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
Creed
Suffering
4 min read

Assisted dying: in praise of being a burden

It's not a reason to end a life, it's the very possibility of our being human.
A younger hand holds a wrinkled older hand of someone in a bed.

A lot has been said already about assisted dying. In the raging bonfire of public discourse, there has been a lot of heat, but not a lot of light. But amid all the noise surrounding Parliament’s upcoming discussion around assisted dying, a recent conversation hosted by Prospect between Brenda Hale (former President of the Supreme Court) and Rowan Williams (former Archbishop of Canterbury) served as a reminder that we are, despite everything, still capable of having meaningful and fruitful discussion about even the most divisive of issues.  

The conversation is earnest and hard-won throughout; both Hale and Williams each push and probe the other for more detail, more nuance, more outworking of implications. And yet their tenor remains respectful. There is no cheap point scoring, no trite comments or easy aphorisms. These are two people working to understand the other, in full recognition of the gravity of the topic.  

One particular moment, however, was frankly spine-chilling. As the conversation progresses, Hale is asked the following: “How do you deal with the pressure questions – pressure from family or financial pressures? What safeguards can you build in?” Her response – in full, for context – is as follows: 

“Well, you can build in the safeguards that the decision must be made without undue influence, coercion, duress or fraud. But in the end, it’s a matter of evidence, isn’t it? One of the things I find most difficult is that I don’t think it’s necessarily irrational for somebody to take into account the suffering their suffering is causing to the people dear to them, or the burden that looking after them is placing upon the whole community.  

I wouldn’t call that “undue influence”, but it’s one of the questions I find most difficult about all of this. You know, obviously there’s duress, there’s financial abuse, there are all of those sorts of things that have got to be checked against, and there ought to be objective evidence of absence of that. But when it comes down to somebody thinking, “I don’t want to be a cause of others suffering,” that seems to me to be a reasonable thing for somebody to take into account.”  

The idea that my dependency or burdensomeness might factor into decisions about whether I continue to live, seems to me to be contrary to the very notion of the Christian message. Let me explain why. 

We are made to be a burden, then. To depend on others, to be burdensome to them, is to be human.

We are, whether we like it or not, now rapidly approaching Christmas. At this time of year, Christians celebrate the birth of Jesus; the divine Son of God made flesh and born of a virgin. As the divine Son of God, Jesus lived the perfect human life of joy, grace, and faithfulness; the kind of life I can only aspire to. 

Because of this, as a Christian, I look to Jesus’ perfect life of faithfulness as a model for what a truly healthy human life looks like. And I am often surprised by what I find there. For example, it turns out true human flourishing does not involve getting married, having sex, or having children; Jesus’ perfect life of flourishing featured none of these things. 

But crucially, Jesus’ perfect life often involved depending upon others; upon being a burden to those around him. As an itinerant travelling teacher, Jesus relied on the financial support of his followers to make his ministry possible. He relied on being made and given food to eat, and a roof to sleep under. He was far from self-sufficient. Rather, he gladly made himself a burden to others in service of his ministry.  

But more than this, we often overlook the radical significance of the Christian claim that, at Christmas, we celebrate God’s becoming a baby. For the first years of his perfect life, Jesus was entirely – entirely – dependent upon his parents for all his needs. Here we see God, in the person of Jesus, depending upon Mary and Joseph to feed him, to clothe him, to cuddle him, to clean up his sick and his excrement. This is what human flourishing looks like. 

This is mirrored at his glorious death, too. Prior to his arrest, Jesus asked his friends for support; to stay awake while he prays for comfort. The Gospels go on to tell us that, having been mercilessly tortured, beaten, stripped, and interrogated, Jesus had his cross carried by a man named Simon of Cyrene. After his death, having no tomb of his own, Jesus was buried in the family tomb of his follower Joseph of Arimathea. And this, too, is what human flourishing looks like. 

Throughout his entire life Jesus lived the perfect life of human joy and faithfulness. And this often involved depending upon others and being a burden to them in every way conceivable. We are made to be a burden, then. To depend on others, to be burdensome to them, is to be human.  

To think, then, with Baroness Hale, that my dependency and burdensomeness upon others might somehow serve to underwrite a decision to end my life, is fraught with difficulty for me as a Christian. I simply cannot reconcile her words with the life I see Jesus living in the Bible: a life of joyful, difficult burdensomeness.  

There may be many other reasons why people decide they want their lives to end. But a sense of burdening others ought not to be one of them. Being a burden is not a reason to bring one’s life to an end, because it is the very possibility of our being human in the first place. To need others, to place ourselves into their care, does not make us less human, it makes us more human. And therein lies its glory.