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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Sustainability

4 November 2024

3 min read

Coal’s demise teaches us to be cautious about progress

Why the extinguishing of coal power should dampen attitudes to what promises to be progress.

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A sky line shows steam rising from a power station's chimney and cooling towers.

Ratcliffe on Soar power station.

Malcolm Neal, CC BY-SA 2.0 , via Wikimedia Commons.

Chimneys. In our 1920s house, we have two of them, rising into the sky like solid brick antennae. Look across most big cities in the UK today and virtually every house still has them. Yet most of them remain idle, monuments of a bygone age. Useful for holding the TV aerial but not much else.

I thought of chimneys recently when driving up the M1 past Ratcliffe-on-Soar Power Station. On the last day of September this year, it was disconnected from the national grid, as the UK’s last coal-fired power station. The age of coal was over.

Back in the day, chimneys were busy. In the Industrial Revolution of the 1700s and 1800, coal was used to light towns, power railways, and fuel steam engines. By 1850 we were mining 62 million tonnes of coal every year. Coal was the fuel of the present, driving the technology of the future. Chimneys were a sign of a bright way ahead, churning out smoke from coal-fired factories and bringing safe fires into the hearth and home on those dark wintry northern European nights. Coal was leading us into the sunny uplands of prosperity, comfort and mastery over nature. The power behind the industrial revolution, it was as crucial to the present - and the future - as the smartphone seems to us today.

It began to dawn on us we had a problem with coal during the Great Smog of London in 1952. A period of cold weather, an unusually high number of domestic coal fires, no wind and an anticyclone which acted like a thick, stifling blanket, all of it kept the soot-filled fumes from escaping into the atmosphere. As a result, a miasma of dense, smelly fog sat for days over London, killing thousands of people. It led to the Clean Air Acts of 1956 and 1968, banning emissions of black smoke and making residents of urban areas and operators of factories convert to smokeless fuel. Margaret Thatcher’s fight with the miners in 1982, leading to the closure of many pits, was another nail in the coffin of coal.

In October 2001, the Large Combustion Plant Directive aimed to reduce carbon emissions throughout Europe. The UK planned to end coal use by 2025, and we managed to get there a year early. On the domestic level, not many of us use coal or wood fires anymore. Since May 2023, it has been illegal to sell ordinary domestic coal in the UK. Wet wood is banned too. You can burn what’s called ‘dry wood’, with 20% moisture or less, but you can’t go into the woods and bring home random logs you find on a weekend walk any more. Wood burners remain popular, yet even they are suspect, as they produce high levels of CO2.

Gradually we realised that there was an order and a rhythm to the natural world that we messed with at our peril. There was, as Marilynne Robinson once called a ‘Givenness’ to the world. We simply had to learn to respect that givenness, that order, and live within the limits it placed upon us. And as a result, the chimneys lie idle.

The demise of coal - and chimneys - teaches us a lesson. Not everything that promises progress is good. Wisdom lies not in pushing forward with whatever technology or new idea offers more choice, more possibility, but knowing what will diminish us and what will give us life.