Will clinicians and carers objecting to assisted death be treated as nuisances?

The risk and mental cost of forcing someone to act against their conscience.

Henna Cundill

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

A tired-looking doctor sits at a desk dealing with paperwork.

Francisco Venâncio on Unsplash.

After a formal introduction to the House of Commons next Wednesday, MP’s will debate a draft Bill to change UK legislation on Assisted Dying. Previously, a draft Bill was introduced in the Scottish Parliament in March 2024, and is currently at committee stage. Meanwhile, in the House of Lords, a Private Member’s Bill was introduced by Lord Falconer in July and currently awaits its second reading. These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who wish to recuse themselves from carrying out a patient’s end of life wishes on grounds of Conscientious Objection.

There are various reasons why someone might want to conscientiously object. The most commonly cited are faith or religious commitments. This is not to say that all people of faith are against a change in the law – there are some high-profile religious advocates for the legalisation of Assisted Dying, including both Rabbi Dr Jonathan Romain and Lord Carey, the former Archbishop of Canterbury. Even so, there will be many adherents to various faith traditions who find themselves unable to take part in hastening the end of someone’s life because they feel it conflicts with their views on God and what it means to be human.

However, there are also Conscientious Objectors who are not religious, or not formally so. Some people, perhaps many, simply feel unsure of the rights and wrongs of the matter. The coming debates will no doubt feature discussion of how changing the law for those who are terminally ill in the Netherlands and Canada has to lead to subsequent changes in the law to include those who are not terminally, but instead chronically ill. The widening of the eligibility criteria has reached a point where, in the Netherlands, one in every 20 people now ends their life by euthanasia. This troubling statistic includes many who are neurodivergent, who suffer from depression or are disabled. It is reasonable that, even if a Conscientious Objector does not adhere to a particular religion, they can be allowed to object if they feel uneasy about the social message that Assisted Dying seems to send to vulnerable people.

“You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances”

Mehmet Ciftci

Conscientious Objection clauses can themselves send a social message. A response to the Scottish Bill produced by the Law Society of Scotland notes concern over the wording of the Conscientious Objection clause, as it appears to be more prescriptive in the draft Bill than in previous Acts such as the Abortion Act of 1967. In the case of any legal proceedings that arise from a clinician’s refusal to cooperate, the current wording places the burden of proof onto the Conscientious Objector, stating (at 18.2):

In any legal proceedings the burden of proof of conscientious objection is to rest on the person claiming to rely on it.

The Bill provides no indication of what is admissible as ‘proof’. Evidence of membership of a Church, Synagogue, Mosque or similar might be the obvious starting point. But where does that leave those described above, who object on grounds of personal conscience alone? How does one meaningfully evidence an inner sense of unease?

The wording of the Private Member’s Bill, currently awaiting its second reading in the House of Lords, provides even less clarity, stating only (at 5.0):

A person is not under any duty (whether by contract or arising from any statutory or other legal requirement) to participate in anything authorised by this Act to which that person has a conscientious objection.

Whilst this indicates that there is no duty to participate in assisting someone to end their life, there remains a wider duty of care that healthcare professionals cannot ignore. Thus, a general feature in the interpretation of such conscience clauses in medicine is that that the conscientious objector is under an obligation to refer the case to a professional who does not share the same objection. This can be seen in practice looking at abortion law, where ideas around conscientious objection are more developed and have been tried in the courts. In the case of an abortion, a clinician can refuse to take part in the procedure, but they must still find an alternative clinician who is willing to perform their role, and they must still carry out ancillary care and related administrative tasks.

Placing such obligations onto clinicians could be seen as diminishing rather than respecting their objection. Dr Mehmet Ciftci, a Researcher at the McDonald Centre for Theology, Ethics and Public Life at the University of Oxford comments:

You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances who are just preventing the efficient delivery of services. They are forced to refer patients on to those who will perform whatever procedure they are objecting to, which involves a certain cooperation or facilitation with the act.

This touches everyone, even those who (if the Bill becomes law) will still choose to conscientiously object. Therefore, it is important to consider that the human conscience is a very real phenomenon, which means that facilitating an act that feels morally wrong can give rise to feelings of guilt or shame, even if one has not been a direct participant.

Psychologists observe that when feelings of guilt are not addressed, if they are treated dismissively or internalised, this can significantly erode self-confidence and increase the likelihood of depressive symptoms. But even before modern psychology could speak to the effects of guilt, biblical writers already had much to say on the painful consequences of living with a troubled conscience. In the Psalms, more than one ancient poet pours out their heart to God, saying that living with guilt has caused their bones to feel weak, or their heart to feel heavy, or their world to feel desolate and lonely.

If the Conscientious Objection clauses of the new Bill being proposed on Wednesday are not significantly more robust than those in the draft Bills proposed thus far, then perhaps that is something to which we should all conscientiously object? There is much to discuss about the potential rights and wrongs of legalising Assisted Dying, but there is much to discuss about the rights and wrongs of forcing people to act against their consciences too.

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Death & life

Music

19 November 2024

2 min read

Lullabies and lists that tell of lifelong love

A Laura Marling gig and an All Souls remembrance reverberate life.

Jess Scott

Jess Scott is an assistant professor at the University of Nottingham.

A misty back lit stage hosts a singing guitarist and a double base player

Laura Marling performs at Hackney Church.

YouTube.

This year, I did not go to my own church’s All Souls Day service. I went instead to another church - Hackney Church - to hear Laura Marling perform her new album, Patterns in Repeat. Marling wrote its songs in the months following the birth of her first child. Her daughter’s coos and gurgles occasionally overwrite the recording of Marling’s own ethereal, elastic voice as she contemplates parenthood, heritage, and new domesticity. Critics are in agreement: this is Marling’s most accomplished album yet.

As I stood amid the congregation gathered to hear her, I was struck by the overwhelming love contained in those lullabetic songs. As if line by line Marling swaddles her daughter, each lyric wrapping her with words that hold and assure. Sleep my angel, you’re safe with me. What she conjures is the magnificent reorientation entailed in love - Time won’t ever feel the same - and the promises that tip from the mouths of those experiencing it - I’m not gonna miss it, child of mine.

Of course, love is not always so pure. We may find, miserably, our own love tilting this way or that, towards dominance or possessiveness, or muddied by some other perversion. But this isn’t to deny that there really are pockets of pure love in our midst. All around us are people writing their own lullabies: sending texts, preparing meals, writing cards, taking photos. And, in these ways, saying to one another, as the theologian Josef Pieper paraphrases the affirmation of love, ‘I am glad you exist’.

While I listened to Marling sing lullabies for her baby daughter in one church, the gathered faithful of my own congregation read out the names of the dead in another. Each year the list is long and spans several minutes. By its end the names start to undo themselves, beginning to sound only like their component syllables, blurring towards the non-words found in a book of phonics. But each name uttered - perhaps for the only time that year - tells of a whole beloved life, witnessing some homely love swirling still, years later, in the memory of a congregant. In years past I have sat around that altar as those names are read out. I have listened out for the names I added, like a child seeking the face of her mother.

These two Saturday evenings, unfolding a few Overground stops apart, were not wholly discrepant. Each sounded the cry of love from one person to another, against cynicism, even against death. Each told of love that reverberates where love cannot yet, or still, be reciprocated. All these hearts swelling and bending and breaking for each other strikes me as a kind of Grand Canyon: a remarkable thing to consider, seeming to be a miracle that might, if we let it, render us speechless.