Assisted dying is not a medical procedure; it is a social one

Another vote, and an age-related amendment, highlight the complex community of care.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

Graffiti reads 'I miss me' with u crossed out under the 'mem'

Sidd Inban on Unsplash.

Scottish Parliament’s Assisted Dying bill will go to a stage one vote on Tuesday 13th May, with some amendments having been made in response to public and political consultation. This includes the age of eligibility, originally proposed as 16 years. In the new draft of the bill, those requesting assistance to die must be at least 18.

MSPs have been given a free vote on this bill, which means they can follow their consciences. Clearly, amongst those who support it, there is a hope that raising the age threshold will calm the troubled consciences of some who are threatening to oppose. When asked if this age amendment was a response to weakening support, The Times reports that one “seasoned parliamentarian” (unnamed) agreed, and commented:

“The age thing was always there to be traded, a tactical retreat.”

The callousness of this language chills me. Whilst it is well known that politics is more of an art than a science, there are moments when our parliamentarians literally hold matters of life and death in their hands. How can someone speak of such matters as if they are bargaining chips or military manoeuvres? But my discomfort aside, there is a certain truth in what this unnamed strategist says.

When Liam McArthur MSP was first proposed the bill, he already suggested that the age limit would be a point of debate, accepting that there were “persuasive” arguments for raising it to 18. Fortunately, McArthur’s language choices were more appropriate to the subject matter. “The rationale for opting for 16 was because of that being the age of capacity for making medical decisions,” he said, but at the same time he acknowledged that in other countries where similar assisted dying laws are already in operation, the age limit is typically 18.

McArthur correctly observes that at 16 years old young people are considered legally competent to consent to medical procedures without needing the permission of a parent or guardian. But surely there is a difference, at a fundamental level, between consenting to a medical procedure that is designed to improve or extend one’s life and consenting to a medical procedure that will end it?

Viewed philosophically, it would seem to me that Assisted Dying is actually not a medical procedure at all, but a social one. This claim is best illustrated by considering one of the key arguments given for protecting 16- and 17- year-olds from being allowed to make this decision, which is the risk of coercion. The adolescent brain is highly social; therefore, some argue, a young person might be particularly sensitive to the burden that their terminal illness is placing on loved ones. Or worse, socially motivated young people may be particularly vulnerable to pressure from exhausted care givers, applied subtly and behind closed doors.

Whilst 16- and 17- year-olds are considered to have legal capacity, guidance for medical staff already indicates that under 18s should be strongly advised to seek parent or guardian advice before consenting to any decision that would have major consequences. Nothing gets more major than consenting to die, but sadly, some observe, we cannot be sure that a parent or guardian’s advice in that moment will be always in the young person’s best interests. All of this discussion implies that we know we are not asking young people to make just a medical decision that impacts their own body, but a social one that impacts multiple people in their wider networks.

For me, this further raises the question of why 18 is even considered to be a suitable age threshold. If anything, the more ‘adult’ one gets, the more one realises one’s place in the world is part of a complex web of relationships with friends and family, in which one is not the centre. Typically, the more we grow up, the more we respect our parents, because we begin to learn that other people’s care of us has come at a cost to themselves. This is bound to affect how we feel about needing other people’s care in the case of disabling and degenerative illness. Could it even be argued that the risk of feeling socially pressured to end one’s life early actually increases with age? Indeed, there is as much concern about this bill leaving the elderly vulnerable to coercion as there is for young people, not to mention disabled adults. As MSP Pam Duncan-Glancey (a wheelchair-user) observes, “Many people with disabilities feel that they don’t get the right to live, never mind the right to die.”

There is just a fundamental flawed logic to equating Assisted Dying with a medical procedure; one is about the mode of one’s existence in this world, but the other is about the very fact of it. The more we grow, the more we learn that we exist in communities – communities in which sometimes we are the care giver and sometimes we are the cared for. The legalisation of Assisted Dying will impact our communities in ways which cannot be undone, but none of that is accounted for if Assisted Dying is construed as nothing more than a medical choice.

As our parliamentarians prepare to vote, I pray that they really will listen to their consciences. This is one of those moments when our elected leaders literally hold matters of life and death in their hands. Now is not the time for ‘tactical’ moves that might simply sweep the cared-for off of the table, like so many discarded bargaining chips. As MSPs consider making this very fundamental change to the way our communities in Scotland are constituted, they are not debating over the mode of the cared-for’s existence, they are debating their very right to it.

