Article
Assisted dying
Care
Comment
Politics
6 min read

Assisted dying’s problems are unsolvable

There’s hollow rhetoric on keeping people safe from coercion.

Jamie Gillies is a commentator on politics and culture.

Members of a parliamentary committee sit at a curving table, in front of which a video screen shows other participants.
A parliamentary committee scrutinises the bill.
Parliament TV.

One in five people given six months to live by an NHS doctor are still alive three years later, data from the Department of Work and Pensions shows. This is good news for these individuals, and bad news for ‘assisted dying’ campaigners. Two ‘assisted dying’ Bills are being considered by UK Parliamentarians at present, one at Westminster and the other at the Scottish Parliament. And both rely on accurate prognosis as a ‘safeguard’ - they seek to cover people with terminal illnesses who are not expected to recover. 

An obvious problem with this approach is the fact, evidenced above, that doctors cannot be sure how a patient’s condition is going to develop. Doctors try their best to gauge how much time a person has left, but they often get prognosis wrong. People can go on to live months and even years longer than estimated. They can even make a complete recovery. This happened to a man I knew who was diagnosed with terminal cancer and told he had six months left but went on to live a further twelve years. Prognosis is far from an exact science. 

All of this raises the disturbing thought that if the UK ‘assisted dying’ Bills become law, people will inevitably end their lives due to well-meaning but incorrect advice from doctors. Patients who believe their condition is going to deteriorate rapidly — that they may soon face very difficult experiences — will choose suicide with the help of a doctor, when in fact they would have gone on to a very different season of life. Perhaps years of invaluable time with loved ones, new births and marriages in their families, and restored relationships. 

Accurate prognosis is far from the only problem inherent to ‘assisted dying’, however, as critics of this practice made clear at the – now concluded – oral evidence sessions held by committees scrutinising UK Bills. Proponents of Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill and Liam McArthur’s Assisted Dying for Terminally Ill Adults (Scotland) Bill have claimed that their proposals will usher in ‘safe’ laws, but statements by experts show this rhetoric to be hollow. These Bills, like others before them, are beset by unsolvable problems. 

Coercion 

Take, for example, the issue of coercion. People who understand coercive control know that it is an insidious crime that’s hard to detect. Consequently, there are few prosecutions. Doctors are not trained to identify foul play and even if they were, these busy professionals with dozens if not hundreds of patients could hardly be counted on to spot every case. People would fall through the cracks. The CEO of Hourglass, a charity that works to prevent the abuse of older people, told MPs on the committee overseeing Kim Leadbeater’s Bill that "coercion is underplayed significantly" in cases, and stressed that it takes place behind closed doors. 

There is also nothing in either UK Bill that would rule out people acting on internal pressure to opt for assisted death. In evidence to the Scottish Parliament’s Health, Social Care and Sport Committee last month, Dr Gordon MacDonald, CEO of Care Not Killing, said: “You also have to consider the autonomy of other people who might feel pressured into assisted dying or feel burdensome. Having the option available would add to that burden and pressure.” 

What legal clause could possibly remove this threat? Some people would feel an obligation to ‘make way’ in order to avoid inheritance money being spent on personal care. Some would die due to the emotional strain they feel they are putting on their loved ones. Should our society really legislate for this situation? As campaigners have noted, it is likely that a ‘right to die’ will be seen as a ‘duty to die’ by some. Paving the way for this would surely be a moral failure. 

Inequality 

Even parliamentarians who support assisted suicide in principle ought to recognise that people will not approach the option of an ‘assisted death’ on an equal footing. This is another unsolvable problem. A middle-class citizen who has a strong family support network and enough savings to pay for care may view assisted death as needless, or a ‘last resort’. A person grappling with poverty, social isolation, and insufficient healthcare or disability support would approach it very differently. This person’s ‘choice’ would be by a dearth of support. 

As Disability Studies Scholar Dr Miro Griffiths told the Scottish Parliament committee last month, “many communities facing injustice will be presented with this as a choice, but it will seem like a path they have to go down due to the inequalities they face”. Assisted suicide will compound existing disparities in the worst way: people will remove themselves from society after losing hope that society will remove the inequalities they face. 

