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. Much as we all sympathise and feel the force of stories of agonising suffering, to put it bluntly, is it right to make such a fundamental shift in our moral landscape for the sake of the two per cent 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. 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.

A 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 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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22 November 2024

1 min read

The bird-brained behaviour of holding a grudge

Cranky corvids and feuding pop stars share something in common.

Jamie Mulvaney

Jamie is Associate Minister at Holy Trinity Clapham, London.

A crow stands at the end of an overhanging rock.

Still in the huff.

Haaslave185, CC BY-SA 4.0, via Wikimedia Commons.

Sometimes it's just too hard to let it go. Art Garfunkel recently told The Times that he and Paul Simon have put aside their feud. Again. I was at their gig in Melbourne in 2009, four rows from the front. Although Art's voice soared, it faltered on Bridge Over Troubled Water. But it was glorious. Their setlist began with Old Friends, the name of their reunion tour, tragically describing a duo marked by both harmony and discord.

It's not just old friends who can harbour old grudges. It turns out, according to John Marzluff from the University of Washington, that crows can similarly prolong a grudge for up to 17 years. Putting aside a longstanding grudge can be a good commercial decision, as evidenced by a certain Britpop band recently... but when I heard on the radio the other morning that crows are good at holding grudges, I must admit it made me laugh. There's something about the pettiness, the silliness of human grudges that seem to befit the ridiculousness of a bird. The bird-brained behaviour of holding a grudge may similarly find its root in fear: just as Marzluff has discovered that crows' brains show evidence of human-like fear.

But grudges, just like fear, are no laughing matter. They aren't light, and they don't soar like crows or an ageing rocker's voice, but thud and squelch in all their onomatopoeic heft. We hold onto petty and significant grievances because, however unpleasant, we feel we have control. But the language we use around grudges is telling - we bear grudges, hold them, nurse them. Grudges, just like children, grow over time. And whether they last for weeks of crow-like decades… they destroy things around us and within us. Perhaps it's apt that the collective noun for a crow is 'murder'. Indeed, it's old wisdom that such grudges are destructive. Jesus said 'anyone who is so much as angry with a brother or sister is guilty of murder. Carelessly call a brother 'idiot!' and you just might find yourself hauled into court.'

Grudges towards coworkers, family and friends can be subtle and invisible but no less real and consequential as visible damage. When Garfunkel asked Simon recently why they hadn't seen each other, 'Paul mentioned an old interview where I said some stuff. I cried when he told me how much I had hurt him. Looking back, I guess I wanted to shake up the nice guy image of Simon & Garfunkel. Y'know what? I was a fool!'

The sense of freedom, joy, yes tears, and the possibility of singing together again has only been possible by them talking it through.

Forgiveness won't necessarily mean condoning or reconciling, particularly if a crow has swooped on you. And sometimes those opportunities will be out of our reach. But however out of control our grudges may feel, we can hand them over, in all their deathly ugliness, to someone who is willing to absorb them.