Snippet
Assisted dying
Care
Comment
Ethics
2 min read

Who holds the keys of death? The logic of assisted dying

The ethical principle of double effect.

Tom has a PhD in Theology and works as a hospital physician.

white pills form an angle on a blue background
Hal Gatewood on Unsplash.

Healthcare hinges on the principle of double effect. This ethical principle makes the vital distinction between intent and effect. That is, one’s intent does not always result in a single intended effect, whether foreseen or not. In taking a patient’s blood, for example, my intent is to acquire information to aid treatment. An additional effect of this process is that—almost inevitably—this patient will experience pain, albeit minor. This principle of single intent and multiple effects applies throughout the practice of caring for human bodies, in all those instances where caring for those bodies involves physical interference, from prescribing medications to surgical procedures. And, in some instances, identifying and treating symptoms (such as terminal breathlessness) involves the use of medications that, as an unintended effect, result in death. 

In the case of assisted dying, the distinction is important. The intent of assisted dying is to end pain and suffering by ending life. The ending of life is the treatment used to relieve pain and suffering. The intent is not to isolate and treat particular symptoms associated with a condition. The intent is to bring the condition itself to an end—which requires bringing the patient’s life to an end. This is not to make any judgment whatsoever about whether such a course is “right” or “wrong”, but rather to draw out the simple observation that this course involves an unprecedented change in medical practice. Assisted dying involves the categorical adoption of ending life as a possible treatment for a condition. 

This is not quite the same as the slippery slope argument; it is about the logic of assisted dying. The point I am making is this: once ending life is introduced as a treatment, the key ethical step has already been taken. Applying that treatment in other instances of “suffering” (be they mental illness or ageing, for example) does not involve any new ethical steps. It simply involves the further application of a principle that has already been adopted. Despite the considered safeguards of the bill, therefore, the moral-ethical arguments against applying this treatment more widely will, at best, stand on shaky ground. For who could be so bold as to insist on what constitutes “suffering” for an individual?  

Should the bill hold out the keys of death in this way? I can only think of One who is strong enough to wield those… 

Article
Comment
Leading
Politics
4 min read

Covid inquiry: Johnson, Cummings, and the cost of refusing to grieve

The report exposes mistakes, but our real challenge is learning how to face loss without denial

Jonah Horne is a priest, living and working in Devon.

Boris Johnson sits, giving evidence to an inquiry.
Boris Johnson giving evidence to the inquiry.
UK Covid-19 Inquiry.

I distinctly remember the sheer confusion of January to March 2020. Should we flee our flat in London? Should we cancel the lease on our workspace? Will I be able to continue breakfast with my friend on Thursday mornings? I ignorantly scoffed that a lockdown could conceivably take place and then, stood devastatingly corrected only a few months later. However, the UK Covid-19 Inquiry reveals that this ignorance induced confusion was not restricted to the personal level but instead enacted on a national stage. 

What’s glaringly obvious as you read the recommendations is that the government acted too slowly and too indecisively. If the initial restrictions been introduced sooner, say in January or February, the first lockdown “might have been shorter or not necessary at all.” This, the report suggests, could have saved approximately 23,000 lives. Brenda Doherty, of the Covid-19 Bereaved Families for Justice group, believes her mother could have been one of these. Instead, she and her sister stood by her graveside in March 2020 as her family members waited a few metres back sectioned off by red tape. The report and accompanying evidence call for sombre reading. 

In response, those in charge at the time have understandably launched an attack in their own defence. Boris Johnson has labelled the inquiry "totally muddled,” which ironically sounds like the informal conclusion of his leadership in the report. Similarly, Dominic Cummings has hurled a 2,000-word response into the social media stratosphere, which feels almost as long as the 800-page paper itself. 

What seems glaringly obvious about both men’s responses is the very thing Brenda Doherty displays with such elegance: grief. There is, in these men’s retorts, a stunning omission of any sense of responsibility or indeed any willingness to admit defeat. And what frightens me most, as we look towards the future, is our refusal to grieve over the things of the past. The threat on Europe from Russia is growing. AI’s disruption on our workforce seems to be being enthusiastically brushed aside. And another, potentially much more violent, pandemic is unsettlingly likely. 

However, in the face of these disruptive forces grief is a remarkably generative power. Without grief we remain, much like Johnson and Cummings, frozen in time. Immovable in our ineptitude and ignorance. Grief, I’d argue, is the very thing that enables us to recognise our shortcomings and, when mixed with hope, energises us towards a future which lies on the other side of sorrow. Yet, when we exist in a place of fragility, the idea of imagining that life lies beyond my incompetency, if only I grieve it, is frightening. Devastatingly though, for us humans, this may be the only way to learn and move forward.  

Our future and redemption is undeniably bound up in our ability to grieve. Grief is inherently futural. By grieving our ineptitude, we inevitably witness to the places that require growth, mercy and grace. When we fail to grieve, we remain frozen in time—precariously hiding behind the illusion of our infallibility. This is a deeply fragile state. From this position, any assault or critique on our mistakes becomes a personal attack rather than invitation to redemption. We find ourselves lashing out in fear, terrified of being exposed. Johnson and Cummings embody this predicament to a tee.  

This situation however is not unique to the Covid iquiry and our late-prime minister’s response. Another character who lashes out in fear is St Peter, one of Jesus’s friends and disciples. There is a rather poetic story that illustrated this at the end of John’s gospel in the New Testament. One of Jesus’s friends Peter rejects him as he’s taken to be murdered. Peter attacks a guard, cuts his ear off and Jesus famously disarms him and heals the man. Moments later, Jesus is taken, Peter flees and we find him standing in a courtyard, by a fire and where claims not to know his friend and master Jesus. To make matters worse, he rejects him not once, but three times. However, when Jesus returns from the grave, he meets Peter again, at a fireside on a beach, and asks him “do you love me?” Not once but three times. The thing that I think is particularly remarkable about this meeting is that Jesus recognises Peter’s future in bound up in the redemption of his past mistakes. Jesus takes Peter to the place of failure, a fireside, and gives him an opportunity to declare his allegiance and love for him, the same amount of times he had rejected him. He reminded him of his wound to heal him for his future.  

If we are to take seriously our response to the Covid-19 inquiry, we must take responsibility for our errors. Not begrudgingly but with a grace filled grief. Our future, one that is filled with hope, does not come to us without a confession of past errors. Instead, a hopeful future may only come to us when we confess, recognise and grieve our mistakes. Indeed, to freely grieve over my failures is to grieve believing in life beyond my defeat. 

Support Seen & Unseen

Since Spring 2023, our readers have enjoyed over 1,500 articles. All for free. 
This is made possible through the generosity of our amazing community of supporters.

If you enjoy Seen & Unseen, would you consider making a gift towards our work?

Do so by joining Behind The Seen. Alongside other benefits, you’ll receive an extra fortnightly email from me sharing my reading and reflections on the ideas that are shaping our times.

Graham Tomlin
Editor-in-Chief