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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Economics

Sustainability

26 November 2024

4 min read

Black Friday: don’t shop, try stewarding instead

We're so fallible to consumer culture. Here's how to counter it.

Rosie Phillips

Rosie studies theology in Oxford and is currently training to be a vicar.

A phone screen is held up, showing a shopping page, behind a window displays a Black Friday Sale banner.

CardMapr.nl on Unsplash.

Have you noticed how many times in the last 24 hours you’ve been targeted or tempted by a Black Friday marketing campaign?

It’s estimated that we can see anywhere from 50 to 400 adverts per day - on TV, billboards, online, and, more than ever, through social media. I’ve never felt more seen and known by the Instagram algorithm, and many of us have experienced items popping up on our feeds which we were talking about with friends only hours before. Is it possible to resist such incessant and elaborate marketing schemes?

In the lead up to Black Friday this year, I’ve been looking out for a new vacuum cleaner (the rock-and-roll life of a thirty-something year-old). Having done all the research, I’m now poised to cash in on the discounts, regularly refreshing my Argos and Amazon tabs for the latest prices.

But, as I’ve been comparing the relative pros and cons of cordless versus cylinder vacuums (and marvelling at the development of anti-hair wrap technology), it’s been difficult not to have my interest piqued by various other products being put under my nose by these websites, too.

And difficult not to feel like, if I don’t act quickly, I’m going to miss out on an offer that’ll not come around again. It’s almost as if these marketing executives know how my brain is going work - even before I go online. But are we humans really as transparent as that?

Netflix’s new documentary, Buy Now? The Shopping Conspiracy, says that we are. It profiles several ex-insiders from the world’s biggest brands, who expose the manipulative tricks used by these corporations to make us buy more, and the extent to which our desire for endless consumption has been cultivated and capitalised on by design.

It seems that we humans, evolved and intelligent as we like to believe ourselves, are still fallible to serve the things which were designed to serve us. And the consequences are far-reaching. Online shopping may have dehumanised the consumer experience, but we remain connected to people around the world by global supply chains, and it is individuals and communities whose livelihoods are most dependent on the availability and quality of natural resources, and who live closest to the land, who reap the harmful effects of our incessant buying habits.

Hazardous e-waste, for example (including discarded laptops, phones, and TVs), is rising by millions of tonnes annually. The UK is a particularly bad offender for illegally exporting toxic e-waste around the world, dumping it in landfills where it releases toxic substances such as mercury, zinc, and lead into local water and soil supplies.

Back here in the UK, we can feel like such small cogs in such a huge, capitalist machine, that a lot of this seems beyond the realms of our human agency.

There is certainly value in being savvy with our spending power as consumers. In doing the research to get the best Black Friday deals, as we tighten the purse strings and navigate what has become a protracted and painful cost of living crisis for many. It can be hard for Christmas not to feel like an unavoidably expensive time of year.

But, perhaps there is also an opportunity to take small, subversive acts of resistance against this dehumanising consumer culture. Actions which reclaim our humanity and human agency, and which recognise our global interconnectedness.

For example, maybe you could resist the urge to impulse buy something this weekend, by stepping away from the screen to make a cup of tea or go for a walk outside, before clicking ‘Pay Now’.

Perhaps we could get better at comparing companies’ supply chains and ethical brand ratings, using our spending power to support those which align best with our values.

And, when we’re making a purchase, let’s take a moment to be grateful for the things we already have, the items we’re buying, and the people who made them.

The Christian faith invites us to reframe how we see our money and belongings through the lens of stewardship. It’s an underrated principle in today’s context. Stewardship goes beyond just thinking about how we spend our income, to the inherent responsibility we have as humans to look after the world around us, recognising that the earth’s resources are not ones we are entitled to, but are gifts which sustain life.

The principle of stewardship makes it impossible to hide behind a screen and to ignore the impact which our spending decisions have on people and communities around the world, however far removed from our lives they seem. It invites us to use our money and resources to invest in things which will serve us - and others - well, and tells the world that it matters that we challenge systems which perpetuate economic and environmental injustice.

And, if I happen to miss out on that vacuum cleaner while I’m out for a walk this weekend, at least it’s less than a month until the Boxing Day sales hit our screens.