Article
Assisted dying
Comment
Life & Death
5 min read

The careless conflation of independence, autonomy and dignity

As Jersey begins to legalise assisted dying, there’s keyword confusion.
A elderly women in a care home stands and places her hands on the shoulders of a seated woman.
Eberhard Grossgasteiger on Unsplash.

Reviewing Canada’s legislation on assisted dying, one anonymously authored article raises the concern: “Does it make dying with dignity easier than living with dignity?” This insightful question cuts to the centre of the debate: dignity. Or more particularly, the unwitting conflation of dignity with independence, and of independence with autonomy.  

As Jersey becomes the first place in the British Isles to begin the process of legalising assisted dying, I feel that we should listen carefully as to how and where these terms are being used, both in the formal debate, and in the commentary that surrounds it. The States Assembly in Jersey voted to allow the development of assisted dying legislation for those with six months to live (or twelve months if their condition is neurodegenerative). A second vote to make assisted dying available more broadly to those who experience conditions that entail “unbearable suffering” was defeated by a narrower margin. Reading the flurry of press releases that followed the vote, these keywords, autonomy, independence, and dignity, are everywhere. But are we really thinking about what these words communicate?  

People in positions of wealth and power have more independence and autonomy, more choices and freedoms, but it is we who ascribe dignity to those in that position.

The word dignity comes from the Latin word dignus, meaning ‘worthy’, and this is still the primary definition given to the English word dignity today. The OED has it as “the quality of being worthy or honourable”, immediately followed by reference to “honourable or high estate”. If this is so, then dignity is not something that can be bought, nor assumed – it is a status conferred upon someone by the esteem in which other people hold them. The haughtiest person in the world can still be esteemed undignified, as can the richest. Moreover, the opposite is also true: we are never prevented from conferring dignity upon, and esteeming the worthiness of, those who live the humblest of lives.   

And yet, if we are honest with ourselves – do many of us not quietly associate the idea of becoming rich and powerful with becoming dignified? Do we not tend to assume the worthiness of those in high office – at least until we meet them and realise pretty quickly that they all put their trousers on one leg at a time, the same as the rest of us. This association happens because we have such a tendency to conflate dignity with independence (the ability to live without assistance from others) and autonomy (the ability to make one’s own decisions, and not have those decisions limited or interfered with). People in positions of wealth and power have more independence and autonomy, more choices and freedoms, but it is we who ascribe dignity to those in that position. It is society who sees the autonomy of those in high status, and esteems it as dignified.    

Does this not unwittingly suggest that choosing to live in a state of extreme dependence on palliative care is, by implication, undignified? 

Repeatedly ancient wisdom, in the bible, warns us not to assume that dignity comes with the freedom of wealth or power. All the great ‘heroes’ of that book suffer their indignities. Fresh from the success of his Ark project, Noah gets drunk and exposes himself. Elated from a victory against an enemy, King David dances half-naked through the streets. These are just two examples of the catalogue of embarrassments and mishaps that beset nearly all the kings and leaders whose stories are told as part of the Christian story. One after another, they stumble and struggle with life and leadership. The apostle Paul explains that this is because God uses the foolish things of this world to shame human pride, “for even the foolishness of God is still wiser than human wisdom.” Therefore, Paul argues, God chooses to speak to us through the weak and the lowly things and people of this world. Never was this demonstrated so clearly as when Jesus was born in a draughty stable, lived a life of poverty, and died a criminal’s death on a cross.  

But what has all this to do with the debate over assisted dying? Well, I am struck by how often the idea of losing one’s independence (through disabling or terminal illness) is conflated with losing one’s dignity, and so dying through personal choice (autonomy) is presented as regaining it. One campaign group that speaks to this debate even calls itself ‘Dignity in Dying’ – but does this not unwittingly suggest that choosing to live in a state of extreme dependence on palliative care is, by implication, undignified?  

Independence is not possible for everybody, or not possible to the same degree. And dignity? Well, dignity is possible for anyone. 

The Dean of Jersey, the Very Reverend Mike Keirle, has spoken of his concern that the change in legislation will make vulnerable people feel pressured to end their lives. Examples from Canada, where physician assisted dying is already available, show that his concern is not unfounded. In 2022, Canadian veteran and Paralympian Christine Gauthier phoned her caseworker to chase up the over-due installation of her new wheelchair ramp. She then describes how she was horrified to find herself being advised to consider assisted dying instead.  

