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 These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who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

Just where does the arc of history bend towards today?

What happens when the optimism bubble bursts.

Roger is a Baptist minister, author and Senior Research Fellow at Spurgeon’s College in London. 

The feet and legs of someone walking on a white rug, beside the words Justice and Government woven in to it,
Obama's Oval Office rug.
The White House, via Wikimedia Commons.

"Yes we can! 

Yes we can! 

Yes we can!"

There was something magical about hearing Barak Obama speak to a crowd. The rhythm of his sentences, the rhyme of his words and the melodic cadence of his baritone delivery had the ability to hold you spellbound. It felt so positive, so uplifting, so inspiring.  

The call and response with the audience only underlined the positivity of the impression: ‘Yes we can!’  

It was listening to Obama that I first heard the quote: 

 ‘The arc of history is long, but it bends towards justice.’ 

I loved it. Obama used it a lot, and so did I.  

It seemed to epitomise the hopefulness his presidency embodied. Implicitly, it advocated the qualities of patience and persistence that are so important in working for a better world. It doesn’t happen overnight. It also acknowledged his rootedness in what had gone before, ‘As Dr King used to remind us …’. Obama was borrowing the line from one of his own heroes. 

In fact, the quote was with him all the time in the Oval Office of the White House, to the right of his desk. Along with four other quotes it was woven into the perimeter of a 23 by 30-foot oval rug that almost filled the room. 

The one-liner still delivers a punch, just as it did for Martin Luther King. However, I am increasingly convinced that it doesn’t stand scrutiny. As much as I want it to be true, and long for it to be true, I do not believe that it is. 

The sentiment was of its time. Not the 1950s and 60s of Dr King, but the 1850s of the Unitarian minister Theodore Parker from Massachusetts. The germ of an idea originated with him in a sermon entitled, ‘Of Justice and the Conscience’. At this point it was a complicated paragraph rather than a pithy one-liner. 

‘You see a continual and progressive triumph of the right. I do not pretend to understand the moral universe, the arc is a long one, my eye reaches but little ways. I cannot calculate the curve and complete the figure by the experience of sight; I can divine it by conscience. But from what I see I am sure it bends towards justice.’ 

Parker was also responsible for ‘government of the people, by the people, for the people’ that Abraham Lincoln would go on to cut and paste into his famous Gettysburg Address during the Civil War. It also appeared on Obama’s rug. 

The intellectual circles of the 1850s were alive with many new ideas like progress, equality and the abolition of slavery, and ‘transmutation’ (or evolution as it would become known). In science, industry and social life things were moving forward and getting ever better. 

As the century moved on this conviction continued to grow and become more widespread. By the early years of the twentieth century Parker’s thought itself had been distilled down into the single line we’re familiar with and included in popularly published collections of aphorisms. 

Prosperity and progress informed the narrative of Western culture and ideas of evolution were imported into other disciplines. In anthropology, for example, this gave rise to ‘social evolutionism’ and the categorisation of societies into a developmental sequence ranging from ‘primitive’ to ‘civilised’.  

Of course, it doesn’t take much imagination to recognise that there was a darker side to such notions. Here was also an underpinning for a colonial worldview and an intellectual justification for racial hierarchy. Western culture was more ‘evolved’.  

These views were epitomised in psychology where, for example, in Freud’s Totem and Taboo (1913) he speaks of indigenous people as ‘the most backward and miserable of savages’, comparing the way they live with features of a neurosis and mental disorder. 

The carnage of the First World War effectively popped the bubble of an overly optimistic ‘progressivism’. I do wonder whether we are now at another ‘bubble popping’ moment in the West. 

Is your ‘bubble of optimism’ in danger of popping, or has it even popped already, like mine? 

In the decades since the Second World War we have succumbed to our own narrative of progress. We have witnessed amazing technological advances and stunning scientific discoveries. The forward movement is obvious, and the promise of an even better future is clear. 

Then, supported and monetised by the market economy, our lives are tempted, enhanced and festooned by the latest products and services that our money can buy. From smart doorbells to wearable tech and TikTok to ChatGPT our world is constantly changing and upgrading and the movement forward is undeniable. 

