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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22 November 2024

1 min read

The bird-brained behaviour of holding a grudge

Cranky corvids and feuding pop stars share something in common.

Jamie Mulvaney

Jamie is Associate Minister at Holy Trinity Clapham, London.

A crow stands at the end of an overhanging rock.

Still in the huff.

Haaslave185, CC BY-SA 4.0, via Wikimedia Commons.

Sometimes it's just too hard to let it go. Art Garfunkel recently told The Times that he and Paul Simon have put aside their feud. Again. I was at their gig in Melbourne in 2009, four rows from the front. Although Art's voice soared, it faltered on Bridge Over Troubled Water. But it was glorious. Their setlist began with Old Friends, the name of their reunion tour, tragically describing a duo marked by both harmony and discord.

It's not just old friends who can harbour old grudges. It turns out, according to John Marzluff from the University of Washington, that crows can similarly prolong a grudge for up to 17 years. Putting aside a longstanding grudge can be a good commercial decision, as evidenced by a certain Britpop band recently... but when I heard on the radio the other morning that crows are good at holding grudges, I must admit it made me laugh. There's something about the pettiness, the silliness of human grudges that seem to befit the ridiculousness of a bird. The bird-brained behaviour of holding a grudge may similarly find its root in fear: just as Marzluff has discovered that crows' brains show evidence of human-like fear.

But grudges, just like fear, are no laughing matter. They aren't light, and they don't soar like crows or an ageing rocker's voice, but thud and squelch in all their onomatopoeic heft. We hold onto petty and significant grievances because, however unpleasant, we feel we have control. But the language we use around grudges is telling - we bear grudges, hold them, nurse them. Grudges, just like children, grow over time. And whether they last for weeks of crow-like decades… they destroy things around us and within us. Perhaps it's apt that the collective noun for a crow is 'murder'. Indeed, it's old wisdom that such grudges are destructive. Jesus said 'anyone who is so much as angry with a brother or sister is guilty of murder. Carelessly call a brother 'idiot!' and you just might find yourself hauled into court.'

Grudges towards coworkers, family and friends can be subtle and invisible but no less real and consequential as visible damage. When Garfunkel asked Simon recently why they hadn't seen each other, 'Paul mentioned an old interview where I said some stuff. I cried when he told me how much I had hurt him. Looking back, I guess I wanted to shake up the nice guy image of Simon & Garfunkel. Y'know what? I was a fool!'

The sense of freedom, joy, yes tears, and the possibility of singing together again has only been possible by them talking it through.

Forgiveness won't necessarily mean condoning or reconciling, particularly if a crow has swooped on you. And sometimes those opportunities will be out of our reach. But however out of control our grudges may feel, we can hand them over, in all their deathly ugliness, to someone who is willing to absorb them.