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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Education

Leading

26 July 2024

5 min read

Why I teach over my students’ heads

Successful teaching is a work of empathy that stretches the mind.

James K.A. Smith

James is a philosopher, cultural critic and author.

A blackboard covered in chalk writing and highlights.

James's chalkboard.

I’ve been teaching college students for almost 30 years now. As much as I grumble during grading season, it is a pretty incredible way to make a living. I remain grateful.

I am not the most creative pedagogue. My preference is still chalk, but I can live with a whiteboard (multiple colors of chalk or markers are a must). Over the course of 100 minutes, various worlds emerge that I couldn’t have anticipated before I walked into class that morning. (I take photos of what emerges so I can remember how to examine the students later.) I think there is something important about students seeing ideas—and their connections—unfold in “real time,” so to speak.

I’ve never created a PowerPoint slide for a class. I put few things on Moodle, and only because my university requires it. I’ve heard people who use “clickers” in class and I have no idea what they mean. I find myself skeptical whenever administrators talk about “high impact” teaching practices (listening to lectures produced the likes of Hegel and Hannah Arendt; what have our bright shiny pedagogical tricks produced?). I am old and curmudgeonly about such “progress.”

But I care deeply about teaching and learning. I still get butterflies before every single class. I think (hope!) that’s because I have a sense of what’s at stake in this vocation.

I am probably most myself in a classroom. As much as I love research, and imagine myself a writer, the exploratory work of teaching is a crucial laboratory for both. I love making ideas come alive for students—especially when students are awakened by such reflection and grappling with challenging texts. You see the gears grinding. You see the brow furrowing. Every once in a while, you sense the reticence and resistance to an insight that unsettles prior biases or assumptions; but the resistance is a sign of getting it. And then you see the light dawn. I’m a sucker for that spectacle.

This is how the hunger sets in. If you can invite a student to care about the questions, to grasp their import, and experience the unique joy of joining the conversation that is philosophy.

Successful teaching is, fundamentally, a work of empathy. As a teacher, you have to try to remember your way back into not knowing what you now take for granted. You have to re-enter a student’s puzzlement, or even apathy, to try to catalyze questions and curiosity. Because I teach philosophy, my aim is nothing less than existential engagement. I’m not trying to teach them how to write code or design a bridge; I’m trying to get them to envision a different way to live. But, for me, it’s impossible to separate the philosophical project from the history of philosophy: to do philosophy is to join the long conversation that is the history of philosophy. So we are always wresting with challenging, unfamiliar texts that arrive from other times that might as well be other planets for students in the twenty-first century.

So successful teaching requires a beginner’s mindset on the part of the teacher, a charitable capacity to remember what ignorance (in the technical sense) feels like. To do so without condescension is absolutely crucial if teaching is going to be an art of invitation rather than an act of alienation. (The latter, I fear, is more common than we might guess.)

Such empathy means meeting students where they are. But successful teaching is also about stretching students’ minds and imaginations into new territory and unfamiliar habits of mind. This is where I find myself especially skeptical of pedagogical developments that, to my eyes, run the risk of infantilizing college students. (I remember a workshop in which a “pedagogical expert” explained that the short attention span of students required changing the PowerPoint slide every 8 seconds. This does not sound like a recipe for making students more human, I confess.)

That’s why I am unapologetic about trying to teach over my students’ heads. I don’t mean, of course, that I’m satisfied with spouting lectures that elude their comprehension. That would violate the fundamental rule of empathy. But such empathy—meeting students where they are—is not mutually exclusive with also inviting them into intellectual worlds and conversations where they won’t comprehend everything.

This is how the hunger sets in. If you can invite a student to care about the questions, to grasp their import, and experience the unique joy of joining the conversation that is philosophy, then part of the thrill, I think, is being admitted into a world where you don’t “get” everything.

This gambit—every once in a while, talking about ideas and thinkers as if students should know them—is, I maintain, still an act of empathy.

When I’m teaching, I think of this in a couple of ways. At the same time that I am trying to make core ideas and concepts accessible and understandable, I don’t regret talking about attendant ideas and concepts that will, to this point, still elude students. For the sharpest students, this registers as something to learn, something to be curious about. Or sometimes when we’re focused on, say, Pascal or Hegel, I’ll plant little verbal footnotes—tiny digressions about how Hannah Arendt engaged their work in the 20th century, or how O.K. Bouwsma’s reading of Anselm is akin to something we’re talking about. The vast majority of students won’t be familiar with either, but it’s another indicator of how big and rich and complicated the intellectual cosmos of philosophy is. For some of these students (not all, certainly), this becomes tantalizing: they want to become the kind of people for whom a vast constellation of ideas and thinkers are as familiar and present as their friends and cousins. This becomes a hunger to belong to such a world, to join such a conversation.

This gambit—every once in a while, talking about ideas and thinkers as if students should know them—is, I maintain, still an act of empathy. To both meet students where they are and, at the same time, teach “over their heads,” is an invitation to stretch into new terrain and thereby swell the soul into the fullness for which it was made. The things that skitter just over their heads won’t be on the exam, of course; but I’m hoping they’ll chase some of them for a lifetime to come.

This article was originally published on James K A Smith’s Substack Quid Amo.