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.

Article

Comment

Loneliness

Mental Health

5 March 2024

5 min read

What Bobby Brazier, Jo Marsh and Eleanor Rigby have in common

A public health campaign asks influencers if they are lonely.

Belle Tindall

Belle is the staff writer at Seen & Unseen.

a young man looks pensive as he answers a questuon while sitting in a fancy room.

Bobby Brazier at 10 Downing Street.

NHS.

‘Loneliness. It’s a part of life. Let’s talk about it’

That’s the new slogan offered by the NHS in partnership with the Department for Culture, Media and Sport. As part of their campaign, they recently invited young influencers and TV personalities to Downing Street to do just that – to talk about loneliness.

With those aged between 16 and 29 now twice as likely to report feeling lonely as those over 70, these celebrities were tasked with answering a few of the questions most asked by people within that age group. Their questions went along these heart-wrenching lines:

Why am I so lonely?

Is it normal to feel lonely?

Will I always be this lonely?

And while their answers to such questions were a little ‘meh’ (whose wouldn’t be? They were given seven seconds to answer some of humanity’s deepest questions), it doesn’t much matter, their answers weren’t really the point. Rather, viewers were presented with a handful of popular, successful, lovable (looking at you, Bobby Brazier) and happy looking people doing something notoriously difficult: admitting loneliness.

And I think that may be the point.

I am of the firm opinion that admitting to feeling lonely is one of the hardest things a person could do. I have certainly never had the bravery to do it.

I remember watching Greta Gerwig’s 2019 adaptation of the beloved 1868 novel, Little Women, for the first time; I was always going to love it, I had decided as much before even stepping foot in the cinema. But there was one scene that felt as if it literally took my breath away. I was left winded in row C.

It is toward the end of the film, and Jo Marsh, the feisty, strong and independent protagonist, is giving a feminist monologue for the ages (albeit to her mum) as she stands in the attic of her childhood home. Jo speaks of women’s minds and souls, their ambitions and talents, she explains how sick she is of being underestimated, getting more impassioned with every word. That is, until she tearily ends her speech by declaring – ‘…but I’m so lonely.’

This isn’t in the book.

This final line was written by Greta Gerwig specifically for this adaptation. And the only person who seemed to be more taken aback by Jo’s words than me (an owner of more editions of the novel than is cool to admit), was Jo herself, who instinctively clasped her hand to her mouth as if she couldn’t believe that she’d just said such words aloud.

As far as filmmaking goes, it was genius. As far as human nature is concerned, it was, well, true.

Not only do we find loneliness acutely painful, but we also tend to find it near impossible to admit to, so much so, the government currently feels the need to step in. Why is that, I wonder? Why does ‘lonely’ seem to be the hardest word?

Those who admit to their own loneliness are wading into profoundly vulnerable waters.

Part of it is certainly because there is a social stigma attached to feeling lonely. Ironic, isn’t it? How loneliness has social connotations. Nobody wants to be Eleanor Rigby, nor Father McKenzie, nor any of ‘the lonely people’ that Paul McCartney so pities, for that matter. It’s one of the only Beatles songs you wouldn’t want to have been written about you. Loneliness feels like a failure somehow, and so we struggle to admit it, even to ourselves. A failure because, we’re supposed to be self-sufficient, independent, free-thinking, emotionally-sturdy individuals (which is the operative word, of course). That’s what individualism has taught us, isn’t it? And so, how do we reconcile that with the piercing pain of isolation? How do we admit that there’s a deep crack within us that can’t be papered over by success, or wealth, or another episode of our favourite podcast? How do we go about admitting such a lack? A lack, which despite individualism’s best efforts, has us naturally wondering why it’s there in the first place; are we unpopular? Unattractive? Unlikable? Or worst of all, unlovable?

Those who admit to their own loneliness are wading into profoundly vulnerable waters. And most of us are utterly unwilling to follow them there, lest we be spotted by a budding Paul McCartney and our loneliness be immortalised.

And then, of course, there’s the other side of the coin: what does our loneliness say about the people who we are in relationship with? Nobody wants to unleash the panic and guilt tucked away in that can of worms (which, I must note, is unnecessary panic and guilt - there could be any number of reasons you’re feeling lonely, despite your very rich relationships).

And so, we just don’t say the word. And that’s what appears to be making the NHS and, rather randomly now that I think about it, the Department for Culture, Media and Sport so nervous.

We need to admit when we’re lonely. We have to pull a Jo Marsh and say it out loud. We must give language to the lack that we feel.

To be known and loved is my deepest and truest need.

One of the things that I find myself most consistently thankful for when it comes to my Christian faith (you know, apart from the most obvious aspects…) is that it gives me such language. At the risk of sounding annoyingly self-centred, it dignifies the feelings that I find hard to even acknowledge. It offers explanation, and therefore, a comfort that I could never find anywhere else; a comfort rooted in truth.

It may sound nuts, but I have come to understand the reality of loneliness, not through influencers on a sofa in Downing Street (although that’s great), and not even through Jo Marsh’s monologue (which is even greater), but through an ancient Hebrew poem. This poem tells me that to be alone is ‘not good’.

Not good. Not right. Not as it should be.

That’s God’s point of view at least – that to be alone, properly, completely and permanently alone, goes against the very fabric of the world. It is at odds with human flourishing. I’ve come to deeply value how concrete that is. I’ve also learnt to relax into the knowledge that not only is loneliness ‘normal’ (referring to one to the questions referenced at the beginning), it’s natural, in every possible sense of the word.

To be known and loved is my deepest and truest need. I was designed for relationship, with God and with people. And therefore – with all the complex ways that life unfolds - to be lonely, is to be human.

So, with all of this in mind, I’m tempted to end where we began, to come full circle and once again borrow the government’s words:

‘Loneliness. It’s a part of life. Let’s talk about it.’