Review
Ageing
Assisted dying
Culture
5 min read

For love there is no charge

Out of mind old people are at the centre of Allelujah! Sian Brookes reviews the film adaptation of Alan Bennett’s play.

Sian Brookes is studying for a Doctorate at Aberdeen University. Her research focuses on developing a theological understanding of old age. She studied English and Theology at Cambridge University.

In a hall decorated for a celebration a person stands in front of a seated group, all have their arms raised in celebration.
Jazz hands at the hospital.
BBC Films.

Spoiler alert – this film review reveals significant elements of the plot. 

Allelujah! is not a film that shies away from the big issues. In fact, you would be hard pressed to find a big issue this comedy/political commentary/drama/part-thriller doesn’t at least make reference to (and yes, it spreads itself across all of these genres too). With such an eclectic approach it is difficult at times to keep up with the narrative, and the deeper meaning of the film. Based on the Alan Bennett play, the plot centres around The Bethlehem, a small northern hospital for geriatric patients, which is facing closure due to the Tory government’s efficiency drive. It focuses on two members of staff, Alma Gilpin, a stoic and matter-of-fact but seemingly excellent nurse who has served the hospital her entire career, and a younger Dr Valentine. Other protagonists include an ex-miner patient and his son, a management consultant who has “made it” to London and is currently advising the Health Secretary to close hospitals such as the one in question for the sake of government finances. 

Whether it’s politics or the personal, this film has it all. It deals with levelling up, the cultural and economic gap between the north and south, the challenges of budget cuts in the NHS, the problems of a national health service claiming to 'care' but with managers more preoccupied by Westminster’s economic priorities. It depicts families waiting for older relatives to die in order to grab their inheritance, the broken relationship between an ageing man and his son, and those all-important stories of the older patients’ lives well-lived. And yet as the story line develops, a plot twist emerges which comes to overshadow the entire film, and in the process speaks to what is perhaps the most poignant of the many discussions it raises. Nurse Gilpin, who, until now has appeared consistently caring and committed to her patients, has been quietly administering fatal beakers of milk and morphine to those who she deems to be on “her list” of those who most need relief from their situation. When confronted by the doctor she justifies her actions with a multifaceted answer based on the requirement to provide more beds to a broken healthcare system, but also insisting “I had ended someone’s suffering”.  

When Dr Valentine remarks, “I like old people” a visitor responds “not even old people like old people”.

The manner in which Nurse Gilpin goes about what is effectively enforced euthanasia, is deeply chilling. And yet her reasoning is not entirely foreign to us – to end suffering could be deemed a noble cause. In fact, the need to simply delete the reality of suffering, particularly the suffering of the old is one that perhaps is not so uncommon. Throughout Allelujah!,we are reminded of our tendency to run from, to detest, to reject the suffering of the elderly in our society. When Dr Valentine remarks, “I like old people” a visitor responds “not even old people like old people”. A teenage intern declares to a patient “I hope I never live to be your age”. At the same time, characters look back on the days “when the elderly weren’t farmed out”, and questions are asked of families “if they love them, why do they put them away?”. A very good question. Of course, care needs are often too great for families to endure, yet it is still important to ask why the suffering of the old has become a professionalised service, which most of us avoid at all costs. Perhaps the answer to this is that we don’t like to watch the old suffer, we don’t like to watch them die, because their suffering and their death remind us of our future selves, our future suffering, our future death. In our sanitised, anything-is-possible-with-medicine-and-science society, death and the suffering that comes with it, is something from which we flee at all costs. Instead of acknowledging and working with it, we would rather pretend it wasn’t there at all.  

And yet, even as we try to avoid it, suffering and death are both certain parts of all our futures. 100% of us will die. For Nurse Gilpin, the solution to this is to bring on death prematurely, to erase the pain, overcome the misery by offering a false hope – that it doesn’t need to exist at all. In direct contrast to this, in a film which is littered with Christian references (Allelujah, The Bethlehem), there is a different approach taken by a messiah-type figure who seems to get everything right. Dr Valentine is compassionate and understanding. He not only challenges the political systems which undermine those most at the margins of society, but also has the kind of bedside manner we would all hope for in a doctor. In a closing monologue Dr Valentine utters the words of the doctors in the NHS, “We will be here when you are old, and we would die for you, we are love itself and for love there is no charge”.  

It is this suffering with which is so compelling, this suffering with which is truly sacrificial.

Nurse Gilpin and Dr Valentine offer two fundamentally different approaches to end of life care. One hastens the end quickly, deletes the suffering as efficiently as possible in order to make way for those in less pain. The other sits with those who suffer, holds their hand, gently cares for the human person that is in front of them. Even more, and perhaps most significantly Dr Valentine does not only watch from afar, but is willing to suffer himself for the sake of those in pain - working tirelessly, giving himself over day after day, fighting on with little sleep for limited pay just to make things a little less painful. It is this suffering with which is so compelling, this suffering with which is truly sacrificial, this suffering with which speaks of something much greater than politics, efficiency or inheritance, this suffering with which is indeed “love itself”, completely free of charge.  This is the logic that Christians see in the ancient notion of the incarnation, celebrated every Christmas, of God with us. This is what our older people need, this is what we will all need when we grow old. Let us only hope that when we get there, we find the one who is willing to offer it.

