Article
Assisted dying
Comment
Death & life
Politics
5 min read

The careless conflation of independence, autonomy and dignity

As Jersey begins to legalise assisted dying, there’s keyword confusion.
A elderly women in a care home stands and places her hands on the shoulders of a seated woman.
Eberhard Grossgasteiger on Unsplash.

Reviewing Canada’s legislation on assisted dying, one article raises the concern: “Does it make dying with dignity easier than living with dignity?” This insightful question cuts to the centre of the debate: dignity. Or more particularly, the unwitting conflation of dignity with independence, and of independence with autonomy.  

As Jersey becomes the first place in the British Isles to begin the process of legalising assisted dying, I feel that we should listen carefully as to how and where these terms are being used, both in the formal debate, and in the commentary that surrounds it. The States Assembly in Jersey voted to allow the development of assisted dying legislation for those with six months to live (or twelve months if their condition is neurodegenerative). A second vote to make assisted dying available more broadly to those who experience conditions that entail “unbearable suffering” was defeated by a narrower margin. Reading the flurry of press releases that followed the vote, these keywords, autonomy, independence, and dignity, are everywhere. But are we really thinking about what these words communicate?  

People in positions of wealth and power have more independence and autonomy, more choices and freedoms, but it is we who ascribe dignity to those in that position.

The word dignity comes from the Latin word dignus, meaning ‘worthy’, and this is still the primary definition given to the English word dignity today. The OED dictionary has it as “the quality of being worthy or honourable”, immediately followed by reference to “honourable or high estate”. If this is so, then dignity is not something that can be bought, nor assumed – it is a status conferred upon someone by the esteem in which other people hold them. The haughtiest person in the world can still be esteemed undignified, as can the richest. Moreover, the opposite is also true: we are never prevented from conferring dignity upon, and esteeming the worthiness of, those who live the humblest of lives.   

And yet, if we are honest with ourselves – do many of us not quietly associate the idea of becoming rich and powerful with becoming dignified? Do we not tend to assume the worthiness of those in high office – at least until we meet them and realise pretty quickly that they all put their trousers on one leg at a time, the same as the rest of us. This association happens because we have such a tendency to conflate dignity with independence (the ability to live without assistance from others) and autonomy (the ability to make one’s own decisions, and not have those decisions limited or interfered with). People in positions of wealth and power have more independence and autonomy, more choices and freedoms, but it is we who ascribe dignity to those in that position. It is society who sees the autonomy of those in high status, and esteems it as dignified.    

Does this not unwittingly suggest that choosing to live in a state of extreme dependence on palliative care is, by implication, undignified? 

Repeatedly ancient wisdom, in the Bible, warns us not to assume that dignity comes with the freedom of wealth or power. All the great ‘heroes’ of that book suffer their indignities. Fresh from the success of his Ark project, Noah gets drunk and exposes himself. Elated from a victory against an enemy, King David dances half-naked through the streets. These are just two examples of the catalogue of embarrassments and mishaps that beset nearly all the kings and leaders whose stories are told as part of the Christian story. One after another, they stumble and struggle with life and leadership. The apostle Paul explains that this is because God uses the foolish things of this world to shame human pride, “for even the foolishness of God is still wiser than human wisdom.” Therefore, Paul argues, God chooses to speak to us through the weak and the lowly things and people of this world. Never was this demonstrated so clearly as when Jesus was born in a draughty stable, lived a life of poverty, and died a criminal’s death on a cross.

But what has all this to do with the debate over assisted dying? Well, I am struck by how often the idea of losing one’s independence (through disabling or terminal illness) is conflated with losing one’s dignity, and so dying through personal choice (autonomy) is presented as regaining it. One campaign group that speaks to this debate even calls itself ‘Dignity in Dying’ – but does this not unwittingly suggest that choosing to live in a state of extreme dependence on palliative care is, by implication, undignified?  

Independence is not possible for everybody, or not possible to the same degree. And dignity? Well, dignity is possible for anyone. 

The Dean of Jersey, the Very Reverend Mike Keirle, has spoken of his concern that the change in legislation will make vulnerable people feel pressured to end their lives. Examples from Canada, where physician assisted dying is already available, show that his concern is not unfounded. In 2022, Canadian veteran and Paralympian Christine Gauthier phoned her caseworker to chase up the over-due installation of her new wheelchair ramp. She then describes how she was horrified to find herself being advised to consider assisted dying instead.  

"It is remotely just what they're doing,” says Gauthier, “exhausting us to the point of no return. […] I was like, 'Are you serious?' Like that easy, you're going to be helping me to die but you won't help me to live?"

Gauthier is not alone – she spoke out when she learned that four other Canadian veterans had reported similar experiences. In these unhappy moments, one can see how dangerous the assumption can be – the assumption that no one would want to live a life of needing help. Here are disabled people who do want to live, and this assumption, this careless conflation of independence, autonomy, and dignity, leaves them fighting for their right to do so. Why should anyone have to fight or even speak for their right not to commit suicide? It is little wonder that disabled actress, Liz Carr, describes assisted dying legislation as “terrifying” for disabled people. 

