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.

Column

Comment

Film & TV

29 February 2024

4 min read

It's a miracle that ITV's drama-docs tell gospel truth

What we need to ask of the well told stories that move us.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A doctor in blue scrubs stands looking exhausted.

Joanne Froggatt playing Dr Rachel Clarke.

ITV Studios/ITV.

ITV has reopened a debate over the value and validity of drama-documentaries, with two immensely powerful political serials. Breathtaking, set in hospital wards as the covid crisis hit the UK, concluded last week. Before that, Mr Bates vs. the Post Office did more for justice in a few hours for wrongly accused sub-postmasters, sacked and imprisoned for frauds that didn’t exist, than any number of leaden public inquiries stretching into a cynically can-kicking future.

A regular refrain from doubters of drama-doc is to question whether events portrayed really happened. At the most extreme end of denial, invariably motivated by political self-interest, if a scene can be shown to be non-factual, then the whole thing can be dismissed as rubbish.

I’m here to knock down that argument, not least because it has the most profound implications for people of faith and how they own their sacred scriptures.

Truth is not only about events, but about love and hope and self-sacrifice and much else besides.

Take Breathtaking, based on the book of the experiences of front-line doctor (and breathtakingly good writer) Rachel Clarke. There were more than a couple of scenes that I thought wouldn’t, indeed couldn’t, have happened in a factual reality. I can’t know, because I wasn’t there. But, importantly, I don’t care either, for reasons I’ll come to.

These scenes related to the death from covid, contracted on duty as a consequence of inadequate PPE equipment, of a much-loved fellow nurse called Divina. A colleague reads cards from friends to her as she switches off the life-support machines, while our heroine consultant bears tearful witness. Later, all her colleagues gather, socially distanced, to watch a livestream of her funeral.

If these events happened in real time, then I apologise profusely to Clarke and her team. But my guess – and this makes the drama even more heartbreaking rather than less – is that they simply wouldn’t have had the time. As with soldiers in a war zone, which is the regular analogy of choice, they were overrun by critical cases for whom survival was the imperative. They surely would not have had the bandwidth, as it were, to bury their dead.

Why this doesn’t matter, indeed why it is vital that it doesn’t, is that drama addresses human emotions as well as human experiences. So it’s at least as important to express how it felt as to show exactly what happened. This isn’t manipulative, because truth is not only about events, but about love and hope and self-sacrifice and much else besides, all of which point to bigger truths about the human condition.

Those somethings are miracles. So, ask not: Did it happen? Ask instead: What has happened?

Not so long ago, you couldn’t bump into anyone from the digital marketing professions without them mooing on about “storytelling”, the idea that corporates and their brands need to frame their offers to market in an engaging narrative.

I’ve always thought they were rather late to that party. So stories are important? Who knew? Similarly, journalists – or reporters at least – speak of their products as stories. And the good ones tell us something we don’t already know. But the effort here (or at least it should be) is to relate what is provably, factually true.

This is rather different from the motivation of those of us with a religious faith, for whom Truth with a capital T points to something that transcends the demands of simple reportage. Yes, it’s about an emotional response, but emotions are human too. They’re also insufficient on their own for full engagement with the divine drama.

The mystery of this drama is played out at church on at least a weekly basis in the Eucharist, when Christians come together in communion, as the mystical body of Christ and as if invited to his supper for the very first time. It’s not just an event or a re-enactment, it’s the drama of now and of the real presence (call it the real thing).

Mystery is what the scriptures of the three Abrahamic faiths endeavour to address. For Christians, the life death and resurrection of the Christ; for Jews, the deliverance of God’s people and, for Muslims, the revelation of the Prophet. These are not just historical records, they are stories that explore the mind of God, the better to understand human existence.

That’s to explore the miraculous, to allow room for miracles in human existence. At Easter, Christians will celebrate what we might call the big one: The resurrection of the Christ and the defeat of death. So, to that obvious question: What really happened?

Well, something happened. Something so incalculably enormous that, within three days of the crucifixion, the utterly defeated and dispersed first disciples were transformed. Something so incomprehensible that they struggled to explain it with the language of simple reportage, though they tried. Something for which untold thousands were suddenly prepared to die. Something which was apparently defeated by worldly power, but is alive and well as the world’s largest religion two millennia later.

Those somethings are miracles. So, ask not: Did it happen? Ask instead: What has happened? And the story is not only about what has happened, it’s really about how, emotionally and spiritually, we feel and respond to it.

In short, we’re asked to give ourselves up to this drama-documentary. It’s breathtaking.