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 These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who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

Leading

18 February 2025

4 min read

Carney’s call for character still resonates now more than ever

In both business and politics, the vocation of public service is at risk.

Emerson Csorba

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

Mark Carney sits between two other speakers, holding a mic.

Mark Carney on the campaign trail.

On May 27 2014, a group of business, political and faith leaders gathered in London for the inaugural Conference on Inclusive Capitalism.

As a 23-year-old Masters student at Cambridge University at the time, it was a defining moment, this in the final months of my first stint in the UK. One of three young people invited, I had prepared carefully and waited impatiently in line in central London on a boiling summer evening.

The most poignant moment of the conference, in hindsight, was less the attendees or the historic venue, but rather a particular speech that I continue to reflect on a decade later.

The speech in question was one given by the then Bank of England Governor, the Canadian Mark Carney, and it was called ‘Capitalism: Creating a Sense of the Systemic’.

It was, and remains, one of the most impressive speeches I have heard, and whose message is as important as ever.

It is a message that Canadians today, as well as others living in Western democracies, need to hear as much as at any time in recent history.

In the wake of the financial crisis, Carney raised a point that is seldom asked in business or political circles - that of responsibility, and more specifically, of vocation. It is as follows:

"To build this sense of the systemic, business ultimately needs to be seen as a vocation, an activity with high ethical standards, which in turn conveys certain responsibilities."

And soon after: "It can begin by asking the right questions. Who does finance serve? Itself? The real economy? Society? And to whom is the financier responsible? Herself? His business? Their system?"

He references Michael Sandel, the philosopher who in his book What Money Can’t Buy: The Moral Limits of Markets takes aim at the "skyboxification" of American life.

The example used by Sandel is taken from the sport of baseball. In the not-too-distant past, people from across all walks of life sat together in the stands, the low ticket prices allowing baseball to be the great unifier across divides.

Today? Expensive box seats see the rich and poor seated in different areas, the rich even physically above - looking down on - others. The same goes for ice hockey, soccer, or other sports which no longer see diverse families, across income levels, sitting together.

In short, if you impose a price on a good or increase the price of a good significantly (baseball tickets), the nature of value of that good changes, often irreparably so. Lost is a sense of fairness, and a reduction in the potential to repair divides.

In short, the idea of public service - that to be first, you must come last - seems increasingly bizarre to people.

We live in a world where immediate gratification and personal enrichment are particular cultural values. If there is any tell on the character of President Trump and his new White House, it is the launch of the Trump and Melania meme coins before the Presidential Inauguration: politics used for the advancement of personal interest.

In short, the idea of public service - that to be first, you must come last - seems increasingly bizarre to people. (A conversation with a young person several weeks ago struck me especially on this front, in which I had to explain that the purpose of politics is to serve others, not yourself.)

Carney's 'Creating a Sense of the Systemic' speech is therefore a reminder of what we need from political leaders: people who, outside of compelling rhetoric focusing on putting their nations first, actually consider their responsibilities toward others and who take these responsibilities seriously.

These responsibilities are vocations to which we are called. The responsibilities are not about us but rather are part of the system (made up of people and institutions) of which we are a part, and beyond.

In Canada, the potential election of Mark Carney as Leader of the Federal Liberals, and in turn as Prime Minister, is a step in the direction of a public service focused on responsibility and vocation. It is a step toward a more vocationally oriented public service, which our world needs. Whatever one's partisan affiliations, having political leaders acting with a sense of responsibility toward people and a higher calling beyond themselves is something we should embrace.

If Carney is to channel the same energy, poise and focus of this May 2014 speech, then there is a good chance the Canadian Federal Liberals win a future term. This is because our world is, deep down, yearning for political leadership based on real character, sense of purpose and responsibility beyond the self. But there is equally an opportunity for Pierre Poilievre to do the same, emphasizing the need for character, purpose and responsibility toward Canadians.

For Canada, it is a focus on responsibility, a sense of the broader system and our calling as Canadians in the world that can serve as a foil to the leadership in the United States.

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