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28 November 2024

4 min read

Here's why we need to keep democracy holy

It's much more than a utilitarian deal that benefits the most.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A sign reading 'polling station' stands by the entrance to a church.

Red Dot on Unsplash.

One of the more ludicrous constitutional contributions of late has been the parliamentary petition, with well past two million signatures when I last looked, demanding another general election be called, because the Labour government, elected in July, has “gone back on the promises they laid out in the lead-up to the last election.”

Prime minister Sir Keir Starmer has surprised precisely no one by saying that he won’t be calling one. And so we’ll move on. But, in passing, what is truly breathtaking is how little our democracy is understood and, apparently, how unseriously democracy in the west is now taken. If that sounds unduly censorious, I have a two-word response: Two million!

Little time need be spent on demolishing the premise of this spurious petition, other than to wonder how many of those signatories would have appeared on one calling for, say, a fresh mandate after the coalition government of David Cameron and Nick Clegg (where is he now? Ah yes) performed a massive reverse-ferret on a manifesto pledge not to raise university tuition fees.

Or how many of these same fearless electors believe the result of the Brexit referendum should be voided because of the lies of the Leave campaign, most notable the one painted on the side of Boris Johnson’s battle bus. But no – two million residual, self-righteous righties can only be mobilised against a Labour government.

This event none the less raises valid questions about what our democracy is (and is not) and why we should want to protect or even cherish it. These questions become the more critical because there’s a tangible feeling of slippage in western democracy, as if we’re growing a bit tired and even contemptuous of it.

There’s the ominous re-growth of nationalism across Europe. And not a few bien pensants – me included, to my shame – might admit to a feeling after Donald Trump’s re-election as US president that democracy is too important to be left to the people.

Slightly more seriously, we need to ask ourselves what the qualities of democracy are that we should seek to defend. The first of these is, quite obviously, the rule of law. Should a political actor seek to overthrow a democratically established electoral process, then that is a crime within the rule of law. Witness the horrors on Capitol Hill in Washington DC on January 6 2021.

That’s the Feast of the Epiphany as it happens, but nothing to do with the coming of wise men. With Trump at the centre of it. Draw your own democratic conclusions – and weep for the rule of law.

Natural justice is to ensure that vexatious petitions don’t overthrow legally elected governments, either by lobby or violence.

Again, why does this matter and what is it about democracy that we hold sacred, even holy? It can’t simply be that we hold dear a kind of hard utilitarian ideal that what we elect to do is for the benefit of most of the people, for most of the time, as decided by popular mandate among the demos.

If we believe in democracy, as I believe most of us do, we’re presented with a choice: We can look to secularism as a solution, universal Enlightenment principles built on citizenship and equality before the law. Or we can look to a multiculturist model, keeping the peace between essentially separate communities and the state.

Or we can shape something on Augustinian Christianity, that recognises the limits of political democracy, which would eschew undemocratic theocracy, but which would hold that no political order other than the Body of Christ (the Church) can claim divine authority.

We’re in classic Rowan Williams theological territory here: “[T]he Body of Christ is not a political order on the same level as others, competing for control, but a community that signifies, that points to a possible healed human world.”

Unsurprisingly, I buy that. Williams goes further to state this spiritual effect on the political environments in which we find ourselves is likely to be “sceptical and demystifying.” Which seems to be a reasonable manifesto in a democracy.

The principle of election can be a worrying one in theological terms. We don’t “elect” God, though some secularists would claim that the Godhead is our invention. Rather, it has sometimes been perceived to be the other way around historically.

Reformational Calvinism would hold, among many other things, the rather terrifying view that we’re elected by God. “The Elect” are those who will be saved, while the rest of us (I presume) can rot in hell. Little democracy there.

Less deterministically, a more modernist worldview would argue that the Christian faith, on which foundation western civilisation is built, offers a viable moral definition of the lawful state, with which politicians of all (democratic) persuasions can tackle issues of global justice.

One such issue of natural justice is to ensure that vexatious petitions don’t overthrow legally elected governments, either by lobby or violence. That’s an important aspect of Christian witness and will require true grit in in its application during the years ahead. That’s, if you will, our grit in the democratic oyster.