Article

Assisted dying

Comment

Justice

15 October 2024

5 min read

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 These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who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.

Article

Character

Comment

Politics

Virtues

5 March 2025

5 min read

Are virtues irrelevant in today’s uncertain politics?

We need to exercise the character traits that uphold our values.

Emerson Csorba

Emerson writes on geopolitics. He is also a business executive and holds a doctorate in theology.

President Zelensky raises a hand while President Trump talks at him.

MSNBC.

In Oliver O'Donovan's Finding and Seeking, the theologian makes a telling comment about virtue, virtue referring to ‘the goodness the world has already seen and known…. Talk about virtue is always third person talk, observers’ talk about deeds that have already taken determinate form.’

Put differently, virtue is about the past. It is about how others have lived and acted in admirable ways. But it is not about today, in all of its ambiguity and uncertainty.

To put it directly – virtue falls apart when hit with reality. It is easy to talk about what virtuous people have done, much harder to be virtuous in the present. Or so O’Donovan says.

There has been a lot of talk over recent years about the need for virtues and values in politics (and in the world more widely), but what even are these things?

Values are principles or standards that individuals or societies consider important.

Virtues are moral excellences or traits of character, such as courage, patience, or humility.

Virtues are the moral character traits individuals need to uphold values, in practice.

When thinking about virtues and values, I often reflect on a simple but profound point made by Nigel Biggar speaking at Oxford University many years ago:

"If you want pure heroes, you won't have any."

Put differently, people – including the most virtuous at first glance – are complicated.

Yet, our world is one in which virtue seems to be in short supply. Some would even say virtue (and values) are non-existent, or on the verge of extinction.

The older I become, the more I am left reflecting on why it is that so few individuals – in political life, but also more generally – seem to live without principle. Integrity – which I define as ‘your word (or principle), and action aligning’ – seems increasingly a thing of the past.

Many seem to think that integrity is ‘old-fashioned,’ acting accordingly, saying one thing and doing another as if there are no repercussions.

This is replaced with an ‘anything goes’ mentality, focused on short-term gratification. It is a “you do you” culture, acting without conscience. People seem to believe there are few if any repercussions for doing bad things. This culture is not only permitted, but even celebrated.

The American situation is, of course, the example par excellence of this. American politicians and diplomats wake up each morning waiting for what their President will write on social media, responding accordingly. Alliances are thrown out the window. Nothing is off the table.

There is seemingly less interest in Western societies in being good persons, doing what is right in hard circumstances, and where few or no people are watching.

Whether in politics or in society more widely, people seem increasingly focused on protecting themselves, doing whatever they need to do to get ahead, rather than looking out for each other.

So where do we draw the line? Is there space for virtue (and values) in a world where growth is slowing, and more people are battling for parts of a shrinking pie?

I believe the answer is yes. My sense is that many people are today yearning for clarity of values and virtues in a world that is becoming much more anchorless.

There does then seem to be interest in values and virtues, but it is perhaps worth remembering that values and virtues are like muscles... It is possible to lose these muscles without practice.

In my home of Canada, where I recently moved back, many value decency, politeness, and a sense of moderation.

In 1955, while serving as Canada’s Secretary of State for External Affairs, Lester B Pearson put his figure on this pulse, delivering a series of lectures at Princeton University entitled Democracy in the World. Pearson argued that a sense of moderation is a leading value for Canadians.

He described this as a ‘confidence in the ability of the peoples and the leaders of democratic nations to grow into the new situations and to accept the greater self-discipline which the preservation of freedom in an interdependent world requires.’

And he saw Canada as especially emblematic of this ability to grow into new situations, this adaptability in working in an interdependent world.

Many Canadians believe that the thirteen provinces and territories need to adapt and work together in order to respond to the threat of the United States.

The candidate for Leader of the Liberal Party, Mark Carney, seems to agree (and is rising in the polls because of this), whereas his opponent Pierre Poilievre is moving in the opposite direction given his more combative approach. But Poilievre has time and the opportunity to turn this around, channeling Canadians' frustrations into a vision focused on the values and virtues we share in common.

In other words, Canadians value working together when faced with challenges, valuing this solidarity when times are tough. We become more courageous the tougher things become.

The virtue of courage is here a noteworthy virtue, so well proven in the Great War battles of Vimy Ridge, Passchendaele and The Somme, or the Battle of the Atlantic in World War Two.

We see this Canadian virtue emerge often in times of crisis.

Andrew Davison in previous writing in Seen & Unseen is especially eloquent on courage, writing that this virtue is:

‘both bracing and realistic. It reminds us that all is not well with the world. We will often need courage because doing the right thing can be costly.’

There does then seem to be interest in values and virtues, but it is perhaps worth remembering that values and virtues are like muscles – a point made by Carney in previous writing and speeches. And Poilievre, well-known for his considerable discipline, certainly understands the importance of the exertion that builds muscle."

It is possible to lose these muscles without practice. Over recent years, societies and individuals have become more permissive, rather than encouraging consistent exercise.

The question therefore is less about whether values or virtues will survive in the harsh light of reality. Instead, it is whether societies – their political representatives and citizens – are open to making the short-term investments necessary to uphold what they believe is good in their countries and in the world?

A tall task, to be sure, but one that I believe is both possible and necessary for Canadians and non-Canadians alike. Canada can here be an example for the world.

This task – upholding certain values and virtues, is not third person talk, as O’Donovan suggests. It is rather an imperative for action in the present. We are called to act accordingly today.