Politicians should also assess the claim that assisted deaths are “compassionate”. The rhetoric of campaigners vying for a change in the law have led many to believe that it is a “good death” — a “gentle goodnight”, compared to the agony of a prolonged natural death from terminal illness. However, senior palliative medics underline the fact that assisted deaths are accompanied by distressing complications. They can also take wildly different amounts of time: one hour; several hours; even days. Many people would not consider a prolonged death by drug overdose as anguished family members watch on to be compassionate. 

Suicide prevention 

 It is very important to consider the moral danger involved with changing our societal approach to suicide. Assisted suicide violates the fundamental principle behind suicide prevention — that every life is inherently valuable, equal in value, and deserving of protection. It creates a two-tier society where some lives are seen as not worth living, and the value of human life is seen as merely extrinsic and conditional. This approach offers a much lower view of human dignity than the one we have ascribed to historically, which has benefited our society so much.  

Professor Allan House, a psychiatrist who appeared before the Westminster Committee that’s considering Kim Leadbeater’s Bill, described the danger of taking this step well: “We’d have to change our national suicide prevention strategy, because at the moment it includes identifying suicidal thoughts in people with severe physical illness as something that merits intervention – and that intervention is not an intervention to help people proceed to suicide.” 

 Professor House expressed concern that this would “change both the medical and societal approach to suicide prevention in general”, adding: “There is no evidence that introducing this sort of legislation reduces what we might call ‘unassisted suicide’.” He also noted that in the last ten years in the State of Oregon – a jurisdiction often held up as a model by ‘assisted dying’ campaigners – “the number of people going through the assisted dying programme has gone up five hundred percent, and the number of suicides have gone up twenty per cent”. 

The evidence of various experts demonstrates that problems associated with assisted suicide are unsolvable. And this practice does not provide a true recognition of human dignity. Instead of changing the law, UK politicians must double down on existing, life-affirming responses to the suffering that accompanies serious illness. The progress we have made in areas like palliative medicine, and the talent and technology available to us in 2025, makes another path forwards available to leaders if they choose to take it. I pray they will. 

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Article
Comment
Gaza
Israel
Middle East
Old Testament
Trauma
War & peace
10 min read

Two years on: the tragedy and the trauma of Gaza

As the anniversary of 7th October comes round again, an ancient story helps shed a new light on this conflict

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Split-screen on TC shows many different news channels in English, Arabic and Hebrew.
Split-screen reporting.
Al Jazeera.

It is now two years since Hamas' vicious attack on Israeli citizens at the Nova music festival. Two years later, much of Gaza lies in ruins, nearly 70,000 of its people have died, and Israel continues its campaign to rid itself once and for all of Hamas, a hostile neighbour. The spectre of antisemitism has raised its ugly head again on the streets of Manchester. Meanwhile, the world waits to see if the Trump peace plan has a chance of working. 

The world is also deeply divided on the question of who is to blame here. Is it, as the Israelis say, firmly Hamas’ fault, the result of a fanatical Islamist group, sponsored by Iran, determined to extend militant Muslim control over the Middle East in general and Israel in particular? Or, as the pro-Palestinian crowds chant, are we watching a genocide which is the inevitable outcome of Israel’s ongoing occupation of the West Bank and Gaza? Everyone is pushed to decide. As a child of a friend asked his mum the other day: “Which side are we on?” 

Yet what if we try to see this conflict in a different light - not so much in terms of blame but pain?

Echoes of the past

Of course, this is not the first time there has been war between the people of Israel and their enemies on the coastline of Gaza.

The book of Judges in the Bible recounts a series of confrontations around 3,400 years ago between the Israelites and the Philistines, who harassed and taunted the Hebrew tribes as they struggled to establish themselves in the land of Canaan (NB - the Philistines are not the ethnic ancestors of modern Palestinians, despite the similarity in name. The Romans. partly to annoy the Jews, simply decided to change the name of the region from Judaea to Palestina.)

One of those ancient stories tells of Samson, an immensely strong Israelite warrior, who kills numerous Philistines in a spree of violence lasting several years. Samson eventually marries a Philistine woman, Delilah, who betrays him into the hands of his enemies. He is captured, and his eyes are gouged out. In a final act of violence, he brings down the roof of the Philistine Temple at the height of a religious feast, killing both himself and more of his enemies than he killed in his lifetime.

