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 care 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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Sustainability

13 September 2024

7 min read

Living sustainably doesn’t have to be a burden, here’s the case for action

How not to get hot and bothered about climate change.

Barnabas Aspray

Barnabas Aspray is Assistant Professor of Systematic Theology at St Mary’s Seminary and University.

A protester holds up a green sign reading: 'It's hard to be green. Kermit'.

Markus Spiske on Unsplash.

The fundamental tenets of Christianity show why Christians are called to love not just one another but all created things.

1. God is love.

2. God created everything.

Therefore, God loves everything he created.

3. God appointed humanity as the guardians of creation.

Therefore, a fundamental part of our identity and calling as human beings is to protect and sustain all that God created.

This lies at the basis of everything Christians believe and do. But a case can be made that is more basic still because it appeals, not to anything distinctively Christian, but to natural human wisdom. The climate crisis is not a Christian crisis. It’s a crisis for everyone who cares about their future and that of our planet. The climate crisis may be something unprecedented in the history of humanity, but the principles that are needed to resolve it are not new at all. Sustainability is not a new or particularly abstruse idea. It is something everyone understands as basic common sense. If I cut down trees faster than they can grow, I won’t be able to do that forever. One day I will cut down the last tree and then there won’t be any more trees, ever again. If I catch fish faster than they can reproduce, then one day I will catch the last fish and then won’t be able to catch any more ever again.

But it’s not only about foresters and fishermen. Since the dawn of humanity, we have been living sustainably – wisely preserving resources and using only what we can replace, so that we and our descendants can continue to live. This applies to everyone regardless of their profession. All of us, if we spend more money than we earn, are living in a way that cannot last for long. If we use resources at a faster rate than we can replenish them, we will run into trouble at some point in the future. Every person possessed of reason and common sense knows this intuitively without having to be taught it. Only someone seriously deluded, foolish, or with some kind of mental health problem fails to understand the need for sustainability in order to have any kind of future at all, let alone a pleasant future.

The call to live sustainably can lead us to feel burdened by a permanent sense of guilt, a feeling that we ought to be doing more than we are...

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We are burning fossil fuels at hundreds of times the rate they can be produced. We are producing plastics that cannot be recycled, meaning we have to dump them in landfills that are growing all the time. We are pouring carbon dioxide into the air faster than anyone can take it out. All of these things mean that there is a time limit on the kind of lifestyles we are all leading now. If we carry on in this way, then one day we will cross a line from which there is no returning. As Mark Scarlata has pointed out, the solution cannot be technological. Even if we find a way to balance carbon outputs with inputs, we are only kicking the can further down the road. Our inability to live within our means will simply resurface somewhere else later on. The problem is spiritual, not technical.

Everyone understands this at some level even if it’s the kind of truth from which we prefer to avert our eyes. The harder problem is to understand why this basic common sense isn’t proving effective. Why are we living collectively in a way that only a foolish or insane person would live, when most of us taken by ourselves are neither foolish or insane?

The problem, at least in part, is that we are all entangled in systems that make it very hard for us to live sustainably. If I am an ordinary Brit living in an ordinary town or city, and I need to buy toothbrushes or nappies or cucumbers or strawberries, I go to the local supermarket: and the only options available are made of plastic or wrapped in plastic that will not decompose for 500 years, and often brought here from the other side of the world using huge amounts of carbon emissions. Most of us are busy people with limited financial resources. We don’t have the time to find sustainable alternatives and often they are too expensive even if we can find them. The societal structures that we live in limit the choices we have. The call to live sustainably can lead us to feel burdened by a permanent sense of guilt, a feeling that we ought to be doing more than we are, but also an inability to see how we could be doing more given all the pressures, needs and constraints on our time and money.

Christians do not naively believe that God will sweep in and fix everything if we just wait. That would be to deny our responsibility, and it is not what hope means.

We are all culprits in part, since we all contribute to non-sustainable living. But we are also partly victims of forces beyond our control, large cultural forces that shape and determine our actions more than we can imagine. We have very little power over those structural forces and currently things do not look good. Common sense principles aren’t working. The climate crisis is only getting worse. So, what do we do?

It is at this point that Christianity has something special to offer to the problem.

First, Christians are never called to be defeatist or to throw in the towel. This is because we are called to an enormous hope, a hope that surpasses understanding, a hope that the world cannot understand because it stands over against all the odds and all the possibilities. This hope is rooted in the conviction that our God is God Almighty, that he has not abandoned his creation, and that he has power to save. He is a saviour. He is the God of our salvation. This is the God we believe in. The climate crisis may look bleak right now, but Christians need never despair or become indifferent. If we do our small part, we can trust that God is in control of what is out of our control.

Secondly, Christians believe that every human being is a free agent with the capacity to choose how he or she will act. Our freedom may be limited by the societal structures that shape and constrain our choices, but it is not destroyed. We can still make choices within those limits to buy and live more sustainably – anything from choosing a holiday destination within driving distance, to giving up beef (by far the worst food for carbon emissions). There is something all of us can do.

Thirdly, Christians believe in a God who transforms hearts and lives, winning them to the power of the gospel and to a new way of living that is free of the shackles that this world – the structures of society – puts on us. This transformation is slow – slower than we would like it to be sometimes. We feel the shackles still gripping us at times. We are not expected to change everything all at once, to become holy overnight. Nevertheless, God gives us the power to change our lives, and to become part of the solution rather than part of the problem. The way towards sustainable living is not to try to change everything at once, but to ask: what one thing can I change in my daily lifestyle that would make it more sustainable? And then once we’ve mastered that and integrated it so we no longer even think about it and it’s just a default, then we can ask: what’s the next thing I can do? All of a sudden what looks like an unimaginable height of transformation, when it is broken down, becomes a series of manageable steps.

Even if we do everything in our power, we cannot by ourselves avert a possible catastrophe. We are small players in a big game. Christians do not naively believe that God will sweep in and fix everything if we just wait. That would be to deny our responsibility, and it is not what hope means. Hope means the opposite: that we continue to fight to avert climate disaster even when it seems hopeless. Christians are called to be part of the solution rather than part of the problem. We are called to live in such a way that, if catastrophe comes, it won’t be because of us – to live in hope that our actions are meaningful and worthwhile and that we are in the hands of a God who is far more powerful than the most powerful forces in this world.