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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Politics

5 March 2024

5 min read

Politics needs some deep stirring emotion

In politics, the struggle between our reason and desire is a fair fight.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A young woman in a blue suit stands at a wooden box in a parliamentary debating chamber looking upward while speaking.

British Youth Council parliamentary debate.

British Youth Council.

“The government you elect is the government you deserve.” So goes the famous quote, variously attributed to Thomas Jefferson, Joseph de Maistre and George Bernard Shaw. Of all these thinkers, Maistre is perhaps the most interesting, describing the business of government as a kind of religion, a political “faith” – one complete with dogmas, mysteries and even ministers.

Maistre was, somewhat surprisingly amid the turmoil of eighteenth-century France, a staunch monarchist. His argument was that, if the authority of a political leader was only a product of social convention, then that authority would always lack a sufficient degree of legitimacy, leaving the door wide open for violence and strife. His solution was to defend the divine right of kings. This was a controversial position, as much then as it is now.

Aside from his famous quote about elections, Maistre’s political philosophy is oft-criticised as polemical, hearkening back to a golden era of European monarchy that never really existed. Nevertheless, within his writings, Maistre laid bare a reality that we often prefer to keep veiled: that our political will is as much about what we find to be emotionally compelling as it is about what we find to be rationally convincing, indeed, the latter is very much dependent on the former. The more social scientists are able to demonstrate the reality of subtle phenomena such as confirmation bias, unconscious bias, and racial prejudice, the more we see that we are often being governed by pre-cognitive or non-cognitive instincts, even those of us who like to think that we are better than that. In the end, we have to concede that when it comes to politics, as with so much else, the struggle between our faculty of reason and the desire of our heart is a fair fight.

“They have few standards by which to judge between falsehood and truth in revolutionary movements.”

Amy Buller

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Henna Cundill

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In 1930’s Europe, there was certainly a lot of emotionally compelling politics around. Fascinated by the language and culture of the German people, thinker and educator Amy Buller made repeated visits to Germany from the 1920’s onwards, often accompanied by reading parties of British academics, church leaders and university students. In those decades, as the political landscape of Germany began to shift, her purpose became less about countryside walks and studying, and more about the facilitation of urgent, open and honest dialogue between Buller, her fellow travellers, and their German counterparts in the churches and universities wherever she had contacts. As Hitler rose to power, and even before the full horrors of Nazism became widely known, Amy was compelled to find out why so many people, especially young people, were being attracted by what she saw as a “brutish” ideology.

In 1943, amid the violence and destruction of World War II, Buller published a book, Darkness Over Germany, which gives a first-hand account of the many people that she and her travelling parties had met, and the conversations that had taken place. Like Maistre, Buller proposed that without God, politics was a dangerous kind of faith in something, one that tended towards violence. In the introduction to her book she writes of “…the tragedy of a whole generation of German youth, who, having no faith, made Nazism their religion.”

It’s common these days to hear complaints about the political apathy of the young, with polls commonly reporting that only about 50 per cent of British 18 to 24-year-olds are intending to vote in the next General Election. However, there are those who raise the caution that this may not be a symptom of apathy, so much as a symptom of the cultural and structural injustices that put barriers in the way of young people engaging with our nation’s political life. Young people are not likely to “believe in” a political system from which they feel excluded. As Buller’s writing notes – when this happens, young people are likely to put their “faith” in something else.

Maistre’s solution was perhaps too extreme for modern sensibilities: asking the politically minded populace to believe that their leaders were imbued with the authority of God, by God. In the twentieth-century, Buller took a more moderate view. As the Nazis began to view her with suspicion, trips to Germany became increasingly difficult to arrange, so she travelled elsewhere to places such as Hungary and Bulgaria. Wherever Buller went, she found more and more young people who wanted to talk to her about their political hopes and ideals. Summarising the whole, Buller suggested that Europe’s political landscape was eschewing “shallow rationalism” and instead being shaken by a “deep stirring” of emotion, particularly among young people. She recorded the observation:

“They all want change, and they all want a chance to play a part in that change, but so few have any religious faith, which means that they have few standards by which to judge between falsehood and truth in revolutionary movements.”

In a recent report, published by the Jo Cox Foundation, increasing the public’s “political literacy” was highlighted as a key response to prevent the outbreaks of abuse, intimidation and violence towards elected officials. As any educator will tell you, literacy is a two-way street – it includes not only the “shallow rationalism” of knowing information, or knowing where to access information, but also the ability to communicate that information effectively to others. Such communication comes from a much deeper, embodied kind of knowing, one which requires one to have assimilated knowledge and worked with it, feeling its malleability, and testing its apparent truth-claims against an internal standard of what is true and false, or right and wrong.

For Buller, this internal standard was inextricably linked to faith. To the end of her life, she remained open minded as to what form this faith might take, albeit her own religious practice was firmly Christian. Cumberland Lodge, the educational charity she set up to promote her aims, was from the start open to those of all faiths and none, and she warmly welcomed dialogue between those of different faith groups, including atheism. But in 1943, as Amy Buller looked with hope towards the prospect of a post-war Europe, she summed up the political landscape as follows:

We are now faced with the greater task of bringing healing to the nations, including our own, I am convinced this cannot be done without a faith in God adequate to the tremendous task of reconstruction.

Given Amy Buller’s open-mindedness, one can read the word “God” in this statement its broadest possible sense, as referring to whatever moral compass one takes as an internal standard of what is true and false, or right and wrong. But the point remains that the political will is therefore not a matter of rational thought, or not only of that, but is an expression of feelings and instincts that run far, far deeper.