The story is both a tragedy and a trauma. John Milton’s great verse drama Samson Agonistes, written around 1650, presents Samson as a tragic figure, gifted and heroic, a hero of Israel brought low into his Gazan prison by a fatal character flaw of pride and lust, betrayed by his cunning wife, and in his famous phrase, ‘eyeless in Gaza at the mill with slaves, Himself in bonds under Philistian yoke’. The tragedy ends in his final act of destruction of both himself and his enemies.

Yet besides a tragedy, this is also trauma. The roots of the trauma lie deeply hidden in the history between Israel and the various tribes that surround them. Samson is one of many dragged into a history of tit-for-tat violence which ends in this scene of death and devastation. In the story of the Bible, he is caught up in the long history of human wrongdoing – as both victim and perpetrator - that stretches right back to Adam and Eve in the garden. The result is Samson and his enemies all lying dead in the rubble of a demolished building in the heart of Gaza.

In this one small strip of land today we find two peoples living out the trauma of what has happened to them in the past. And without a new approach, the result will be the same – destruction and devastation.  

On many trips to Israel/Palestine over the past 35 years, as I listened to Palestinians and Israelis look at the same issue with such different eyes, this conflict often struck me as both a tragedy and a trauma. That sounds bleak. Yet this perspective can, despite its apparent gloom, bring a glimmer of hope.

Tragedy and trauma don’t avoid the question of blame, but they don’t start there. They start with a posture of empathy. Tragedy makes us pause before making moral judgments and instead, simply to notice and enter into the sadness, the grief of it all. When we watch the final scenes of Hamlet or Macbeth, or even the Samson story, we are simply left in silence. We don’t rush to judgment, but simply acknowledge the heart-breaking sorrow experienced by the ordinary people caught up in this. Tragedy sits with the grief and darkness, and does not reach immediately to blame, realising that real life is usually more complex and the causes of conflict more opaque.

At the same time, understanding this as trauma forces us to enter into the pain underlying the conflict. Samson is born into traumatic times with his people under attack, and ends up living out the trauma he has experienced by brutal revenge on his enemies. In a similar way, in this one small strip of land today we find two peoples living out the trauma of what has happened to them in the past. And without a new approach, the result will be the same – destruction and devastation. 

The Jewish people of today, especially in Israel, remain deeply traumatised by the history of anti-Semitism which climaxed in the Holocaust of the 1930s and 40s. A determined attempt by a sophisticated, modern European nation to systematically exterminate every single one of the Jewish race is not just a historical event but one whose ripples or perhaps better, stormy waves, reach us today. Alongside this there is the expulsion of Jews during the C20th from Muslim countries such as Syria, Iraq, Yemen, Algeria, Tunisia and Libya. For those of us who are not Jewish it is hard to imagine the impact of such a reality, not just as a fact of history but as a real danger in the future. After all, if it happened once, it could happen again. It explains why Israel has always paid scant attention to international opinion and resolutions of the UN for a ceasefire, such as the one recently called for. As the Jewish writer Daniel Finkelstein put it:

“The origin of the state of Israel is not religion or nationalism, it is the experience of oppression and murder, the fear of total annihilation and the bitter conclusion that world opinion could not be relied upon to protect the Jews. So, when Israel is urged to respect world opinion and put its faith in the international community the point is rather being missed. The very idea of Israel is a rejection of this option. Israel only exists because Jews do not feel safe as the wards of world opinion. Zionism, that word that is so abused, so reviled, is founded on a determination that, at the end of the day, somehow the Jews will defend themselves and their fellow Jews from destruction. If world opinion was enough, there would be no Israel.”

So, with such a trauma behind them, it is not surprising that when a Muslim kills Jews in a British synagogue, when rockets rain down on Israeli towns, or Hamas militants swagger through kibbutzim, shooting people just because they are Jews, it triggers exactly the memory of the trauma that they have been through as a people. What Palestinians think of as resistance to an occupation of their land, is experienced by Israelis as an echo of the desire to exterminate the entire Jewish people, in a way that sends a shiver down the spine for anyone who has lived this story.

Just like Samson and his enemies. An eye for an eye leads both to end up eyeless in Gaza.