Article
Assisted dying
Care
Comment
Easter
5 min read

I know who will be most affected by legalising assisted dying

Contemplating lent revives hard memories and raises fresh fears.

Ryan is an ordained Priest in the Church of England, currently serving in south London. 

A close up of a forehead bearing an ash cross marked on it.
Ahna Ziegler on Unsplash.

“What’s that - a face tattoo?” 

These were the words of one person as I walked past them on the streets on a recent Wednesday, with the ashes of last year’s burnt palm-branches placed across my forehead in the shape of the cross.  

The cross has been a symbol of hope for over two millennia; that even in the most painful of circumstances, darkness does not have the final say, including in death.  

As a society, we don’t really talk about death that much. Margot Robbie’s Barbie was the quintessential party-pooper when she pondered: 

 “do you guys ever think about dying?”. 

It’s no fun to dwell on death and dying, and for many of us, we put it off as long as we can. That all changed last year with the introduction of the assisted dying bill into the Houses of Parliament. Our national attention was, for a rare moment, captured by death.  

As a parish priest, I’ve seen the finality of burying someone into the ground. I’ve seen the sadness in the eyes of those trying to grieve. 

The words of Ash Wednesday, which remind us that we are ‘but dust, and to dust we shall return’ are echoed in the famous words that the priest recites in those last moments of burial, ‘ashes to ashes, dust to dust’. In that moment, amongst the bereaved, there is no escaping the inevitability of death. It is the ultimate statistic, 1 in 1 die. 

Whilst death is of course universal and will affect us all, the impact of this assisted dying bill could have consequences for some of the most vulnerable in society.  

As I reflect on my time as a Priest in East London, this is not abstract theory, but something I lived with each day. I served amongst a hugely diverse, vibrant, community in one of the poorest parts of the city. As I try to picture some the people I’ve walked alongside, I know it is these lives that will be most affected.  

One of the reasons I have concerns about the bill is the prospect of these people being coerced into ending their own lives prematurely, by a world that has already told them their lives are of little value. There are already huge disparities in access to the current provision of palliative care at the end of life, particularly amongst people of colour, the disabled and the poor.  

Of the 500,000 people who die each year, 100,000 do not access the care they need. This number is skewed towards ethnic minorities and those who come from poorer backgrounds.  

There is much confusion and misinformation about what end-of-life care even is. Research conducted by Marie Curie shows that 1 in 5 people from an ethnic minority background believe Palliative Care is actually Euthanasia.  

We only need to look at what has happened around the world when the ‘right to die’ becomes a duty to die. Even with the best of intentions, other jurisdictions show us that safeguards rapidly deteriorate and those who are already vulnerable become even more so.  

I worry that the way in which this bill is being handled - rushed through, little time being given to properly chew over the profound consequences it may have - reflects the wider way we view death. 

By trying to provide a ‘choice’ for a certain group of people, the consequence will be taking away real choice from those who already have little. 

Yet we know that for those who do access it, palliative care can be hugely effective in improving their quality of life, and for some, they can even outlive their prognosis. During Ash Wednesday’s service, I met an elderly gentleman who was diagnosed with stage four pancreatic cancer in 2019. He was told he had five months to live. He described every day of his six-year survival since as a ‘miracle’, his eyes filled with evident joy.  

Such a blessing stands in stark contrast to the lonely final days of my 96-year-old great grandmother. She was suddenly taken ill during the Covid-19 pandemic and was frantically rushed to a hospital. Amidst the chaos, exasperated by the restrictions against seeing family that were in place at the time, I distinctly remember confused conversations about placing her in a care home for her final days. It was clear she needed a lot of specialist attention, more than our family could provide ourselves.  As she was discharged to stay with our aunt, she never did reach that care home, as she died at home. She was buried in our local cemetery, with our family watching on Zoom.  

My final memory of my great-grandmother will be the FaceTime call we shared when she was taken to hospital, with the poor data connection and shaky picture. I am so grateful for the few family members who were able to be by her side when she died, but I’ve often wondered whether she fully received the care she actually needed during those final days, in the way she needed it.  

What my great-grandmother didn’t have a lot of at the end of her life was time.  

That’s also true for this bill. Concerns have been raised that only five hours of debate were given to this Bill in the chamber, comparatively short for a change in the law of this magnitude.  

I worry that the way in which this bill is being handled- rushed through, little time being given to properly chew over the profound consequences it may have- reflects the wider way we view death.  

Do we view death - and indeed the dying- as something to be shoved to one side, not spoken about in the hopes we can avoid its impact? Or do we view death as an important moment to review who and what matters most in life?  

Perhaps for some, the fact that Christians devote a period of 40 days to dwell on death may be one of the mysteries of faith. However, perhaps it’s not such a bad idea after all.  Death may bring with it fear, grief and pain and so we tend to avoid it. But do we risk missing out on much more? As we head into Easter, the cross still serves as a powerful reminder that, especially in death, Hope can be found, that Good has triumphed over evil, and Light shines even in the darkest of places.  

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