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

The ethical principle of double effect.

Tom Dove

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…

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14 March 2025

3 min read

University turmoil makes the case for chaplains

Creating space, offering time, across cultures.

Piotr Ashwin-Siejkowski

Piotr is a chaplain and faith advisor at Brunel University.

A cup of coffee is offered across a table to a hand that is hesitant.

Priscilla Du Preez 🇨🇦 on Unsplash.

As the university sector convulses, what’s the point of their chaplains?

The university chaplains fulfil a role which calls for a unique set of skills, including pastoral imagination, flexibility, and creativity as they respond to various, often unpredicted, challenges. Chaplains occupy a place between highly professional Students Services colleagues at the university - think counsellors, experts on emigration and finances, and local parishes representing diverse theological viewpoints.

Every year, while meeting and greeting international students, one of the earliest tasks for the chaplains is to explain their role, as in non-European languages and cultures there is no equivalent of a “chaplain”. Are the chaplains sort of “spiritual gurus”, “life coaches”, “champions of wellbeing”? What is the real difference for the students and the staff in a secular academic institution, between approaching a chaplain and a professional counsellor?

In addition to all these initial questions that a student might ask, other observers question the role of chaplains in a secular academic institution, for being counterproductive. Why provide and finance a chaplain without any measurable outcomes of his or her work? Whether it is counting confirmations, ensuring Christian faith and values as clearly pronounced, or/and conducting regular acts of worship for the students and staff?

Looking at my daily engagement with the international, diverse community of the students and the staff, there are at least three areas of presence (rather being than doing, adapting famous Gabriel Marcel’s distinction), which illuminate this unique type of vocation.

First, currently British universities are going through a very painful, dramatic time of saving money and redundancies. Chaplaincy is becoming a visible space for emotional support to those who are worried about their immediate future. Students and staff are going through a period of uncertainly, if not confusion, so chaplaincy holds the unique space on the campus to show empathy to those who cry, and to offer time for those who need to speak about their pain.

Secondly, chaplaincy has the privilege of being very creative in the ways of engaging with the local academic community. The memorial services for the students and the staff who died recently are not the formal funerals: yet they allow the participants to speak, play the music, show videos about the departed. There is a real celebration of life, brings consolation to academic colleagues, families and relatives.

Thirdly, unlike other professional services, only chaplaincy is able to show the generosity of time to anyone who comes through the door. That’s because those individuals are welcome as the ‘image’ of God. The rest about that individual is accidental, he or she finds ‘home away of home’ in the space of chaplaincy, because through the eyes of Christian faith: he or she is precious and unique.

What about proclaiming the message about Jesus Christ? There is a story about St Francis of Assis who said to his brothers, while approaching an Italian city: “now we will proclaim the Gospel to all who live in this city”. After that he and his companion marched through the streets in silence. When they left the city, one of his brothers, rather surprised by lack of preaching, asked: “Francis, when did we proclaim the Good News?”. “Our way of walking was the proclamation of our faith”. The way how we greet, spend time with students, talk, joke and pray – reflects that proclamation.

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