Article

Assisted dying

Care

Comment

Death & life

Suffering

27 November 2024

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 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.

Essay

Attention

Comment

Feminism

15 March 2024

5 min read

Sarah Everard: she was 'exactly like us'

An anniversary of anguish deserves the miracle of our attention.

Belle Tindall

Belle is the staff writer at Seen & Unseen.

Sarah Everard.

BBC/Everard Family.

This week, three years ago, we’d been shut in our homes for nearly a year and things were anything but normal. I don’t know about you, but when I think back to those locked-down days, it’s all a bit of a haze, those weird weeks tend to blur into one.

Except this week, that is. This week, three years ago, was a wholly different story.

We, the public, had just learnt that Sarah Everard, a thirty-three-year-old woman in South London, had been abducted, raped and murdered by Wayne Couzens, a serving police officer in the Metropolitan Police. And the news of this heinous crime took our breath away. Do you remember it? How you felt when you learned what had happened to Sarah? I can remember the anguish of hundreds of people ringing out from Clapham Common, reaching every corner of the country. I can remember that, legal or not, nothing seemed to quell the outrage that was drawing people to the vigil being held there. All that grief, it had to go somewhere.

The anger that night was so visceral, it feels like it’s still in the soil of the Common. The fear, so palpable, it still lingers in the air. And at that point, we didn’t even know the half of it. ‘She was just walking home’ - That’s the sentence, isn’t it? The one that haunted those days, weeks, and months.

Three years on and we’re no closer to coming to terms with what happened. Not really. In the wake of the recent Angioloni Inquiry, which concluded that Wayne Couzens should never have been allowed to become, let alone remain, a police officer, the BBC released a documentary that follows DCI Katherine Goodwin’s story as she led the investigation. From first seeing the bulletin of a missing young woman, to hearing the ‘whole life’ sentence come down on Couzens – viewers are walked through the whole thing, step by step. What led up to Sarah’s death, and what followed it. It’s something that we should all see, even though we’ll immediately wish that we hadn’t.

Because it would be hard to unsee the grainy footage of Wayne Couzens standing next to a handcuffed Sarah on the side of a busy road, abducting her while his hazard lights flash, all of it so sickeningly hidden in plain sight. It would be harder still to unhear the victim statement from Sarah’s mum, who admitted that every night, right at the time of the abduction, she silently screams ‘don’t get in the car, Sarah. Don’t believe him. Run!’.

All of it, it’s just so hard to know.

The details are hard to think about, and harder still not to think about. But that’s the point, I suppose. I remember what philosopher Simone Weil wrote,

that ‘capacity to give one’s attention to a sufferer is a very rare and difficult thing; it is almost a miracle… it is a miracle’.

I’m just not used to a ‘miracle’ making me feel so nauseous. In theory, Weil’s words are beautiful, in reality though – they ache.

I don’t tend to acquaint a feeling of utter helplessness with the miraculous. Where my understanding runs dry, my answers falter, and my tears flow – those aren’t the places I expect to see anything of any use, spiritual or otherwise.

But Weil goes on:

‘…it is recognition that the sufferer exists, not only as a unit in a collection, or a specific from the social category labelled ‘unfortunate’, but as a man (or woman), exactly like us, who was one day stamped with a special mark by affliction.’

Sarah Everard – her memory, as well as the people within whom her memory is most vivid, and her loss most keenly felt – deserve the miracle of our attention. Then, now, and for many years to come. We continue to grieve her, the woman who never made it home, as if we each knew more of her than her name. And that’s a beautiful thing, a human thing, a sacred thing. Because Sarah was more than her name, and she was more than her death. And so, she must be grieved as such, with our eyes fixed on the beauty of who she was, and the tragedy of who she will never be.

And it’s tricky, because you can’t tidy up lament, can you? There’s no silver-lining, nothing to polish. You can’t put a neat bow on despair or grief.

And then there’s Weil’s ‘exactly like us’ line to grapple with. And grapple with it, we do. The knowledge that it could have been any of us is ever-present. As a woman, I feel it every single day. If male violence against women is a spectrum - 1 being a wolf-whistle as we walk down the street, and 10 being death – the truth is that most of us will only ever face experiences that sit on the lower end of that scale. And yet, we are ever aware that 10 exists and that we could encounter it at any point. So, we are on the lookout for it. We are alert, always.

Sarah walked home a specific way that night; not the quickest route, but the best lit.

That’s what we all do. ‘Exactly like us’, indeed.

Lament; I suppose that’s what this feeling in my stomach is. And maybe yours too. It’s a feeling that goes beyond the rage I feel toward the monstrous perpetrator, and the institutions that failed to stop him, and so many others. It’s a kind of wordless grief that things are the way they are, agony that we live in a world that hurts this much, despair at how things could have been so different. I felt all this three years ago, when I heard about Sarah’s death. And I felt it last night, when my sister walked home from my house in the dark with her hood up so that she was less distinguishable as a woman walking alone.

And it’s tricky, because you can’t tidy up lament, can you? There’s no silver-lining, nothing to polish. You can’t put a neat bow on despair or grief, and you can’t pull yourself out of it by your own bootstraps. And that’s not to be defeatist, or to relinquish our responsibility to enact justice and fight for change. On the contrary, lament is rooted in the knowledge that things can be, and should be, better. But to try and find a way to solve the outrage we feel when it comes to the death of Sarah Everard is to completely misunderstand it, and ourselves, and reality.

Bad things hurt.

So, although writing this piece has been hard, I’m at least comforted in the knowledge that it was supposed to be a hard piece to write. And that the queasiness I feel and the tears that are threatening my professional resolve are the evidence of some kind of miracle that I don’t fully understand.