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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Character

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24 October 2023

5 min read

Daunted by dad-hood, encouraged by dad

Imminent parenthood pushes Nick Brewer to pause and consider what sort of Dad he needs to be.

Nick Brewer

Nick Brewer is a critically acclaimed rapper and recording artist. He is a patron of Anxiety UK, and runs Talk About It - helping young people explore creative writing.

A dad hovers with open arms ready to catch a baby taking first steps

Peter Dlhy on Unsplash

I’m about to become a father for the first time.

While there is excitement and joy as my wife and I prepare to start this new chapter of life, I’m not sure that I feel qualified to be a dad. As someone with an anxious disposition, I like to be as prepared as possible for any task ahead. However, just six weeks from the due date, I could quite easily do with another nine months to get ready for the new arrival.

I’ve been reading books about parenting, listening to podcasts, attending classes with my wife, all to try and equip myself with the necessary skills. I’ve also tried to do as much DIY as my limited skillset allows me, to make the house ‘baby ready’.

Yet, I can’t get away from this nagging feeling that I might not have what it takes to be a good dad. Watching my wife flourish over these last few months, building a strong connection with the baby and preparing for motherhood, is quite astounding. Honestly, I can’t say I have that same feeling of connection with the baby.

What do I say to a bump? I’m rarely at a loss for words in life, but I was stumped.

This lack of connection became clearest to me when my wife first suggested that I speak to the bump, so that the baby could get to know my voice. As I hesitantly stooped down and got in position to talk, my mind went completely blank. What do I say to a bump? I’m rarely at a loss for words in life, but I was stumped. An awkward ‘hello’ and ‘how are you?’ wasn’t cutting it.

Suddenly, I had an idea to sing a song. My song of choice was ‘All My Loving’ by The Beatles. This isn’t a song that I’ve listened to in at least ten years, and my wife had never even heard it. So, why did this song come to mind at that moment? Some sort of distant memory had crept in, of my own father singing this to me as a child, most nights before I went to sleep. As this memory came back to me, I started to think, what can I learn about the role of a father from the example set by my own father?

Can I reach the incredibly high bar that my dad has set for parenting? I’m not so sure, but I’ve got no excuse not to, as I’ve had a near perfect example in him.

My dad is a very different character to me. While I often overthink and worry about everything, my dad just seems to have an ability to get on with life, regardless of what he might be going through. He’s not the most outwardly emotional man. It would be rare for him to answer the question ‘how are you?’ with anything other than ‘fine’.

He’s much more of a ‘man’s man’ than me; one of those guys that just seems generally good at most handy things. He’s the type of guy that you would want to help install laminate flooring or rewire a lamp. He’s reliable, having been with the same employer for nearly 40 years, and he gives great financial advice. He is not hypermasculine in any way, but he’s solid. Dependable. He would do anything to help anyone, no matter what it may cost him.

He has a lot of qualities that a good father needs, and as his son I’ve reaped many rewards from having a dad like this. I’ve grown up feeling safe and reassured. And while I’ve picked up some of my dad’s traits, I’m not sure how similar we are. I’m a lot more emotionally wired than he is. I worry about things that I imagine have never crossed his mind. I’ve spent a lot of time chasing creative pursuits and sought work opportunities that I believed would fulfil me. I’ve spent countless hours trying to figure out my ‘purpose’. I’m extremely unskilled when it comes to DIY. I worry that I’m just a lot more selfish than he is. Can I reach the incredibly high bar that my dad has set for parenting? I’m not so sure, but I’ve got no excuse not to, as I’ve had a near perfect example in him.

While I could go on about my dad’s various qualities, when I think of the ways in which he has impacted me most, one of the most important things he did was create a safe environment for me to grow up and develop in.

Through his willingness to patiently let me become myself, with the parental guidance that was required of him of course, he demonstrated love.

From a young age, I just had this feeling that I could express anything to my dad. Over the years I’ve asked countless questions, expressed numerous fears, and explored several different interests with him. Looking back as an adult, I imagine that I’ve frustrated my dad on several occasions; pondering and worrying about things that he knew I didn’t need to. But he didn’t shut me down, he created space for me to express those things.

There’s a piece of advice from James, one of the leaders of the early Christians, way back 1,900 years ago. He encouraged his reader to be ‘quick to listen, slow to speak, and slow to get angry’. That’s what my dad exhibited to me. He didn’t bat away my worrisome thoughts or ignore my silly questions. He didn’t show frustration, although I’m sure at times he might’ve wanted to. The way that he interacted with me communicated that I was safe and loved. I’m sure he didn’t get everything right, and I imagine if I asked him, he would be able to detail all the things he did wrong. But through his willingness to patiently let me become myself, with the parental guidance that was required of him of course, he demonstrated love.

For me, the love my father showed me is a picture of God’s love for his children. As I spend these last few weeks to prepare in whatever way I can to become a dad, I rest assured that, even though I am guaranteed to get things wrong, I will have ample opportunity to love my child. St Paul described love as, among other things, patient, kind, the opposite of self-seeking, and always protective.

As I embark on a journey where I will try and fail and try again to be a good father, I know that I don’t need to be perfect, I just need to show love in tangible ways. My favourite line of ‘All My Loving’ by The Beatles is: