Article
Assisted dying
Care
Comment
Death & life
Suffering
5 min read

Why end of life agony is not a good reason to allow death on demand

Assisted dying and the unintended consequences of compassion.

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

A open hand hold a pill.
Towfiqu Barbhuiya on Unsplash.

Those advocating Assisted Dying really have only one strong argument on their side – the argument from compassion. People who have seen relatives dying in extreme pain and discomfort understandably want to avoid that scenario. Surely the best way is to allow assisted dying as an early way out for such people to avoid the agony that such a death involves?  

Now it’s a powerful argument. To be honest I can’t say what I would feel if I faced such a death, or if I had to watch a loved one go through such an ordeal. All the same, there are good reasons to hold back from legalising assisted dying even in the face of distress at the prospect of enduring or having to watch a painful and agonising death.  

In any legislation, you have to bear in mind unintended consequences. A law may benefit one particular group, but have knock-on effects for another group, or wider social implications that are profoundly harmful. Few laws benefit everyone, so lawmakers have to make difficult decisions balancing the rights and benefits of different groups of people. 

It feels odd to be citing percentages and numbers faced with something so elemental and personal and death and suffering, but it is estimated that around two per cent of us will die in extreme pain and discomfort. Add in the 'safeguards' this bill proposes (a person must be suffering from a terminal disease with fewer than six months to live, capable of making such a decision, with two doctors and a judge to approve it) and the number of people this directly affects becomes really quite small. Much as we all sympathise and feel the force of stories of agonising suffering - and of course, every individual matters - to put it bluntly, is it right to entertain the knock-on effects on other groups in society and to make such a fundamental shift in our moral landscape, for the sake of the small number of us who will face this dreadful prospect? Reading the personal stories of those who have endured extreme pain as they approached death, or those who have to watch over ones do so is heart-rending - yet are they enough on their own to sanction a change to the law? 

Much has been made of the subtle pressure put upon elderly or disabled people to end it all, to stop being a burden on others. I have argued elsewhere on Seen and Unseen that that numerous elderly people will feel a moral obligation to safeguard the family inheritance by choosing an early death rather than spend the family fortune on end of life care, or turning their kids into carers for their elderly parents. Individual choice for those who face end of life pain unintentionally  lands an unenviable and unfair choice on many more vulnerable people in our society. Giles Fraser describes the indirect pressure well: 

“You can say “think of the children” with the tiniest inflection of the voice, make the subtlest of reference to money worries. We communicate with each other, often most powerfully, through almost imperceptible gestures of body language and facial expression. No legal safeguard on earth can detect such subliminal messaging.” 

There is also plenty of testimony that suggests that even with constant pain, life is still worth living. Michelle Anna-Moffatt writes movingly  of her brush with assisted suicide and why she pulled back from it, despite living life in constant pain.  

Once we have blurred the line between a carer offering a drink to relieve thirst and effectively killing them, a moral line has been crossed that should make us shudder. 

Despite the safeguards mentioned above, the move towards death on the NHS is bound to lead to a slippery slope – extending the right to die to wider groups with lesser obvious needs. As I wrote in The Times recently, given the grounds on which the case for change is being made – the priority of individual choice – there are no logical grounds for denying the right to die of anyone who chooses that option, regardless of their reasons. If a teenager going through a bout of depression, or a homeless person who cannot see a way out of their situation chooses to end it all, and their choice is absolute, on what grounds could we stop them? Once we have based our ethics on this territory, the slippery slope is not just likely, it is inevitable.  

Then there is the radical shift to our moral landscape. A disabled campaigner argues that asking for someone to help her to die “is no different for me than asking my caregiver to help me on the toilet, or to give me a shower, or a drink, or to help me to eat.” Sorry - but it is different, and we know it. Once we have blurred the line between a carer offering a drink to relieve thirst and effectively killing them, a moral line has been crossed that should make us shudder.  

In Canada, many doctors refuse, or don’t have time to administer the fatal dose so companies have sprung up, offering ‘medical professionals’ to come round with the syringe to finish you off. In other words, companies make money out of killing people. It is the commodification of death. When we have got to that point, you know we have wandered from the path somewhere.  

You would have to be stony-hearted indeed not to feel the force of the argument to avoid pain-filled deaths. Yet is a change to benefit such people worth the radical shift of moral value, the knock-on effects on vulnerable people who will come under pressure to die before their time, the move towards death on demand?  

Surely there are better ways to approach this? Doctors can decide to cease treatment to enable a natural death to take its course, or increase painkillers that will may hasten death - that is humane and falls on the right side of the line of treatment as it is done primarily to relieve pain, not to kill. Christian faith does not argue that life is to be preserved at any cost – our belief in martyrdom gives the lie to that. More importantly, a renewed effort to invest in palliative care and improved anaesthetics will surely reduce such deaths in the longer term. These approaches are surely much wiser and less impactful on the large numbers of vulnerable people in our society than the drastic step of legalising killing on the NHS. 

Editor's pick
Belief
Comment
Politics
6 min read

How to survive a culture war

Blaise Pascal shows us what really underlies our contemporary battles.

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

Two goats lock horns.
Maxime Gilbert on Unsplash.

We often say these days that we are more polarised as a society than ever before. But we're wrong. Maybe the USA is experiencing a particularly sharp divide right now, but they have had their own, much more violent troubles in the past. And in Europe, and especially in Britain, we know a fair bit about culture wars that were literally that – wars.  

In the 17th century, we English had our own civil war where we literally killed each other over religion and politics. We even killed a king. The French did something similar and even more vicious just over 100 years later. That is real polarisation. However spiteful Twitter/X arguments may get, I don't think Charles III or even Kier Starmer is quaking in their beds expecting to be put on trial for treason.  