"It is remotely just what they're doing,” says Gauthier, “exhausting us to the point of no return. […] I was like, 'Are you serious?' Like that easy, you're going to be helping me to die but you won't help me to live?"

Gauthier is not alone – she spoke out when she learned that four other Canadian veterans had reported similar experiences. In these unhappy moments, one can see how dangerous the assumption can be – the assumption that no one would want to live a life of needing help. Here are disabled people who do want to live, and this assumption, this careless conflation of independence, autonomy, and dignity, leaves them fighting for their right to do so. Why should anyone have to fight or even speak for their right not to commit suicide? It is little wonder that disabled actress, Liz Carr, describes assisted dying legislation as “terrifying” for disabled people. 

I respect that there are terminally ill people, and those who love them, who speak from a desire to end their suffering; it is clear that people on all sides of the debate need to have this difficult and emotionally charged conversation. But whatever the eventual outcome in terms of legislation, we must be careful that it is not based on careless assumptions, or on the conflation of one thing with an entirely different other. Independence is not possible for everybody, or not possible to the same degree. And dignity? Well, dignity is possible for anyone – it is a state that can be conferred whenever, and upon whomever society chooses to confer it. Autonomy is the matter in question – we are talking about autonomy in dying. And whatever happens, we should by no means legislate in a way that leaves disabled people esteemed unworthy, left open to the indignity of fighting for their right to live. 

Essay
Belief
Comment
7 min read

Everyone comes from somewhere

Why young people need to understand the religious landscape.

Roger is a Baptist minister, author and Senior Research Fellow at Spurgeon’s College in London. 

A young person stands in front of railway station platfrorms and below a large informaton display.
Rostyslav Savchyn on Unsplash.

I had never been so self-conscious of being British. I had flown into Denver, Colorado and for the first time I realised that I had an accent. I had gone to study and a Canadian instantly knew I was a Brit. The locals were less clear. Some had me down as an Aussie, others guessed a South African.  

But it wasn’t only accents. I quickly learned the differences between us went much deeper. Private health care, guns and the separation of church and state were a whole new cultural landscape. They felt very strange to my British sensibilities that were accustomed to the welfare state, the absence of guns and an established church.  

My exposure to all things American began in the early 1990s. The sociologist James Davison Hunter had just published his prophetic commentary, Culture Wars: the struggle to define America. For those I was beginning to get to know, the campaigns to reverse Roe Vs Wade and ban abortion, along with active attempts to introduce prayer into the public school system highlighted the cultural differences between us. 

Likewise, they found it hard to comprehend that in England Religious Education (RE) in state-funded schools was mandated by Act of Parliament. That I considered this a bad thing mystified them. 

The world we are living in has changed. Issues around religion have become more critical than at any point in my lifetime.

Of course, RE itself had a chequered history. The 1902 Education Act provided state funding for denominational religious instruction, mostly benefiting the Church of England. Nonconformist churches were outraged at the thought of the established church indoctrinating their children. Methodists, Baptists and Congregationalists withheld their taxes and, by 1904, 37,000 summonses had been issued, thousands had their property seized and 80 had gone to prison in protest.   

Thankfully things have moved on. During the twentieth century denominational instruction evolved through several stages to the present world religions curriculum. 

Still, over the years I have consistently felt that our approach in the UK was in danger of proving ‘the inoculation hypothesis’ with regard to faith. That is, providing a small harmless dose of exposure to religion in childhood can effectively prevent the real thing developing in adults. 

Of course, faith-based schools and RE remain hot topics. Only this month the government launched a public consultation on removing ‘… the 50 per cent cap on faith admissions’. Warmly welcomed by providers like the Catholic Schools Service, it was condemned by Humanists UK and others advocating a fully secular provision.  

This line of contention has become a familiar one. On one side sit around a third of mainstream state schools that are church or faith-based, most affiliated with the Church of England. On the other are groups like the National Secular Society who correctly point out that the privileged position of church-sponsored education is not reflective of wider society. 

These positions have become entrenched over the years. Arguments are laced with rhetorical hyperbole and are often either ill-informed or merely raise strawmen arguments to symbolically knock down. We can no longer afford to be so self-indulgent.  

The world we are living in has changed. Issues around religion have become more critical than at any point in my lifetime. It is now more important than ever that we have a handle on it.  

And then there’s the frequent stereotyping of religion in the media. Off-the-peg religious reporting ‘templates’ are easy to use but are ‘lazy’ journalism. 

