Article
Christmas survival
Comment
4 min read

Challenging OCD on Christmas Eve

A night without usual fears allows faith to be reclaimed.

Paula Duncan is a PhD candidate at the University of Aberdeen, researching OCD and faith.

A nocturnal snow-covered scene of a tree, chapel and Christmas tree casting shadows.
A chapel in Krün Germany.
Andreas Kretschmer on Unsplash.

The display on my car tells me that it’s just gone 11pm on Christmas Eve, and the temperature is below freezing. It’s the sort of cold that catches your breath the minute you step outside. The trees are glittering with frost. The stars are sharp and clear in the sky. Everything feels still and clean. In the carpark, I can hear the muffled notes of the organ playing familiar Christmas carols. People in Christmas jumpers are trickling in through the main church door. I can see Santa hats, some reindeer antler headbands; some kids have woolly hats tugged down over their ears. I haven’t been to a Christmas Eve service since I was a child.  

I take a deep breath and try to let go of some of the anxiety about being here. My Obsessive-Compulsive Disorder doesn’t take a break for the festive season. I have previously written about my experience with OCD: the way that it impacts my experience of faith and how it makes going to church feel difficult. I find it a challenge to sit with the doubt and uncertainty of not being 100 per cent sure that I believe in God but badly wanting to. I struggle with not knowing what verses of the Bible will be read and how I will feel. I worry about something sparking my OCD and then being held hostage by my own intrusive thoughts. This always feels worse when I’m tired, too. I am far more likely to engage with the intrusive thoughts my OCD offers up when I’m not well rested. But I’m here. Despite feeling nervous, I am happy to be here. The warm glow of the light inside the church is welcoming and the low hum of happy voices feels reassuring as everyone discusses their Christmas plans.  

There is a flurry of chatter as we are all invited to wish one another a ‘merry Christmas!’ and then we fall into a restless and expectant silence as Christmas day begins.

I don’t have the usual fear of the unknown today. We are here for the carols and the watchnight service – eagerly awaiting midnight and the dawn of Christmas Day. I might not know exactly what the structure of the service will be, but I can almost guarantee that the reading will begin with words from the Gospel of Luke. We’ll be told of the census of the Roman world, and we’ll hear that Mary and Joseph would have to travel to Bethlehem. There will be no room in the inn. The baby Jesus will be born, and laid in a manger.  

This story is one that I heard at childhood Christingle services. It’s the one that we were told every year in primary school with abundant colourful crafts to help us to remember the key points. I’m reminded of nativity plays – watching them and being part of them, and the slightly off-key renditions of ‘Away in a Manger’. I remember doing the reading as a Girl Guide – nervously practicing beforehand to make sure that I could pronounce all the words correctly. I remember being proud of myself for standing up and reading at all.  

Armed with those memories as I cross the carpark, I know there is going to be nothing unexpected in the Christmas Eve service. My OCD still finds ways to make its presence known – I insist that I get to sit at the end of a row because that’s where I feel most comfortable. I read the order of service a few times to check that everything there is as I expect. I make some concessions to anxiety for the sake of being able to turn up at all. But I am here, and I feel safe.  

The readings are exactly as I expected. I know all of the Christmas carols that we sing. At midnight, there is a flurry of chatter as we are all invited to wish one another a ‘merry Christmas!’ and then we fall into a restless and expectant silence as Christmas day begins and we wait for the minister to say a few words about what this means. I am with my family and there are familiar faces in the congregation – people I know from various places. It’s nice knowing that we are all here for the same reason and with the same intention.  

There are many cheerful Christmas wishes as we leave the church and I’m proud of myself for being here. Maybe my faith is something I can reclaim from my OCD eventually, however slowly. For now, I look up to the sky as we head back out into the carpark and smile at the stars twinkling down at us. I feel perfectly fine.  

Since that year, lockdown excluded, my family have been to the watchnight or the Christingle services most years. As a theology student, I sometimes feel a little self-conscious about how infrequently I go to church. I sometimes joke about being a Christmas Christian in terms of my church attendance and certainly in how I engage with the Bible. I like to read a little on Christmas day and I love watching the televised service on the BBC on Christmas morning. It’s the time of year where I am perhaps most active in my engagement with my faith. I look forward to going to the Christmas Eve church services now. It’s the one time where I don’t have to battle with anxiety about going to church and know that plenty of other people are here as infrequently as I am. My OCD comes along with me, certainly, but I feel safe to be here just as I am. 

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.
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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