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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Death & life

Music

19 November 2024

2 min read

Lullabies and lists that tell of lifelong love

A Laura Marling gig and an All Souls remembrance reverberate life.

Jess Scott

Jess Scott is an assistant professor at the University of Nottingham.

A misty back lit stage hosts a singing guitarist and a double base player

Laura Marling performs at Hackney Church.

YouTube.

This year, I did not go to my own church’s All Souls Day service. I went instead to another church - Hackney Church - to hear Laura Marling perform her new album, Patterns in Repeat. Marling wrote its songs in the months following the birth of her first child. Her daughter’s coos and gurgles occasionally overwrite the recording of Marling’s own ethereal, elastic voice as she contemplates parenthood, heritage, and new domesticity. Critics are in agreement: this is Marling’s most accomplished album yet.

As I stood amid the congregation gathered to hear her, I was struck by the overwhelming love contained in those lullabetic songs. As if line by line Marling swaddles her daughter, each lyric wrapping her with words that hold and assure. Sleep my angel, you’re safe with me. What she conjures is the magnificent reorientation entailed in love - Time won’t ever feel the same - and the promises that tip from the mouths of those experiencing it - I’m not gonna miss it, child of mine.

Of course, love is not always so pure. We may find, miserably, our own love tilting this way or that, towards dominance or possessiveness, or muddied by some other perversion. But this isn’t to deny that there really are pockets of pure love in our midst. All around us are people writing their own lullabies: sending texts, preparing meals, writing cards, taking photos. And, in these ways, saying to one another, as the theologian Josef Pieper paraphrases the affirmation of love, ‘I am glad you exist’.

While I listened to Marling sing lullabies for her baby daughter in one church, the gathered faithful of my own congregation read out the names of the dead in another. Each year the list is long and spans several minutes. By its end the names start to undo themselves, beginning to sound only like their component syllables, blurring towards the non-words found in a book of phonics. But each name uttered - perhaps for the only time that year - tells of a whole beloved life, witnessing some homely love swirling still, years later, in the memory of a congregant. In years past I have sat around that altar as those names are read out. I have listened out for the names I added, like a child seeking the face of her mother.

These two Saturday evenings, unfolding a few Overground stops apart, were not wholly discrepant. Each sounded the cry of love from one person to another, against cynicism, even against death. Each told of love that reverberates where love cannot yet, or still, be reciprocated. All these hearts swelling and bending and breaking for each other strikes me as a kind of Grand Canyon: a remarkable thing to consider, seeming to be a miracle that might, if we let it, render us speechless.