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Assisted dying

Care

Comment

Ethics

27 November 2024

2 min read

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…

Article

Character

Comment

Politics

Virtues

5 March 2025

5 min read

Are virtues irrelevant in today’s uncertain politics?

We need to exercise the character traits that uphold our values.

Emerson Csorba

Emerson writes on geopolitics. He is also a business executive and holds a doctorate in theology.

President Zelensky raises a hand while President Trump talks at him.

MSNBC.

In Oliver O'Donovan's Finding and Seeking, the theologian makes a telling comment about virtue, virtue referring to ‘the goodness the world has already seen and known…. Talk about virtue is always third person talk, observers’ talk about deeds that have already taken determinate form.’

Put differently, virtue is about the past. It is about how others have lived and acted in admirable ways. But it is not about today, in all of its ambiguity and uncertainty.

To put it directly – virtue falls apart when hit with reality. It is easy to talk about what virtuous people have done, much harder to be virtuous in the present. Or so O’Donovan says.

There has been a lot of talk over recent years about the need for virtues and values in politics (and in the world more widely), but what even are these things?

Values are principles or standards that individuals or societies consider important.

Virtues are moral excellences or traits of character, such as courage, patience, or humility.

Virtues are the moral character traits individuals need to uphold values, in practice.

When thinking about virtues and values, I often reflect on a simple but profound point made by Nigel Biggar speaking at Oxford University many years ago:

"If you want pure heroes, you won't have any."

Put differently, people – including the most virtuous at first glance – are complicated.

Yet, our world is one in which virtue seems to be in short supply. Some would even say virtue (and values) are non-existent, or on the verge of extinction.

The older I become, the more I am left reflecting on why it is that so few individuals – in political life, but also more generally – seem to live without principle. Integrity – which I define as ‘your word (or principle), and action aligning’ – seems increasingly a thing of the past.

Many seem to think that integrity is ‘old-fashioned,’ acting accordingly, saying one thing and doing another as if there are no repercussions.

This is replaced with an ‘anything goes’ mentality, focused on short-term gratification. It is a “you do you” culture, acting without conscience. People seem to believe there are few if any repercussions for doing bad things. This culture is not only permitted, but even celebrated.

The American situation is, of course, the example par excellence of this. American politicians and diplomats wake up each morning waiting for what their President will write on social media, responding accordingly. Alliances are thrown out the window. Nothing is off the table.

There is seemingly less interest in Western societies in being good persons, doing what is right in hard circumstances, and where few or no people are watching.

Whether in politics or in society more widely, people seem increasingly focused on protecting themselves, doing whatever they need to do to get ahead, rather than looking out for each other.

So where do we draw the line? Is there space for virtue (and values) in a world where growth is slowing, and more people are battling for parts of a shrinking pie?

I believe the answer is yes. My sense is that many people are today yearning for clarity of values and virtues in a world that is becoming much more anchorless.

There does then seem to be interest in values and virtues, but it is perhaps worth remembering that values and virtues are like muscles... It is possible to lose these muscles without practice.

In my home of Canada, where I recently moved back, many value decency, politeness, and a sense of moderation.

In 1955, while serving as Canada’s Secretary of State for External Affairs, Lester B Pearson put his figure on this pulse, delivering a series of lectures at Princeton University entitled Democracy in the World. Pearson argued that a sense of moderation is a leading value for Canadians.

He described this as a ‘confidence in the ability of the peoples and the leaders of democratic nations to grow into the new situations and to accept the greater self-discipline which the preservation of freedom in an interdependent world requires.’

And he saw Canada as especially emblematic of this ability to grow into new situations, this adaptability in working in an interdependent world.

Many Canadians believe that the thirteen provinces and territories need to adapt and work together in order to respond to the threat of the United States.

The candidate for Leader of the Liberal Party, Mark Carney, seems to agree (and is rising in the polls because of this), whereas his opponent Pierre Poilievre is moving in the opposite direction given his more combative approach. But Poilievre has time and the opportunity to turn this around, channeling Canadians' frustrations into a vision focused on the values and virtues we share in common.

In other words, Canadians value working together when faced with challenges, valuing this solidarity when times are tough. We become more courageous the tougher things become.

The virtue of courage is here a noteworthy virtue, so well proven in the Great War battles of Vimy Ridge, Passchendaele and The Somme, or the Battle of the Atlantic in World War Two.

We see this Canadian virtue emerge often in times of crisis.

Andrew Davison in previous writing in Seen & Unseen is especially eloquent on courage, writing that this virtue is:

‘both bracing and realistic. It reminds us that all is not well with the world. We will often need courage because doing the right thing can be costly.’

There does then seem to be interest in values and virtues, but it is perhaps worth remembering that values and virtues are like muscles – a point made by Carney in previous writing and speeches. And Poilievre, well-known for his considerable discipline, certainly understands the importance of the exertion that builds muscle."

It is possible to lose these muscles without practice. Over recent years, societies and individuals have become more permissive, rather than encouraging consistent exercise.

The question therefore is less about whether values or virtues will survive in the harsh light of reality. Instead, it is whether societies – their political representatives and citizens – are open to making the short-term investments necessary to uphold what they believe is good in their countries and in the world?

A tall task, to be sure, but one that I believe is both possible and necessary for Canadians and non-Canadians alike. Canada can here be an example for the world.

This task – upholding certain values and virtues, is not third person talk, as O’Donovan suggests. It is rather an imperative for action in the present. We are called to act accordingly today.