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.

Article

Comment

Community

Politics

8 November 2024

10 min read

How to respond when politicians talk about “our way of life”

Alasdair MacIntyre’s thinking helps us understand what we share across society.

Joel Pierce

Joel Pierce is the administrator of Christ's College, University of Aberdeen. He has recently published his first book.

Four men in suits, sit next to each other smiling, in the House of Commons.

Reform MPs in the House of Commons.

House of Commons, CC BY 3.0, via Wikimedia.

What is “our way of life”? It’s a phrase which slides easily into the rhetoric of politicians of every stripe. It’s what the Reform Party says is threatened by multiculturalism, but what do they mean by it? What kind of politics is sustained by talk of “our way of life” and is there a better way of thinking about such politics?

This summer, we made an exception to the time limit rule for television in my house, mainly so that I could have the Olympics on from morning to night. It’s a habit I acquired growing up in the United States, where an obsession over the quadrennial medal count is one of the few remaining things which bridges political and regional divides. During the Cold War, the Olympics were a way for Americans to proudly affirm the superiority of our way of life over the rigid training schedules and alien ways of the rival Soviet Union.

Although my memories begin around the fall of the Berlin Wall, old habits die hard, and so the Olympics, to me, was endless coverage of plucky underdog Americans overcoming the odds to defeat the machine-like discipline of a new set of rivals–now Russia and China

I moved to Britain just before the 2010 Vancouver Winter Olympics at which Britain won exactly one medal. At first I was bemused by the BBC’s coverage, which, of necessity, had to focus on British Olympians with little chance of winning. I was invited to cheer on eighth or ninth place finishers who had committed their life to a craft which would never bring the rewards of lasting fame or financial security. For them the reward was the Olympics themselves, the chance to compete amongst peers, to push themselves to their highest level, enjoying their sport and their performance for what it was, not for any external reward. In the terms of philosopher Alasdair MacIntyre, what these Olympians displayed was dedication to the internal goods of their sport–those goods that make a particular activity worth doing for its own sake. The Olympics were not about medals for them, but about showing what could be achieved if, as Olympians must do, they made their sport their way of life, dedicating themselves to its unique forms of excellence.

Sports, for MacIntyre, are but one example of a broader category he labels ‘practices’. Although MacIntyre has a technical definition of what counts as a ‘practice’, the general idea can be conveyed through examples he gives such as farming, researching history, architecture, chess, and chemistry. Practices are human activities which are worth doing for their own sake, which require a degree of skill and excellence, and in which what counts as that skill and excellence is, in part, defined and discerned by the people who participate in the practice. This last criterion points at something important about practices for MacIntyre: they are inherently social.

This is obvious in the case of sport. For an individual athlete to compete in a race they need not just other competitors to race against, but also trainers and coaches to prepare them for it, governing bodies to organise it, and, hopefully, spectators to cheer them on. It is, perhaps, less obvious in the case of individual farmer, but even here, one has to be taught to farm and, if one is wise, continues to learn and adapt through consulting with other farmers. A different way of putting this is that practices are the kinds of things which it’s not absurd to call “a way of life”. For an Olympic curler, curling is a way of life, just as much as farming is for a farmer.

There are many ways of life, many modes of being British, as diverse as the professions, hobbies, and passions which we find to have inherent worth.

However, this seems to offer little help in defining “our way of life” if it is being used in the way our politicians like to talk about it. If there’s one thing that I learned from all those BBC features of British Olympians way back in 2010, it was that aside from geographic proximity, there was not much that their way of life had in common with mine. I may be within driving distance of the rink where Winter Olympian Eve Muirhead learned to curl, but my workdays of wrestling spreadsheets and answering emails have little in common with ones spent lifting weights, studying strategy with coaches, and perfecting the just right spin on a stone as it’s released.

And, of course that’s not just true of Olympic athletes. The investment banker who attends our church shares a way of life with his colleagues in Edinburgh, London, and Tokyo, that is completely opaque to my wife and I, immersed as we are in the worlds of ministry and academia. I glimpse some of the internal goods of the practices of our dentist watching her check my daughters’ teeth and our plumber as he fixes our leaking radiators, but their way of life, the rhythms of their days, and what gives them satisfaction in their work as they move from appointment to appointment, eludes my understanding.

Where does this leave the search for a British way of life? If practices are as important to forming us as MacIntyre thinks, then the quest for any singular British way of life will ultimately be fruitless. There are many ways of life, many modes of being British, as diverse as the professions, hobbies, and passions which we find to have inherent worth. And even this characterisation does not go quite far enough, because all of these practices have a way of bursting the boundaries of Britishness if they really are worthwhile. A century and a half ago, football, rugby, and cricket were quintessentially British sports. Now they belong to the world.

Similarly, valuing these practices well within Britain has a tendency to open us to accepting those from outside our borders who can help develop them. The best footballer in Britain is Norwegian. Many of the doctors who ensured my daughters arrived safely after complicated pregnancies were originally from India and Pakistan.

