Article

Assisted dying

Care

Comment

Death & life

9 January 2024

6 min read

What do you make of Esther?

A campaigner’s call to change an assisted dying law got family calling MND sufferer Michael Wenham. Here he shares why such legalisation will increase people’s fear of dying.

Michael Wenham

Michael Wenham lives with a motor neurone disorder, Primary Lateral Sclerosis. He blogs at My Donkey Body.

Today Programme post about Esther Rantzen's comments.

BBC.

"What do you make of Esther Rantzen?" asked my brother.

I knew what he was talking about, as no doubt all listeners of Radio 4's Today Programme would have done. Clearly the advocates of assisted dying, or specifically suicide, have launched the next round of their campaign, even enlisting the late Diana Rigg, whose resemblance to my wife was once commented on by an old welsh policemen, as a witness. The Today Programme devoted a great deal of airtime to the subject over a number of days.

My reply to my brother was that I thought it was a good thing if we were more open about the subject of death and dying. After all they are events everyone without exception will come in contact with at some point or another. So, the sooner we stop treating it as a taboo subject the better. However, the dangers of legalising assisted suicide, are proved by places like Canada and Belgium.

I don’t see any way to protect us from such coercion, internal or external, except to demonstrate through legislation that every life, however tenuous, is equally important.

In January this year I made a submission to the Parliamentary Health and Social Care Committee consultation on assisted dying/assisted suicide. Here’s some of that submission.

“I am writing as an individual who was diagnosed with a rare form of Motor Neurone Disease (MND) twenty-two years ago and who has experienced the condition’s relentless deterioration since then. There are a number of my contemporaries who have survived that long. That, and witnessing the ravages of the disease on friends in our local MNDA branch plus an Ethics qualification from Oxford, is the extent of my expertise.”

“My first observation is how positively my contemporaries, with short or longer prognoses, with the disease seize hold of life. Clearly there are some who, like Rob Burrows, devote themselves to fund-raising and creating awareness; while others enjoy the opportunities of life that come their way. What might have seemed a death sentence has proved a challenge to live.

"Secondly, I have recently discovered myself how expert professional care can enhance what is often portrayed as undignified dependence. Good caring can in fact add to quality of life. The sad thing however is that it is not something which the state will normally provide. Along with terminal palliative care, domestic social care must surely be a spending priority for any government that cares about the well-being of all its citizens. I’m fortunate to live an area of excellent MND provision and good, though not abundant, palliative care. But I understand that this is not equally spread through the country. If it were, I suspect it would reduce the fear of dying which must be a major motivator for assistance to ending one’s life.

"Ironically, in MND, according to the Association’s information sheet, How will I die?, those fears are greatly exaggerated:

In reality, most people with MND have a peaceful death. The final stages of MND will usually involve gradual weakening of the breathing muscles and increasing sleepiness. This is usually the cause of death, either because of an infection or because the muscles stop working.

Specialist palliative care supports quality of life through symptom control. practical help, medication to ease symptoms and emotional support for you and your family.

When breathing becomes weaker, you may feel breathless and this can be distressing. However, your health care professionals can provide support to reduce anxiety.

You can also receive medication to ease symptoms throughout the course of the disease, not just in the later stages. If you have any concerns about the way medication will affect you, ask the professionals who are supporting you for guidance.

Further weakening of the muscles involved in breathing will cause tiredness and increasing sleepiness. Over a period of time, which can be hours, days or weeks, your breathing is likely to become shallower. This usually leads to reduced consciousness, so that death comes peacefully as breathing slowly reduces and eventually stops.

"So, this is a third and subtle danger of legalising assisted dying/suicide. It would increase people’s fear of the inevitable fact of death and dying. I think this can be one factor in explaining why, in jurisdictions which have introduced it, we see it being extended beyond the first strict limits. It is held out as an answer to this fearful fact, death, whereas in fact death and dying should be talked about in realistic terms, as normal, as concisely outlined by Dr Kathryn Mannix. As she says, normally dying isn’t as bad as we think.

If the government should be doing anything, the first thing it might well do, is to promote informed education about dying of the sort exemplified by specialists such as Dr Mannix, as well as adequately funding her former specialism of palliative care. It should start with schools’ curricula. After all every child will have encountered death at some stage.

Finally, the dangers of coercion, in my experience, are not so much external as internal. It’s often rightly observed that prolonged pain is worse for the engaged spectator than for the sufferer. If you care for someone, seeing them struggling is barely tolerable. You may wish to see their struggle over, but underlying that wish is your own desire to be spared more of your own horror show. The person who is ‘suffering’ however has that strong survival instinct, common to all humans, and is more concentrated on living than dying. Having said that, when you are depressed, as might be natural, that instinct gets temporarily eclipsed. Then you need protection from your own dark sky. It is at such times that your other inner demons emerge: your sense of being a burden - to your family, to your friends (if you have any), to the NHS and to the state purse; your fear of losing your savings and of leaving nothing to your loved ones; your fear of pain and of dying (exaggerated by popular mythology), and your sense of suffering, heightened by your depression.

