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 These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who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

Getting hitched should benefit more than the advantaged

Marriage’s decline impacts outcomes for all.
A bride dressed colourfully stands next to her groom, dressed similarly, as he sits in a wheelchair.
Ellie Cooper on Unsplash.

Of all the dramatic changes to Britain in the last half century, one of the least discussed is the extraordinary decline in marriage.  

The marriage rate has fallen by two-thirds in the last 50 years. It was just above six per cent in 1972 and has now been under two per cent since 2017. 

This remarkable decline has corresponded with a rise in a relatively new relation type: cohabitation. Cohabitation was extremely uncommon before the 1960s, and even by 1986 just 10 per cent of new mothers were cohabitants. It is, however, rapidly becoming the mainstream. Now 35 per cent of babies are born to cohabiting mothers, and the total number of UK cohabiting couples increased from 1.5 to 3.7 million between 1996 and 2022.  

Much of this is due to couples delaying marriage: 84 per cent of religious and 91 per cent of civil marriages are now between couples that already live together, and the average age when first marrying has climbed by 10 years since the early 1970s. But it is also due to many more couples not marrying at all. 

Opinions understandably differ on this social transition away from marriage and towards cohabitation. It is a point of progress worth celebrating that the previous societal shunning of those, especially women, who had children outside of marriage has been left in the past. However, such progress has not been without consequences. Cohabitations are less stable, on average, than marriages. Cohabiting parents are around three times as likely to separate in the first five years of their children’s life as married couples.  

This stability is not simply because wealthier, more highly educated people tend to have stable families and also tend to marry. Studies by World Family Maps and the Marriage Foundation have shown marriage to be a larger factor in family stability than either education or income.  

Nor does the stability come from couples staying together miserably.  Studies undertaken in 2017 and 2024 looked at the outcomes of couples 10 years on from considering their relationships to be ‘on the brink’. In the initial study, while 70 per cent of cohabiting couples had separated in the decade since considering themselves ‘on the brink’, 70 per cent of the married couples had remained together. Perhaps even more crucially, just seven per cent of those married couples that had stayed together were unhappy in their relationship a decade on. The 2024 study found none of the sample of married couples that had stayed together were still unhappy 10 years on. For those that had stayed together, things had improved. 

This family instability that the decline of marriage has caused is also unevenly distributed. Affluent couples – often those most likely to criticise the concept of marriage – are much more likely to marry than disadvantaged ones.  

Looking at socioeconomic groups, seven in ten mothers from the most advantaged group are married, while just a third of those from the two most disadvantaged groups are. The effect is geographic, too. Institute for Fiscal Studies research has found parents having children are more likely to be married if they are living in better educated areas. For the advantaged, it is compassionately affirmational to suggest that every relationship is equal, even though the advantaged themselves choose the most secure option of marriage: a hypocrisy only tolerated due to the potent fear of seeming judgemental. 

The consequence of this is deepening inequality: disadvantaged families are rendered more likely to breakdown, while children from affluent backgrounds are disproportionately likely to enjoy the ‘the two-parent privilege’, the substantial emotional and developmental advantages of growing up in a stable home. Melissa Kearney coined the phrase, and her evidence shows how children grow up, on average, to have better educational outcomes, better emotional and physical wellbeing, and higher incomes if they are raised in two-parent homes. 

Stable families are foundational to a stable society, and marriage is crucial to stable families.

So, why are marriage rates so much higher among wealthier couples than poorer ones, and why is this gap growing? 

We can isolate three reasons in particular, each more solvable than the last.  

Most challenging is the feedback loop effect: people whose parents, role-models, and friends have not married are unlikely to do so themselves. The demographic trend compounds itself.  

Second, and easily addressable if only the will was there, is the public messaging effect: politicians – and to some extent celebrities – have consistently told the public that marriage is unimportant. In 2017, Marriage Foundation research found that it had been a decade since a cabinet member had discussed marriage in a speech. This has hardly changed in the years since. In 2024, the only major party whose manifesto even mentioned marriage was Reform; even then the focus in the relevant section seemed to be less on marriage and more on getting ‘people trapped on benefits back into the workplace’. 

Third is the cost of weddings. A quick flick through top wedding magazines suggests that the average wedding costs upwards of £20,000. Survey evidence from both Marriage Foundation and the Thriving Center of Psychology have found that most young people view weddings as unrealistically expensive. 

This financial problem is solvable: much of the costs relate to venue hire. Unless they are having a religious marriage, a couple will need to find a venue that has gone through the bureaucratic process of becoming an ‘approved premises’. The cheapest of these are register offices which, including all expenses, still cost about £500. 

This is eminently mendable. The Law Commission proposal to reorganise wedding law around the officiant, not the venue, opens the door for a future of more affordable weddings by removing the regulatory barrier. It will also bring the law in line with that of other home nations. 

This proposal will not work by itself, though, it will need to be supported by creativity in wedding planning.  

Wedding costs can be substantially reduced by taking a DIY approach. Food, drinks, and decorations can often be coordinated amongst enthusiastic (and appropriately competent!) guests.  

Booze free weddings are a growing phenomenon, and especially good for weddings with children.  

Such ‘group-effort’ approaches often have a unique feel thanks to the high participation of guests, and people are more likely to remember events that they feel a sense of ownership of, having helped make them happen. 

Alongside this is a recommendation by the Centre for Social Justice. It proposes subsidising the necessary statutory fees for the poorest couples, up to £550 per couple. An inexpensive and hugely beneficial adjustment to improve wedding accessibility for the least fortunate.  

Stable families are foundational to a stable society, and marriage is crucial to stable families; perhaps it is time for all of us to make tying the knot easier.  

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