So maybe our history has something to teach us about how we navigate culture wars.  

The literary critic Terry Eagleton once wrote of our age:  

“the world is accordingly divided between those who believe too much and those who believe too little. While some lack all conviction, others are full of passionate intensity.” 

 We tend to think our contemporary divide between left and right, progressives and conservatives is something new. But we can find echoes of this in previous times.  

A case in point was the mid-17th century – the time of many other upheavals in Europe. Part of the febrile atmosphere of the time saw fierce arguments between rationalists and sceptics.  

There were at the time, two broad strands of thinking about the human condition. On the one had there were the ‘Dogmatists’ who were sure that they knew everything through use of reason or the application of philosophical or scientific method (like René Descartes). On the other hand, there were the ‘Sceptics’ who thought everything was random, or custom, and there is no final Truth to be found (like a figure from the century before – Michel de Montaigne). 

Of course, our own time has its fair share of people with an overwhelming confidence in the power of human knowledge, and the physical sciences in particular, to unlock the secrets of life, the universe and everything. The ‘new atheist’ project of Richard Dawkins and friends was hugely confident in reason and its capacity to tell us all we need to know, dispatching religion to the dustbin of history and instead placing an unshakable faith in the empirical methods of science. It had - and has - definite similarities with this picture of human knowledge.  

Yet on the other hand we also have, in the progressive postmodern project, those who reject any kind of underlying rationality or sacred order either above us or beneath us. For them, there is no underlying Truth to be discovered, and they delight in revealing the instability and illusory nature of any claim to truth. It sounds very much like the culture wars of our time. 

One enigmatic 17th century figure charted a way through this dilemma - Blaise Pascal. When he looked at his century’s culture war, he thought both sides had a point. There is, he observed… 

…open war between men in which everyone is obliged to take sides, either with the dogmatists or with the sceptics, because anyone who imagines he can stay neutral is a sceptic par excellence…. Who will unravel such a tangle? This is certainly beyond dogmatism and scepticism, beyond all human philosophy. Humanity transcends humanity. Let us then concede to the sceptics what they have so often proclaimed that truth lies beyond our scope and is an unattainable quarry, that it is no earthly denizen, but at home in heaven lying in the lap of God, to be known only insofar as it pleases him to reveal it. 

So far, he says, the sceptics, like Montaigne, are right. Truth is beyond our grasp, it does not reside here on earth, openly obvious and ready to be found. If it exists, it exists in some world above us, beyond our reach. How do we even know if we are asleep or awake, given that when we dream, we are as convinced that we are awake as we are when we are truly awake?  

And so, modern progressives, looking to dismantle the assumed results of previous understanding, due to its inherent colonial, patriarchal or abusive past, delight in showing how random and arbitrary is so much of what we take for granted from the past. And, Pascal would add, they have a point. Many of our legal, political and cultural assumptions are purely cultural and arbitrary, and sometimes simply serve to the advantage of the rich and powerful rather than the poor and marginalised. 

Yet on the other side, the ‘dogmatists’, like Descartes, have their strong point, which is that we cannot doubt natural principles. The acids of deconstruction can only take you so far. The most sceptical philosopher still puts the kettle on assuming that it will boil to make a cup of tea. She gets up in the morning assuming that the sun will rise and set again at the end of the day. Despite the corrosive effects of scepticism, Pascal wrote,  

“I maintain that a perfectly genuine sceptic has never existed. Nature backs up helpless reason and stops it going so wildly astray.”  

Despite all our doubt, we still live in a world with order and predictability. Scepticism keeps bumping up against reality.   

So, modern conservatives point to a deeper ‘givenness’ to things, an order within the natural world that we did not create, and yet, mysteriously, seems to be prearranged before we got here. Scientific exploration does make sense. There is a regularity to nature that we can, indeed have to, depend on. Sexual differences exist and can’t be ignored. We are not entirely free to override the natural order of things - there is a deeper rhythm to nature and its capacity for renewal that we only mess with at our peril, as climate change has taught us. As a result, the age-old battle between rationalists and sceptics, progressives and conservatives, will never find resolution, as the arguments flow back and forth.  

Christian faith includes both progressive and conservative impulses. Christians are aware of the brokenness of the world and therefore long to see it changed. The progressive impatience with the way things are, and the yearning for a better world has its roots in Christian faith.  

Yet at the same time, Christianity discerns a divinely created order to the world, a rhythm to the natural world, that cannot be broken and needs to be respected. Therefore, an inherent conservatism is part of Christian faith as well. In other words, the Christian story can explain both and offer a bigger picture than either.  

For Pascal, Christianity offers a diagnosis for this mystery of the human condition, the complex mix of grandeur and misery, infinity and nothing, sceptic and rationalist, in the simple, yet endlessly generative idea that we humans are gloriously created, deeply fallen and yet offered redemption through Jesus Christ. Our sadness is heroic and tragic. In Pascal’s suggestive image, it is “the wretchedness of a great Lord, the wretchedness of a dispossessed king.” 

“We show our greatness,” says Pascal, “not by being at one extreme, but by touching both at once and occupying all the space in between.” For him, the very existence of such culture wars points to the truth of the Christian diagnosis of the human condition. 

Pascal offers us a way between the Scylla of Progressivism and the Charybdis of Conservatism – or perhaps better, to embrace the best of both. Culture wars are tricky to navigate. Yet they might find resolution if we allow them to point us to a deeper reality - our strange mixture of greatness and sadness. And not losing sight of either side of this enduring truth.  

 

Graham Tomlin is the author of Blaise Pascal: The Man Who Made the Modern World  (Hodder) £25.  

Watch Graham explain why he is fascinated by Pascal.

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