I respect that there are terminally ill people, and those who love them, who speak from a desire to end their suffering; it is clear that people on all sides of the debate need to have this difficult and emotionally charged conversation. But whatever the eventual outcome in terms of legislation, we must be careful that it is not based on careless assumptions, or on the conflation of one thing with an entirely different other. Independence is not possible for everybody, or not possible to the same degree. And dignity? Well, dignity is possible for anyone – it is a state that can be conferred whenever, and upon whomever society chooses to confer it. Autonomy is the matter in question – we are talking about autonomy in dying. And whatever happens, we should by no means legislate in a way that leaves disabled people esteemed unworthy, left open to the indignity of fighting for their right to live. 

Review
Books
Culture
Economics
Politics
5 min read

Abundance and the attempt to build a better world

Is this policy the antidote to the zero-sum game of politics?

Josh is a curate in London, and is completing a PhD in theology.

Construction worker climb a steel framework.
Josue Isai Ramos Figueroa on Unsplash.

What do you do when more money won’t solve a government’s problems? Abundance: How We Build A Better Future, the new book by Ezra Klein and Derek Thompson is an extended polemic against a form of government—particularly as practiced by US liberals—that stymies policy delivery. However technocratic that sounds (and the book often is), it forces readers to confront deeper questions about the nature of politics.  

At the heart of the book is a critique of what the authors, drawing on the film Everything Everywhere All At Once, call 'Everything Bagel Liberalism'. In the film topping are added to bagel to the point that it becomes a blackhole. So too, Klein and Thompson suggest, with so much well-intended policy, in which in seeking to tick every possible box and satisfy a range of regulators it becomes a delivery blackhole and little is actually done. The authors ask whether parties of the left are focused on measuring spending to the exclusion of measuring what gets built.  

The first chapter gives a good sense of their approach.  It tells a familiar story about the way in which so many are being priced out of cities because of a lack of affordable housing. However, in doing so, it highlights a surprising harm: that geographical proximity remains an important enabler of technological innovation so a lack of affordable housing in cities means a loss of creativity. 

The diagnosis is perhaps even more surprising coming from American liberals. Special interests—including those seeking to protect the value of their own houses—weaponize interlocking sets of well-intentioned legislation to prevent homes being built. Subsequent chapters apply that similar logic—regulation and a lack of focus resulting in inaction—to infrastructure, government capacity, scientific research and the implementation of new inventions. 

The book's strength is that it is not particularly detailed in its policy proposals. Klein and Thompson instead offer abundance as a lens through which policy development can be viewed: what do we need more of and how do we get it? This lens can be applied from within a wide range of ideological frameworks. It is not itself a worldview but a challenge that any politics should be obsessed with effective delivery not simply desiring the correct end-state.  

The book is unapologetically focused on America and the failures of progressive governance, particularly in California. (One of this book's peculiar legacies will be to leave many who have never been there perpetually invested in California's struggles to build high-speed rail.) Nevertheless, the approach already has its advocates in the UK - for example, the Centre for British Progress which set out its stall last week, and it is not hard to see how an agenda here that could be seized by a less hesitant Starmer government.  

Any plausible political analysis must hold together the reality of scarcity and abundance. Losing sight of either unmoors us from the actual world we find ourselves in.

Indeed, perhaps the book might feel more realistic if it had other countries in mind. Reviewing Abundance, Columbia economist Adam Tooze describes the book as painful to read, characterising it as a manifesto for the Harris presidency that never was. Indeed, according to the authors, the book was originally scheduled for release in summer 2024 to influence the Democratic platform leading up to the 2024 elections. Instead, it appears in 2025 amid Trump's assault on institutions, Tooze's Columbia among them.  

In an interview on Pod Save America, the authors argued that the book is still relevant, offering a framework with which Democrats can oppose Trump. Thompson described the Trumpian view of politics as fundamentally shaped by scarcity. He suggests that behind 47th president's policies—most notably the tariff agenda—is the conviction that every interaction is zero-sum; for you to gain, I must lose.  On this analysis, the way to oppose a politics that pits groups against one another over limited resources—housing, trade, jobs—is to figure out how the government can provide more and argue for it. In its critique and its hopefulness, Abundance offers those who believe in institutions a way to navigate—even work with the grain of—the anti-institutional temperament of contemporary politics.  

There might be something to this messaging, but scarcity plays an unmissable role in Klein and Thompson's argument. Remember that they characterise what they oppose as "Everything Bagel Liberalism", policy that tries to achieve every outcome and loses focus in doing so. They may conceive scarcity differently to Trump, but their book is a warning policy cannot deliver as much as we think. It is a call for us to oppose, to compete against those special interests—whether they be residents’ associations wanting to hold up house prices or politicians wanting to cut research grants—whose policy priorities overload the bagel.  

At heart, the book is a reminder that ultimately the salient scarcity in politics is not housing or trade or even money. It is time. Abundance cautions governments that unfocussed policy yields the time entrusted to them by the governed.  

Humans cannot lead politics completely beyond its zero-sum logic. The world is so often a violent competition over resources and government must restrain that violence while avoiding being co-opted as a means of exploitation.  And yet, politics is also—even primarily—an avenue through which communities answer a primal summons to be fruitful, abundant.  

Ultimately, any plausible political analysis must hold together the reality of scarcity and abundance. Losing sight of either unmoors us from the actual world we find ourselves in. Yes, there is so much broken and warped to reckon with, and we must grapple too with our finitude’s bluntness, but so too is creation replete with goodness, among them our capacity to invent and deliver what we need together. 

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