). Louise Gordon, at the vigil, also spoke of the way in which people were counterculturally 'clasping hands in friendship'.

When sociologists today describe the ‘lonely century’ (Noreena Hertz) or when so many sigh over our inability to sit, or stand, in silence, in some sense at least they have not identified anything new. War crimes are, sadly, all too familiar to us. And recently, the lawyer Stephen Toope identified an ‘age of anxiety’ today.

It is not as simple, however, as saying that we have been anxious for the last seventy years. Auden’s age was also one of creativity of which the Anglosphere has been proud, for instance, around the foundation of the National Health Service in 1948. His generation stared into the abyss. They did not die in their dread.

If there are similarities between Auden’s age and our own, then we should be encouraged by that. Lamentation is as old as love, and the choice is as stark as he put it in his poem 85 years ago: ‘love one another or die’.

The notion of vigil is equally old. Today, vigils are held for peace, remembrance, and unity. In Christian liturgy, however, a vigil is specifically a watch during the night, looking forward to the dawn of a new day. ‘As the night watch looks for the morning’, likewise the people wait for Christ, their saviour.

That silent watch is far removed from the solitary ‘faces along the bar’ who ‘cling to their average day’. Horrible events such as those which took place on September 1st, 1939 or October 7th, 2023 bring people together in common purpose, simply to be together and to cling instead to hope for a better tomorrow.

Anxiety is replaced by hope.

Candles are lit. It may well rain. But song will be sung. And people of good-will, having climbed ‘the cross of the moment’, will show what Auden described: that great ‘affirming flame’.