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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War & peace

1 November 2024

5 min read

Put poppy politics in the past and give Remembrance a hopeful future

Memory without hope will lead us to a dead-end.

Mark Gilbert

Mark is a research mathematician who writes on ethics, human identity and the nature of intelligence.

A woman walls along a war memorial wall covered in red poppies.

War memorial in Canberra.

Raelle Gann-Owens on Unsplash.

Remembrance Day is complicated. A nation shows its gratitude for the service and sacrifice of its armed forces and tries to connect to its history. Never far away, are poppy politics, along with anxiety about identity and forgetting, and fears about nationalism and militarism. Is this the way to remember?

Last November, protests in solidarity with Gaza dominated the headlines. On Armistice Day, hundreds of thousands of people marched through central London to demand a ceasefire. In the preceding weeks, there was vigorous debate about whether the march should be cancelled. There were several motivations for this: there were genuine fears of violence and extremism, and of disruption at the Cenotaph, but also questions of whether marching on Armistice Day was inappropriate or disrespectful.

The march itself was organised to minimise the risk of disrupting public commemorations of Remembrance. It started several hours after the two-minute silence and followed a route several miles from the cenotaph. It was mostly peaceful, although there were arrests for anti-Semitism, open support for terrorism and violent attacks on police officers. Armistice Day did see violence around the cenotaph, but this was from the self-described ‘Cenotaph Defenders’ who had organised a counter-demonstration against the Gaza march. The group of football hooligans and far-right EDL members gathered with poppy emblazoned banners declaring ‘Have some respect for British Heroes’. Within a few hours, the calls for respect had degenerated into violent attacks on serving uniformed officers, in this case the police.

The far-right’s adoption of remembrance symbolism can be seen as an extreme form of a wider entanglement of poppies and politics. The red paper poppy is a symbol of remembrance, but it has other connotations. For some it invokes patriotism and feelings of pride in their country, for others it represents conformity and militarism. Whether television news presenters are wearing them attracts disproportionate attention. In 2019, one Australian TV network had a very tasteless segment denouncing a rival station whose newscasters failed to wear poppies. The non-poppy wearing hosts were accused of failing in their duty to respect their country and to help preserve its culture and traditions. Regardless of the presenters’ actual reasons, this feels like a lot of baggage to load onto the delicate poppy, a symbol of quiet remembrance and gratitude.

Unsurprisingly, this has led many to question whether Remembrance Day has become detached from its original purposes. Twelve years after the death of the last British First World War veteran, there is little living connection to either of the two world wars. With this passage of time, there is a growing danger of mistaking the symbols of ceremonial Remembrance for the thing itself.

The focus of remembrance can shift away from the sheer horrors of war, from awe at the sacrifice of our forebears, and from the resolved ‘never again’ to fixing our gaze on the processed goods: the ceremonial silence, the poppies themselves and even the quality of our own emotional response.

Some commentators have suggested that organised Remembrance has served its purpose and is best forgotten, and that too much remembering is a bad thing, fuelling grudges and sectarian conflicts. Personally, I’m not convinced, but I do think our current Remembrance is missing something.

With a strong grounding in a shared past and a common hope, we would talk frankly about the times our country has fallen short without a sense of betraying our history or identity.

Reflecting on the importance and difficulty of memory, the writer and Holocaust survivor Elie Wiesel emphasised the importance of hope. Despite the horrific experiences of the twentieth century, for Wiesel it is hope that “summons the future”. Memory without hope would lead us to a dead-end, where we grip onto the past while feeling it slip like sand through our fingers. Many of the anxieties around Remembrance point to a hope deficit.

How can we remember with hope?

We need to broaden our perspective and engage better with our shared national story. We need to be grounded in our history, stories and myths but we also need to be drawn forward by the good things we have and will have. If this story is big enough then it will be a large tapestry of interwoven strands, and we will be able to generously incorporate new strands, other cultures with their own relationship to the past into it. We will also be better prepared for our remembering to deal with difficult questions about our nation’s history. With a strong grounding in a shared past and a common hope, we would talk frankly about the times our country has fallen short without a sense of betraying our history or identity. Hope would connect us better to our neighbours overseas and to the men and women who risk their lives to serve their country.

Last Remembrance Sunday, I helped our church’s under-7s make big paper poppies out of red paint and paper plates. The older children made origami peace cranes, and both the big red poppies and the peace cranes were placed by the altar. Here the focus is on remembering, but not just on our own memory. For me and countless other Christians, God’s memory is the real focus. God remembers us in our broken and war-torn world, and as Jesus, chose to join us in it, experiencing the worst of suffering while dying a painful death. All our personal and collective stories of pain, loss and sadness are met in this sacrifice. More than this, in the promises of restoration Jesus gave when He rose from the dead, they find a concrete hope.

What does Remembrance look like when it’s really grounded in hope? I think there would be a few noticeable signs. It would be less precious about itself. It would be more open to different emphases of remembrance such as the Peace Pledge Union and the white poppy, and excited about new creative expressions of remembrance like the ‘poppy walks’ organised by the Royal British Legion. More patient to the concerns of those who find the religious elements of Remembrance difficult. More integrated into our attitudes to current and ongoing conflict around the world. Most of all I hope it would make us really hungry for both peace and for righteousness.