Yet the Palestinian people also have a trauma of their own. In 1948, at the time of the creation of the State of Israel, hundreds of thousands of Palestinians were made homeless and stateless, deprived of their homes and their land, often at gunpoint, and many killed by Zionist fighters. The Arab nations did little to help, only interested in their own interests. The European nations stood by. America continue to fund Israel so that their army vastly outweighs any other army in the region, and certainly enough to crush the stones, knives and bombs of various intifadas. Their deep sense of injustice also leaves a scar, one that can continue to be used by groups like Hamas for their own purposes.

And so today when Gazans watch their cities pummelled to dust, when Palestinians are made to queue at checkpoints simply to travel from one place to another,  when land is taken through the building of a security wall, and Israeli settlements continue to get permits to build on Arab land, while it is much harder for Palestinians to get planning permission to build a new home, all this triggers the memory of what Palestinians call the Nakhba or the disaster. What Israelis see as legitimate self-defence, security measures to keep terrorists at bay and to keep their people safe, is experienced by Palestinians as an echo of their own past trauma of dispossession.

The result is that both sides end up caught yet again in a cycle of violence, just like Samson and his enemies. An eye for an eye leads both to end up eyeless in Gaza.

Yet this approach perhaps places upon us who look on, the responsibility to try to enter into the pain of the other side.

Now of course, we can argue about which trauma is the greater. We can debate the merits of each moral case, or where real blame lies. But trauma doesn't work like that. Trauma sits within the mind and the body, and spreads, overwhelming any ability to cope normally and react with a sense of proportion and balance. The effects of trauma are not deliberate or logical but involuntary. Reactions to trauma are notoriously complex and differ according to individuals. Trauma stays with individuals for years and with communities for generations.

Understanding this conflict not so much as through the lens of blame but of pain may help us understand this conflict differently. Of course, it doesn't avoid the question of blame, because terrible things have been done here. It also doesn’t deny Israel’s right to defend itself against Hamas’s attack with legitimate force. Most of us tend to lean towards one side or the other of the conflict. Yet this approach perhaps places upon us who look on, the responsibility to try to enter into the pain of the other side. And when the dust of battle settles, it perhaps promises a better way to cut the cycle of violence in the future.

Understanding this conflict as both tragedy and trauma helps us see it in a new light. And perhaps it gives us the glimmer of a hope of a way forward. The memory never goes away, but trauma victims can find ways to approach the memory of what happened to them in different ways.

The story of Samson ends with destruction and his burial in the family tomb. It ends in death. Within the long story of the Bible, however, the chaotic period of the Judges is superseded by the monarchy – the kings of Israel, the best of whom is King David – a ruler with flaws, but described as ‘a man after God’s own heart’. Beyond that, the story of David points to a later ruler also born in Bethlehem, whose rule meant not hating and killing his enemies, but loving them to the point of dying for them, thus, finally, bringing peace. It is that kind of Jesus-shaped, self-sacrificial, radical, counterintuitive leadership on both sides that can show a way out of the cycle of violence and hatred that was there in the period of Samson, and is there today.

Only leaders who are not concerned with doing whatever it takes to stay in power, nor willing to sacrifice others for their own purposes, who don’t care about personal reputation, but are willing to take the risky path of reconciliation, as I have argued elsewhere on Seen and Unseen - only this kind of leadership can lead us beyond the tragedy and trauma of the past into a more hopeful future.

The last word might come from Audeh Rantisi, a Palestinian evicted from his home in Lydda in 1948. He went on to become an Anglican priest and an activist for reconciliation between Jews and Arabs and the need for both to recognise the scars and humanity of the other:

I still bear the emotional scars of the Zionist invasion. Yet, as an adult, I see what I did not fully understand then: that the Jews are also human beings, themselves driven by fear, victims of history's worst outrages, rabidly, sometimes almost mindlessly searching for security.

Four years after our flight from Lydda I dedicated my life to the service of Jesus Christ. Like me and my fellow refugees, Jesus had lived in adverse circumstances, often with only a stone for a pillow. As with his fellow Jews two thousand years ago and the Palestinians today, an outside power controlled his homeland - my homeland. They tortured and killed him in Jerusalem, only ten miles from Ramallah, and my new home. He was the victim of terrible indignities. Nevertheless, Jesus prayed on behalf of those who engineered his death, "Father, forgive them..."

Can I do less?

 

This article is an updated version of one first published on 7 November 2023