The invasion of Ukraine by Putin’s Russia is no mere materialist land-grab. To fail to take into account the theological dimension compromises any understanding of what is going on. The history of Eastern Orthodoxy and the Russian Orthodox Church help define the Russian identity that sits behind this conflict. 

In Israel, the bloody atrocity enacted on Israeli citizens by Hamas, and the brutal devastation wrought in Gaza by Netanyahu’s Israeli Defence Force are beyond words. But this conflict is theologically as well as politically fueled. Hamas embraces a militant interpretation of extremist Sunni Islam, while Netanyahu’s religious-nationalist coalition sees his Likud party kept in power by ultra-Orthodox parties and far-right religious factions.  

In India, the world’s biggest democracy, 970 million voters this year participate in an election stretching over six weeks. Yet this formally secular state has been travelling on a different trajectory. Yasmeen Serhan observed in The Atlantic that under Prime Minister Modi the ‘Hinduization of India is nearly complete’. 

And then there’s the frequent stereotyping of religion in the media. Off-the-peg religious reporting ‘templates’ are easy to use but are ‘lazy’ journalism.  

A leading newspaper recently carried instant opposition to the thought of Kate Forbes being a potential First Minister of Scotland because of her ‘traditionalist’ views. Somehow, her commitment in a BBC interview to defend the right to same-sex marriage even though it clashed with her personal views was insufficient. 

Across one of my social media feeds as I was writing this piece came a plea, ‘I’m proud to be British. I’m proud to be a Muslim. I am not a terrorist. Why don’t they get it?’ 

Maybe the American approach to religion goes a long way to explain something of their culture wars. 

But always there is America. And here’s where a penny unexpectedly dropped for me. If you keep religion out of schools, for many young people you deny them the tools, the ideas, and a framework with which to understand the religious dimension of life. This can have catastrophic implications.  

As G.K. Chesterton is reputed to have observed, ‘when people stop believing in God they don't believe in nothing; they believe in anything.’ 

Then, for those living within a practising religious home, the absence of religion in school heightens the possibility that their thinking is siloed purely in their own rarefied tradition. 

Maybe the American approach to religion goes a long way to explain something of their culture wars.  

If it's true that whatever happens in America inevitably makes its home in Britain, we need to sit up and take notice. More than ever, we need our young people to be adept at understanding the religious landscape. With the ubiquity of social media, the unseen influence of echo-chamber algorithms and the nefarious activities of those bent on radicalising the vulnerable, we need them to have the tools and skills to be aware, see and understand. 

This is what has caused me to think again and, surprisingly, change my mind. We need to draw a line in the sand on our historic arguments, disagreements and differences of conviction. The situation is more pressing. We need a reset.  

If democracy is not a zero-sum game where the majority gets to impose its will tyrannically on the rest, this has to be a way forward. 

The encouraging thing is that the groundwork for such a step change is already in place. In 2018 the Commission on Religious Education (CoRE) proposed a reconceiving of the subject as Religion and Worldviews. Their intention was to make it more appropriate and inclusive for the twenty-first century. For them, the ‘complex, diverse and plural’ landscapes of different religions and worldviews deserved both understanding and respect. Yet, students also needed to develop the ‘necessary critical facility to ask questions and challenge assumptions’. 

Such an approach embraces the insights and philosophical commitments of non-religious worldviews too. ‘Everyone has a worldview’, said the report. Nobody stands nowhere was the title of an excellent animated short film on YouTube produced by the Theos think tank. 

The truth is, ‘everyone comes from somewhere’. This is as true for secular humanists as it is for cradle-to-grave Anglicans, majority-world Pentecostalists and British-born Muslims. Helpfully CoRE defines a worldview as: 

… a person’s way of understanding, experiencing and responding to the world. 

The report maintained that it was vitally important that different worldviews were understood as ‘lived experience’. This was not just about abstract beliefs, doctrinal understandings and theoretical convictions. This was about real people, the lives they live and what is important and gives meaning to them. 

If living in a genuine democracy is about learning how to rub along together. If it is about understanding and respecting those who have a different take on life than we do, no matter how ‘odd’ it seems. If democracy is not a zero-sum game where the majority gets to impose its will tyrannically on the rest, this has to be a way forward.  

Given the challenges that face us, it seems to me that not to change our approach to RE would be negligent. Yet to remove all reference to religion from our schools risks our young people falling prey to manipulation, subversion and control by bad actors, misinformed activists and cranks. 

These would be the seeds of our very own culture wars.  

Personally speaking, I’d rather not go there.