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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Faith

15 August 2024

4 min read

Faith is no longer a dirty word in publishing

Sarah Perry’s comments suggest a reawakening of concern for its observation.

George Pitcher

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

A woman being interviewed gestures with a hand in front of her

Sarah Perry.

Waterstones.

If there’s one thing anyone who has ever written a novel can’t stand, it’s having to congratulate a successful novelist. So, it’s through gritted teeth that I warmly welcome the words of Sarah Perry (The Essex Serpent) that religious faith is ceasing to be a subject of embarrassment in published fiction.

It’s about time. Perry told the Edinburgh International Book Festival that, for her latest book Enlightenment, she was asked to put in more theology: “I assumed that everybody knew what the doctrine of predestination meant.” Bless.

The cause of my pathetic envy as I applaud her is that I had my first (and, to date, only) novel published in 2017, to almost universal disinterest. I like to tell people that it was well received – all three people who actually read it said they enjoyed it and only one of them was a family member. It actually did a bit better than that, but you get my drift.

It was an unashamedly religious psychological thriller, titled A Dark Nativity. Brace position, here comes a one-sentence synopsis: The narrator, Reverend Natalie Cross, is a frustrated former aid worker who undertakes a mission to Israel, is kidnapped and held hostage, murders her way to freedom, discovers she was the victim of an Anglo-American plot, wreaks her terrible revenge and (spoiler alert!) gives birth to a son of uncertain paternity.

See what I did there? As well as the latter-day Nativity resonance, thematically I was interested in what redemption looks like in Israel and Palestine. I know, I know – but even I thought it would be distasteful to try to cash in on what’s happened there since.

Enough of the plug for a seven-year-old novel. My point is that its religious themes actively militated against it at the time. Novels addressing Christian faith (or any other kind) occupied a particular publishing niche – a harsher word might be ghetto. To try to break out of it was pointless. The great Christian novelist Penelope Wilcock told me (very kindly) that my book was too religious for the secular market and too secular for religious readers.

Perry’s observation that faith is no longer a dirty word in publishing might yet suggest a reawakening of serious concern for its observation.

The restricted area to which religion was confined had its stylistic rules. There was the cathedral close romp, which authors such as Catherine Fox had made their own. The vicarly whodunnit (lately updated by Reverend Richard Coles). Magic realism with its daemons and Philip Pullmans. And anything, in the wake of Dan Brown’s The Da Vinci Code, involving ancient plots that might make a movie, with hooded figures walking in slo-mo through cloisters.

Vicars had to be evil or silly. I may be both those things at times, but I’d like to think there is other stuff going on here for cultural exploration. My narrator, Nat Cross, was driven, often funny and more than a little mad. So like a lot of Anglican clergy.

If she’s right – and I very much hope she is – it’s why what Perry has to say is so hopeful. Because it begins to suggest that religious faith is slowly beginning to be accepted back into polite society. Whisper it softly, it might even become a cultural norm. If Richard Dawkins can describe himself as a “cultural Christian” and the historian Tom Holland, in his book Dominion, can claim that Christianity is the entire foundation of western civilisation, then there is everything to play for. And, indeed, write for.

It’s not as if cathedral frolics and the revelation of Jesus’s wife in Leonardo’s Last Supper was anything other than a fictional diversion of post-modernism. Religion and specifically Christianity had been a staple of the novel in English.

I hesitate to mention their names in the same column as the authors above (including me, most obviously), but Graham Greene’s exposition of Catholic guilt in The End of the Affair and Evelyn Waugh’s of the impossibility of moral reformation in Brideshead Revisited are probably the best religious novels of the twentieth century.

Further back towards the birth of the English novel, the Reverend Edward Casaubon in George Eliot’s Middlemarch is perhaps the most tragic portrait of a clergyman who is neither evil nor silly. He stand as a warning from history to today’s Church of England.

And it’s to that, the established Church, that Perry’s remarks ultimately turn our attention. We’re told that there has been a five per cent spike in church attendance recently, but that of itself isn’t sufficient to suggest a renaissance in our religious culture. Our arts and culture will only ever really reflect what we care about.

Perry’s observation that faith is no longer a dirty word in publishing might yet suggest a reawakening of serious concern for its observation. If so, that’s good news for the religious, as well as for religious authors. And I might just get a sequel out of it.