The narrative runs in our wider life too. We celebrate the triumph of the suffragettes, the defeat of fascism and the collapse of old-school communism. Francis Fukuyama may have been premature declaring the end of the Cold War as the ‘end of history’ in 1989, but it did seem like Western-style liberal democracy was what the world was striving for. 

Then there are the advances in our shared life together in Britain. If Acts of Parliament in some measure illustrate the pulse of the nation, the direction is clear. Take, for example: 

  • the Sexual Offences Act 1967 
  • the Sex Discrimination Act 1975 
  • the Race Relations Act 1976 
  • the Childrens’ Acts of 1986 and 2004 
  • the Disability Discrimination Act 1995  
  • the Human Rights Act 1998 
  • the statutory instruments protecting against discrimination in employment on grounds of religion or belief (2003), sexual orientation (2003) and age (2006) 
  • the Gender Recognition Act 2004 
  • the Equality Act 2010 
  • the Marriage (Same Sex Couples) Act 2013 

This list isn’t exhaustive and there are campaigners who are very keen to add to it. But we live inside this narrative, and we know the plot. It is familiar to us. And it would be so easy to be seduced into a new myth of inevitable progress, ‘The arc of history is long, but it bends towards justice’. 

‘Social evolutionism’ was so deeply embedded in late Victorian culture that its ‘self-evident’ truth went largely unchallenged. The vast majority believed their own hyperbole and complacently embraced the fruits of burgeoning industry and an expanding empire. They lacked the self-critical capacity to comprehend the flaws in their worldview and to understand what their world was capable of in the infernal, apocalyptic catastrophe that was unleashed in 1914. 

Maybe, embracing a more contemporary myth of progress has a similar effect on us. We presume that our way of life will inevitably continue moving forward unchallenged. That we have a right to experience a tomorrow that will always be better than yesterday. And that those who do not subscribe to our notion of ‘progress’ are clearly inferior, ill-informed or backward in some way. But such a mindset also lacks a culturally self-aware and critical edge and is oblivious to how easily things could fall apart. 

At this moment in time the world seems far less secure than at any point in my lifetime. Our community hosts refugees from Ukraine and Hong Kong, a friend has only recently returned from working with a voluntary agency in Israel and I am about to meet up with another friend who has just flown in from the United States.  

Populist, anti-democratic and disruptive forces are more blatantly at work around the world than for many a long year. Developments in AI, cyber-terrorism and digital warfare create a disembodied sense of ‘existential threat’. And then there is the climate crisis. Fires in California, floods in Europe and the unprecedented sequence of six tropical cyclones in the Philippines in late 2024 seem to have had little impact in accelerating the response to global warming. 

Is your ‘bubble of optimism’ in danger of popping, or has it even popped already, like mine? 

Of late I have found helpful insight in observations made by Jesus. Rather than fixating about what might happen in the future, he encouraged those who had attached themselves to him to live in the moment, 

'Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.'  

For those who were concerned about what might be happening and felt the world was falling in around them, he offered reassurance. He counselled that such events did not signal the end of the world. Rather, this was simply the kind of thing that happened.  

'You will hear of wars and rumours of wars, but see to it that you are not alarmed. Such things must happen … these are the beginning of birth pains.'

Rather, the early Christian ethic was rooted in God’s loving, supporting and strengthening presence during unstable times.  

Writing to the Christian community that had formed itself in Rome, the apostle Paul was convinced that whatever befell them – trouble, hardship, persecution, famine, nakedness, danger, or weaponised violence – that nothing would be able to ‘separate us from the love of God that is in Christ Jesus our Lord.’  

And right at the base of this ethic that Jesus advocated was an unswerving commitment to ‘love your neighbour as yourself’ 

Which takes us back to Obama’s rug and the West Wing office. 

On the left-hand side of his desk was a quote from President Theodore Roosevelt: 

'The welfare of each of us is dependent fundamentally upon the welfare of all of us.'

And that really is it. History may not bend towards justice, and hard-won progress we’ve achieved can likewise be lost, but our future will always hang on the ‘welfare of all of us.’  

Well said Mr. President! 

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