"For most of us with long incurable diseases, it’s these internal perceptions that are most coercive, although they can be easily compounded or even exploited from outside. I don’t see any way to protect us from such coercion, internal or external, except to demonstrate through legislation that every life, however tenuous, is equally important to our society and worth caring for. ‘Any man’s death diminishes me...’ and so we will value it to the end."

I'm grateful that when I received my 'motor neurone disorder' diagnosis, which was initially frightening, I couldn't be tempted to opt for an early death. Instead of one Christmas with my family (as I warned them), I've enjoyed 22 more Christmases. That was the law against suicide fulfilling its safeguarding function, protecting the vulnerable, as I was then. Contrary to my preconceptions, my form of MND (PLS) is very gradual and I've been able to live a full if increasingly limited life, thanks to my wife, Jane, who cares for me 100 per cent. 24 hours a day, seven days a week.

My view is still that legalising assisted dying/suicide has more cons than pros. The better choice is to invest in hospice and palliative care, so that everyone may have access to pain and symptom care in the last years of their life.

Article

Comment

Politics

Virtues

27 September 2024

8 min read

The emerging frontier: renewing courage in geopolitics

Narcissistic moralising needs to stop, and we can learn from Churchill too.

Emerson Csorba and Gal Treger

Emerson writes on geopolitics. Gal is a tech investor.

Military personnel, wearing camoflague uniform crowd round a computer monitor.

U.S. Space Force guardians assess a threat.

U.S. Space Force.

In August 1939, the Polish poet Kazimierz Wierzyński reflected on a “Peaceful bliss which had become Europe’s chloroform.” Yet, then as now, crises shake us from moments of calm, especially when we abandon vigilance. We let our guards down, nonchalance replacing serious deliberation toward action.

A shroud of darkness has descended on the world over recent years, with new conflicts emerging just as – or perhaps because – democratic populations turn inward. These conflicts – whether the Russia-Ukraine War, the Israel-Gaza War, or the US-UK led battles in the Red Sea – demonstrate the courage of peoples sacrificing for their nations, families, histories, and traditions.

Yet, in much of the political West, narcissism – rather than courage – has become the focal point of our culture.

Christopher Lasch describes this narcissism in The Culture of Narcissism: American Life in an Age of Diminishing Expectations as a conceit of the present. Lasch notes that we have become a consumer society focused on individual self-absorption that leads to present-focus, sense of isolation, and disconnection from history.

The psychoanalyst Erich Fromm argues in The Heart of Man: Its Genius for Good and Evil that narcissism is an attachment to “self-image,” which “distorts rational judgment.” Yet, Fromm later reflects “If the feeling which the Greek poet expressed in Antigone’s words, ‘There is nothing more wonderful than man,’ could become an experience shared by all, certainly a great step forward would have been taken.”

This wonder of man is in the freedom to act in a world that is yet to be determined.

This is a position of “deep faith.” It encourages full participation in the world, affirming the self through action, though always in relation to something much greater.

The philosopher and theologian Paul Tillich similarly states “this is just what participation means: being a part of something from which one is, at the same time, separate. Literally, participation means ‘taking part,’ in the sense of ‘sharing’ or ‘having in common.’” We play, as legendary Notre Dame football coach Knute Rockne once said, "For everyone that came before us, and everyone that will come after us."

If common history is needed as our foundation for current action in geopolitics, to what then might we turn?

We propose a refocusing and modern renewal of alliances underpinned by Winston Churchill’s A History of the English-Speaking Peoples, a project he initiated in the early 1930s as the threats of Nazism and Fascism had taken centre stage.

This refocusing reprioritises courage in geopolitics, maintaining the light amid descending darkness. It is badly needed given the modern tendency to look inward rather than to sources of value outside of the self.

This is a pathway to vigilance in anticipation of the thief in the night, who may arrive at an unexpected hour.

Churchill – recently demonised by influential conspiracy theorists – emphasises the common cultural and political heritage of the English-Speaking Peoples, including the rule of law, individual rights and parliamentary democracy, which shaped the modern world.

Churchill reminds us of the global influence of English-Speaking Peoples in spreading democratic ideals and governance structures across the world, believing that the global spread of these ideas was instrumental in shaping modern life. He underscores the unity of the English-Speaking Peoples in facing global challenges, particularly in the context of the World War he foresaw. And he viewed the cooperation between the UK, the US, and other Allied nations as crucial to the survival of freedom and democracy.

It is important, now as much as ever, that we remind ourselves of Churchill’s wise words, building on them to address with courage the challenges of our present times.

Specifically, we must adapt Churchill’s emphasis on the English-Speaking Peoples to a focus on nations working at the frontiers of Western civilisation to resist rising darkness which seeks to corrupt the good. Ones not necessarily actually speaking English too.