Still, one might wonder if thinking about community through the lens of practices, as MacIntyre does, is too much of a solvent. Isn’t it a way of imagining us living near each other, but not with each other; siloed in our practices, in each of our communities, not understanding what our neighbours are up to? Not necessarily. For MacIntyre, the familiarity that arise from living near someone, hearing their worries at planning permission hearings, arguing with them at the local school’s parent council meetings, organising a community fundraiser together, or, even, being part of a family with them, can help develop an understanding of the internal goods of practices which we do not take part in. I haven’t lifted a brush to paper to since my secondary school art class, but my mother-in-law’s virtuosity with acrylics has led me to acquire an increasing appreciation for painting. Part of what helps facilitate this recognition is that, as MacIntyre argues, although the internal goods and the skills required to achieve them tend to be different for each practice, the virtues which we develop while pursuing them–patience, honesty, courage, self-control–are universal. Part of what helps us recognise others’ activities as practices, as worth doing for their own sake, are the virtues we see them develop as they do them.

This sort of recognition requires familiarity, the sort I might have with my neighbours in our corner of rural Aberdeenshire, but that I am unlikely to have with fellow citizens in Cornwall, Cardiff, London, or Glasgow. How then are we to respond to national politicians talking about “our way of life”? One answer might be: with extreme scepticism. This is MacIntyre’s approach. He rejects the nation-state, which he calls “a dangerous and unmanageable institution”, as a potential channel of communal unity. Instead, he calls on us to admit that modern nation-states exist as a contradiction, being both “a bureaucratic supplier of goods and services” and yet also something treated as sacred, which we are asked, on occasion, to surrender our lives to preserve. He notes with characteristic acerbity, “it is like being asked to die for the telephone company.”

However, here I’d temper MacIntyre’s rhetoric somewhat. While my attachment to bankers in Canary Wharf is largely a happenstance of history, a contingent fact generated by long forgotten necessities of eighteenth century geopolitics, it has nevertheless resulted in both of us being issued the same passport, governed by the same tax regime, and having the same set of regulatory agencies to complain to when things go wrong. Those may be manifestations of what MacIntyre disparages as “a bureaucratic supplier of goods and services”, but they nevertheless do bind us together. As such we both have an interest in making sure this bureaucracy acts as justly as it can, not because it is the embodiment of all that is British, Britain is much too diverse and interesting to be fully embodied in our political institutions, but because we all have an interest in the institutions in which we are enmeshed, British or otherwise, being run as justly as possible.

Surely politics is all about securing as much money and resources as possible for the people most like oneself. That, it seems, is often the unstated assumption when the talk of “our way of life”

Because we find ourselves tied together by these institutions to a diverse collection of people, we have an interest in learning about those with whom we live. Even those who are far away. And to also celebrate when goods and services delivered by our institutions result in success to which we, in a remote way, have contributed. I may not share a way of life with Adam Peaty, but, thanks to the BBC, I can have a glimpse into what his way of life is and can be happy that through my taxes I have contributed, in a small way, to helping him win another medal. Since that 2010 Winter Olympics Britain has come quite a long way and there is nothing wrong with a little vicarious pride in our athlete’s accomplishments.

But I can also be proud of athletes who didn’t win. Ones like BMX rider Beth Shriever who handled her unexpected last place finish in her final with a kind of grace and maturity, the kind of virtue, which someone more dedicated to her practice than to just winning can demonstrate. It is the facilitating of this kind of moral achievement which is more valuable than any medal.

Similarly, I can rejoice when a new hospital gets built in a neglected area in London, or more council housing is supplied to people in need in Edinburgh, hopeful that these lead to my fellow citizens achieving the kind of flourishing lives they deserve. I can be angry, when I discover that the money I’ve paid towards postage has been used to prosecute innocent victims of a computer glitch, and pleased when the opening of a new rail line eases the otherwise stressful commute of tens of thousands in London. The state may be a bit like a telephone company, but a well-run utility can do a lot to supply people with the goods they need to make their lives. As long as I’m a subscriber, as long as I’m tied to people through national institutions like the state, I have a moral duty to ensure that they’re run as well as possible.

This way of thinking about politics may strike some as idealistic, the kind of view only a naive Christian ethicist could endorse. Surely politics is all about securing as much money and resources as possible for the people most like oneself. That, it seems, is often the unstated assumption when the talk of “our way of life” is deployed and why so much coalition building in our politics turns on finding a convenient other against which to define “our” similarity. Take your pick: immigrants, the EU, woke elites, the Tories, or Westminster (among a certain brand of politician here in Scotland).--. Growing up in the USA, the Soviets, and then the Chinese, and now, depending whether one lives in a Republican or Democratic district, the other political party, have served the same purpose. The problem is that we aren’t that similar, we are and always have been a diverse lot with diverse needs. Every nation is. There is no one British way of life and to allow our politicians to try to sustain the fiction that there is lets them off the hook. Solving deep seated economic and social inequality is hard. Blaming immigrants for not embracing our way of life is easy.

So, perhaps the sort of politics that I am talking about here is idealistic, nevertheless it is the only kind that can sustain a just government in the long term. Without acknowledging the importance of goods we only partly understand which are pursued by people whose ways of life are different from our own, we cannot hope to sustain the minor miracle of coordination and mutual aid that history has gifted us with in our united kingdom.