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 is a physician and completing a theology doctorate. 

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
Assisted dying
Comment
Politics
4 min read

The assisted dying bill is an undignified mess

Literally life-changing legislation needs a parliament at its best not its worst.

George is a visiting fellow at the London School of Economics and an Anglican priest.

A parliamentary committee meets, sitting at wooden raised desks in a wood panelled room.
The bill committee meets.

The first clue came when MP Kim Leadbeater’s private members’ bill passed in the House of Commons at the end of November. She came outside to greet pro-euthanasia campaigners like she was emerging as a winner from the Big Brother house, in tears of joy, whooping and hugging and high-fiving, with prime minister Keir Starmer gurning awkwardly in her wake. 

For her and her supporters, this was indeed great news. But these optics were far from great. It was as though she was celebrating the consequence of the legislation she’d introduced: “Whoa! Wonderful news everybody! We’re going to be allowed to help people to kill themselves.” 

It’s not a good look, even to those who may wish for such assistance. Where was the dignity, the key word that assisted-suicide lobbyists have appropriated for their cause? Not in this carefree triumphalism, this cork-popping celebration of the prospect of death-on-demand. 

Since then, the bill’s faltering passage through parliament has been characterised by this absence of dignity, a kind of cowboy rustler pushing a herd of supporters in a single direction, towards statute. And this lack of dignity matters. Not just because it is, literally, the most life-changing legislation any of us will see in our lifetimes, but because the dignity of parliament matters very much indeed. 

I don’t mean the ritual flummery, the state opening by the monarch, people marching about with wigs and sticks, Black Rod and all that. I mean dignity in the sense with which we honour our democracy, the way in which we frame our legislature seriously and with due process. 

Leadbeater presents as a good person and there is no apparent evidence to the contrary. But she is an inexperienced parliamentarian. Her selection for the seat of Batley and Spen, now Spen Valley, was rushed through in 2021, memories remaining acutely sharp of the murder of her older sister, Jo Cox, in the constituency in 2016. And, naturally, she has sat on the Government’s backbenches for less than a year. 

 Her inexperience of parliamentary process and scrutiny has shown. Committee hearings have been rammed with those who support assisted suicide and held in unseemly haste, such is the rush to get it into law. Before her bill’s second reading, she described it as having the strongest safeguards in the world, each patient requiring a sign-off from a High Court judge. When this proved impractical, the judge was replaced with a social worker, which apparently was “even safer”. So, safer than even the strongest safeguards in the world?   

But more worrying still is how the passage of the bill has been factionalised. Leadbeater has alienated the mild-mannered by calling opposing voices “noise”, which is a bit like lamenting that a debate should have two sides at all. And she’s called those who disagree with her “unconstructive” and complained that opponents have “mobilised”. Well, duh. That’s how parliament works. Indeed, it’s part of its dignity, rather than a simple inconvenience for an MP in a hurry. 

The media have noticed this lack of respect for procedure. I’m not sure that there’s ever been such resistance to proposed assisted-suicide legislation in the public prints before. Even the Guardian, which might be relied upon to see it as a progressive cause, has turned more than ambivalent. Only columnist and assisted-suicide flagbearer Polly Toynbee is available for a piece that amounts to saying we should move along, there’s nothing to see here and Leadbeater’s bill is doing just fine. 

She, too, claims absurdly that opposition is only coming from people who oppose assisted suicide. Well, blow me down. Try as I might, I can’t trace her complaining that Lord Falconer’s supposedly independent Commission on Assisted Dying of 2011 was both funded and packed with his cause’s supporters.  

In passing, it should be noted what an underminer of parliamentary dignity is Falconer too. He has claimed that justice secretary Shabam Mahmood’s opposition to the bill should be discounted because of her “religious beliefs”. Mahmood is a Muslim. For a constitutional lawyer, Falconer shows scant regard for our constitution. We might as well say that his views should be discounted because he’s a progressive secularist.  

One might expect PM Keir Starmer to bring some quality to this, as an alleged stickler for legal procedure. It remains a mystery, as a supporter of the principle, that he’s left assisted suicide to a private members’ bill. If he really wanted it, it should surely be a Government bill. Cynics among us wonder if he has honoured a promise given to the terminally ill Esther Rantzen with token support for a private members’ bill, but knows it will fail.  

Again, lack of dignity. If dignity in dying means anything since it was misappropriated as a campaign slogan for assisted suicide, then it should be accompanied by dignified debate and amendment in parliament. This bill has provided precisely the opposite. Let it die.

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