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

Assisted dying and the unintended consequences of compassion.

Graham Tomlin

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

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.

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Wildness

7 November 2024

7 min read

It’s getting harder to be wild in this world

We’ve trapped and tamed wilderness into a commodity.

Elizabeth Wainwright

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

Against a night sky a lit up face is blurred by the camera movement.

Under a Dartmoor night sky.

Yousef Salhamoud on Unsplash.

Some while back, my husband rearranged the books in our house, making sure that they were grouped together by theme. We have a lot of books, and there are now themes and sub-themes. It was quite an operation. Within the nature-related books, he created a separate shelf for books that have ‘wild’ in the title. We joked about it, but it made me think about how I’d noticed ideas of ‘wild’ pop up in lots of places in recent years: on clothing and stationery (with leaves or words like ‘keep growing’ printed), in shop windows (furniture displays draped in plastic greenery and fake animal skins), on social media (there are accounts that have ‘wild’ in the title connected to farming, conservation, publishing, personal development, coaching, poetry, business, and more), and in book shops (of which we apparently have only half the stock).

A quick online search on the topic of wilderness quickly leads me to conservation initiatives and statistics on the state of nature, but it also leads me to nature connection experiences, wild swimming, wild camping, soul work, and more. Wilderness becomes a pliable and hard-to-define term. It can relate to the natural world, to wildlife and natural spaces that have avoided human domination. It can also relate to the inner world, to spiritual experiences or to isolating and challenging times. But however you approach it, wilderness – inner, outer – seems to be having a hard time.

In recent months, wild camping has come under the spotlight. Dartmoor is the only place in England where wild camping is legal, and this this access helped to form me: as a teenager I hiked and camped with friends, encountered Dartmoor ponies trying to steal our food in the night, stomped through bogs and wolfed down boil-in-the-bag meals as the sun set. As an adult I’ve camped alone in a bivvy bag, my soul singing back to the Milky Way shining above me. Now, these experiences feel as much in need of protection as the nature they depend on, since a wealthy landowner decided to try and prevent people from undertaking this ancient practice of sleeping under the stars. The court case is ongoing, but it has highlighted the fragility of our access to nature here in England. Just 8 per cent of English countryside is accessible, and 3 per cent of rivers have an uncontested right to swim. Now, the last remaining right to sleep under the stars is under threat.

It is hard to know what we’re losing when it becomes harder and harder to see and touch the real thing.

We live in a time of crisis not just of the state of nature, but also of how we experience the natural world. In a recent study of nature connectedness, Britain was ranked lowest of all the countries surveyed. Our biodiversity is in crisis and so is our ability to encounter the natural world. This feels heightened by a way of being in the western world that sees us all living in our individual houses, working hard to pay for them, shuttling children and selves through schedules, spending fewer and fewer hours outside and with each other.

And this is not just a problem ‘out there’, because inner and outer landscapes are linked. It is unsurprising to me that in the UK at least, levels of good mental health, biodiversity, and access to nature have all been in decline. Disintegration of one is, I think, deeply connected to disintegration of the other.

These linked crises feel further threatened by the trapping and taming of ideas of wilderness, wrapping it into trends and materialism, commodifying it. There are some brilliant and essential initiatives helping to re-wild our inner and outer worlds. But there are also offerings that use wilderness imagery and the freedom and adventure associated with it to sell products and services, or as backdrop to human endeavour, or as a destination or resource for our consumption. I think a commodified wild can get in the way of the actual wilderness we need both externally and internally. This commodification is, I think, affecting our understanding of what the wild is and why it matters. It is hard to know what we’re losing when it becomes harder and harder to see and touch the real thing.

If real wilderness is everywhere but where we need it right now, how might we re-find it – in the natural world, but also within ourselves and our communities? Answering that question is work that many people are focused on now in all kinds of ways, and a short essay cannot begin to offer a full response. I will write more on this topic. But the question I have in mind at the moment is, how do we invoke wildness and wonder in the landscape of the modern world? – a physical landscape that is being stripped of nature, but also a social landscape that can often diminish our humanity. Perhaps a simpler way to ask the same question is, how do we not just survive life but get excited about it? – How do we love ourselves, our neighbours, and creation enough to deeply and truly care for these things?

Time stops, something says: here, look at this, it is everything.

There are of course structures, systems, and powers that need to change so that people can move out of mere survival, and so that the wild world is restored. I am not exploring those things here. Here, I want to simply share three things that lately, have energised my ability to feel the love, the excitement, and the desire to cherish and protect our hearts, our relationships, and the generous world that hosts us all. Perhaps by reawakening these things, we might find motivation and sustenance for tackling structures and systems.

First, I have been noticing what my young daughter notices. The light shining off a puddle; the way an ant crawls on her hand; the bright silver moon in the sky. I have never struggled to access the exhilaration of the natural world, but seeing through her eyes, I am doing so again. Time stops, something says: here, look at this, it is everything. The medieval mystic Julian of Norwich saw the wonder of the world, and God’s love for it, in a single hazelnut. She recounts her visions in her book Revelations of Divine Love. Sometimes connecting with the specific can help us see and face the global.

Second, there are authors who help me summon wildness and wonder in the landscape of the modern world, and in a future Seen & Unseen piece I’ll take us on a tour of some of those I love the most. Some of the authors are ancient. In Psalm 78, I read “…they forgot what he had done, the wonders he had shown them”, and “…they kept on sinning; in spite of his wonders, they did not believe.” If sin is a kind of disconnection, perhaps our disconnection from creation might lead our gaze to turn inward, and to land on things that do not call forth the best of humanity, rather than the wonder of each other and the world around us. That we are able to forget wonder is something we must remember and work to counter.

Third, I have been thinking through the encounters that have most exposed me to wilderness of the world and of my soul and of relationship – both the uplifting and the challenging. Encountering the vastness of that shining and vertigo-inducing Dartmoor night sky; encountering others in relationships that have helped me slip my skin and enter their unknowability and fragility and beauty; encountering contexts that seem too broken for repair and yet still light enters in. It is in these encounters that I first found God dwelling, and when I followed his trail, I noticed that throughout the Bible there are many people who experience the challenges, joy, and lessons of the wilderness. Wilderness is not just beauty – it can also be unknowable, disorienting, scary. For 40 days in the wilderness, but also in the beauty of the lily of the field and birds of the air, Jesus is right there with us, showing that God can meet us in beauty and barrenness, in wonder and in despair. Again and again in the Bible I see how God loves the world, how he calls it constantly to life through resurrection, through re-creation, through that three-in-oneness of father/son/holy spirit, of self/other/world, of body/encounter/mystery.

Now, I think our souls and societies might benefit from investing in relationships first conjured in Eden: with a garden, with a human, with God and the mystery he points us to. These things feed each other; when one suffers so do the others. As we face a disintegrating and increasingly commodified natural world, a mental health crisis, and an epidemic of loneliness, I think we are being called back to that garden, and to the kinds of wildness it made possible. I’ll look forward to exploring these themes more.