Building on these unique and complementary strengths, these agile nations united as upholders of the values of English-Speaking Peoples should reindustrialize, rearm, redraft and recommit to a common goal in a world of increasing geopolitical conflict.

The sharing of expertise and overall close collaboration between these agile nations can facilitate rapid preparation for conflict at any moment, proactively addressing Wierzyński's dangerous “peaceful bliss.”

In other words, this is a pathway to vigilance in anticipation of the thief in the night, who may arrive at an unexpected hour.

Renewed partnership is necessary between these nations. There is a need for these nations to re-assert their historical courage, underpinned by vital modern capabilities.

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Alongside the United States as the focal point, these nations are Canada on the Arctic frontier; the United Kingdom as a Northern frontier; Poland as the Eastern frontier; Israel as the Southeastern frontier towards the Eurasian landmass, and Australia, with its recent experiences confronting neighbour China, on the Far East frontier.

Each of these nations serves as a regional center of power and influence: Canada in the Arctic and Atlantic; the US into the Caribbean and broader Latin America; Israel in the Middle East with the Abraham Accords and North Africa; Poland into Central and Eastern Europe, and Australia in the Indo-Pacific. Each of these nations possesses vital agility, given their small geographical sizes or populations.

These frontier nations respond to United States CIA Director William Burns’ 2023 Ditchley Lecture, in which he focused on “[hedging middle power countries who] see little benefit and lots of risk in monogamous geopolitical relationships. Instead, we’re likely to see more countries pursue more open relationships than we were accustomed to over several post-Cold War decades of unipolarity.” The focus here is courage with a long-term view, building a frontier-focused alliance rather than seeking relations based on short-term material interest only.

In this frontier model, it is currently Israel demonstrating the courage to uphold the values captured in Churchill’s account of the English-Speaking Peoples. Hamas’ brutal October 7th attack was predicated on the notion that over the last decades, Israel transformed into a consumer society, focused on short-term economic incentives and leisure pursuits. Israel provides technology and experience in fighting modern wars of various types, as well as persistence and proactiveness that other nations must quickly recover.

Canada is historically a frontier nation of courage, reflected for instance in its contributions to WWI and WWII victories, as well as in the often-quiet contributions that Canadians make to peacekeeping efforts across the globe. But Canada can take bolder action, given its strategic Northern location and proximity to the Arctic, with its vast natural resources including critical minerals supply and its vast freshwater reserves. It can become a more influential global player amid trade wars, helping reduce dependence on Chinese resources.

The United Kingdom’s combination of common law, property rights, financial markets and freedom of the press are important strengths. As Nigel Biggar finds in his Colonialism: A Moral Reckoning, the UK has historically championed free markets generating economic opportunities for diverse peoples; established peace where internal strife previously existed, protected the rural poor from wicked landlords, and provided civil service and judiciary systems to reduce corruption.

Poland, as noted by Radoslaw Sikorski in a recent speech, shares with the United Kingdom “the same strategic vision. It is based on the fundamental assumption that international law is the guardian of peace and stability.” Poland also “consistently supports close, comprehensive cooperation between the UK and the EU’s security and defence frameworks” with continued focus on strengthening its military capabilities. And, of course, Poland is keenly aware of the threat of war which which is ever-present on its border.

Australia has, over the last decade, demonstrated evident success in facing the threat of China on its doorstep, this ever-present threat producing a group of leaders across government, private and media sectors that are as sharp, worldly and realist in nature as any in the Commonwealth.

Renewed partnership is necessary between these nations. There is a need for these nations to re-assert their historical courage, underpinned by vital modern capabilities. C.S. Lewis, in his famous Screwtape Letters, shows that “courage is not simply one of the virtues, but the form of every virtue at the testing point, which means, at the point of highest reality.” Each of these frontier nations has historically demonstrated success in the face of testing.

Our focus cannot be narcissistic moralising – too often the case in today’s geopolitics – which is the product of the serpent’s advice in the Garden of Eden, in which our eyes will be opened as we “become as gods knowing good and evil.” We must not allow others to twist our sense of history, such that we begin to exalt ourselves in the present moment rather than adopting attitudes of service, sacrifice and worship of that which is unfathomably greater and farther-reaching.

Instead, it must be – as we have seen with Churchill, and as described by Dietrich Bonhoeffer in his incredible commentary on the story of the Garden of Eden, to act.

As Bonhoeffer writes, “If the Holy Scripture insists with such great urgency on doing, that is because it wishes to take away from man every possibility of self-justification before God on the basis of his own knowledge of good and evil… The error of the Pharisees, therefore, did not lie in their extremely strict insistence on the necessity for action, but rather in their failure to act. ‘They say, and do not do it.’”

The frontier model we propose facilitates such action, prepared with the necessary capabilities and coordination for the considerable challenges before us.

We must remember that to participate in the world with deep faith – courage – has been and always will be the basis for human freedom.

Indeed, this is the task of the nations: united by the common heritage of English-Speaking Peoples, acting with faith in the good, always at the frontier.