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 These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who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

Editor's pick
Belief
Comment
Politics
6 min read

How to navigate a culture war

Blaise Pascal shows us what really underlies our contemporary battles.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Two goats lock horns.
Maxime Gilbert on Unsplash.

We often say these days that we are more polarised as a society than ever before. But we're wrong. Maybe the USA is experiencing a particularly sharp divide right now, but they have had their own, much more violent troubles in the past. And in Europe, and especially in Britain, we know a fair bit about culture wars that were literally that – wars.  

In the 17th century, we English had our own civil war where we literally killed each other over religion and politics. We even killed a king. The French did something similar and even more vicious just over 100 years later. That is real polarisation. However spiteful Twitter/X arguments may get, I don't think Charles III or even Kier Starmer is quaking in their beds expecting to be put on trial for treason.  

So maybe our history has something to teach us about how we navigate culture wars.  

The literary critic Terry Eagleton once wrote of our age:  

“the world is accordingly divided between those who believe too much and those who believe too little. While some lack all conviction, others are full of passionate intensity.” 

 We tend to think our contemporary divide between left and right, progressives and conservatives is something new. But we can find echoes of this in previous times.  

A case in point was the mid-17th century – the time of many other upheavals in Europe. Part of the febrile atmosphere of the time saw fierce arguments between rationalists and sceptics.  

There were at the time, two broad strands of thinking about the human condition. On the one had there were the ‘Dogmatists’ who were sure that they knew everything through use of reason or the application of philosophical or scientific method (like René Descartes). On the other hand, there were the ‘Sceptics’ who thought everything was random, or custom, and there is no final Truth to be found (like a figure from the century before – Michel de Montaigne). 

Of course, our own time has its fair share of people with an overwhelming confidence in the power of human knowledge, and the physical sciences in particular, to unlock the secrets of life, the universe and everything. The ‘new atheist’ project of Richard Dawkins and friends was hugely confident in reason and its capacity to tell us all we need to know, dispatching religion to the dustbin of history and instead placing an unshakable faith in the empirical methods of science. It had - and has - definite similarities with this picture of human knowledge.  

Yet on the other hand we also have, in the progressive postmodern project, those who reject any kind of underlying rationality or sacred order either above us or beneath us. For them, there is no underlying Truth to be discovered, and they delight in revealing the instability and illusory nature of any claim to truth. It sounds very much like the culture wars of our time. 

One enigmatic 17th century figure charted a way through this dilemma - Blaise Pascal. When he looked at his century’s culture war, he thought both sides had a point. There is, he observed… 

…open war between men in which everyone is obliged to take sides, either with the dogmatists or with the sceptics, because anyone who imagines he can stay neutral is a sceptic par excellence…. Who will unravel such a tangle? This is certainly beyond dogmatism and scepticism, beyond all human philosophy. Humanity transcends humanity. Let us then concede to the sceptics what they have so often proclaimed that truth lies beyond our scope and is an unattainable quarry, that it is no earthly denizen, but at home in heaven lying in the lap of God, to be known only insofar as it pleases him to reveal it. 

So far, he says, the sceptics, like Montaigne, are right. Truth is beyond our grasp, it does not reside here on earth, openly obvious and ready to be found. If it exists, it exists in some world above us, beyond our reach. How do we even know if we are asleep or awake, given that when we dream, we are as convinced that we are awake as we are when we are truly awake?  

And so, modern progressives, looking to dismantle the assumed results of previous understanding, due to its inherent colonial, patriarchal or abusive past, delight in showing how random and arbitrary is so much of what we take for granted from the past. And, Pascal would add, they have a point. Many of our legal, political and cultural assumptions are purely cultural and arbitrary, and sometimes simply serve to the advantage of the rich and powerful rather than the poor and marginalised. 

Yet on the other side, the ‘dogmatists’, like Descartes, have their strong point, which is that we cannot doubt natural principles. The acids of deconstruction can only take you so far. The most sceptical philosopher still puts the kettle on assuming that it will boil to make a cup of tea. She gets up in the morning assuming that the sun will rise and set again at the end of the day. Despite the corrosive effects of scepticism, Pascal wrote,  

“I maintain that a perfectly genuine sceptic has never existed. Nature backs up helpless reason and stops it going so wildly astray.”  

Despite all our doubt, we still live in a world with order and predictability. Scepticism keeps bumping up against reality.   

So, modern conservatives point to a deeper ‘givenness’ to things, an order within the natural world that we did not create, and yet, mysteriously, seems to be prearranged before we got here. Scientific exploration does make sense. There is a regularity to nature that we can, indeed have to, depend on. Sexual differences exist and can’t be ignored. We are not entirely free to override the natural order of things - there is a deeper rhythm to nature and its capacity for renewal that we only mess with at our peril, as climate change has taught us. As a result, the age-old battle between rationalists and sceptics, progressives and conservatives, will never find resolution, as the arguments flow back and forth.  

Christian faith includes both progressive and conservative impulses. It can make sense of both of them. Christians are aware of the brokenness of the world and therefore long to see it changed. The progressive impatience with the way things are, and the yearning for a better world has its roots in Christian faith.

Yet at the same time, Christianity discerns a divinely created order to the world, a rhythm to the natural world, that cannot be broken and needs to be respected. Therefore, an inherent conservatism is part of Christian faith as well. In other words, the Christian story can explain both and offer a bigger picture than either.  

For Pascal, Christianity offers a diagnosis for this mystery of the human condition, the complex mix of grandeur and misery, infinity and nothing, sceptic and rationalist, in the simple, yet endlessly generative idea that we humans are gloriously created, deeply fallen and yet offered redemption through Jesus Christ. Our sadness is heroic and tragic. In Pascal’s suggestive image, it is “the wretchedness of a great Lord, the wretchedness of a dispossessed king.” 

“We show our greatness,” says Pascal, “not by being at one extreme, but by touching both at once and occupying all the space in between.” For him, the very existence of such culture wars points to the truth of the Christian diagnosis of the human condition. 

Pascal offers us a way between the Scylla of Progressivism and the Charybdis of Conservatism – or perhaps better, to embrace the best of both. Culture wars are tricky to navigate. Yet they might find resolution if we allow them to point us to a deeper reality - our strange mixture of greatness and sadness. And not losing sight of either side of this enduring truth.  

 

Graham Tomlin is the author of Blaise Pascal: The Man Who Made the Modern World  (Hodder) £25.  

Watch Graham explain why he is fascinated by Pascal.

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