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. 

Article
Comment
Economics
Nationalism
Politics
4 min read

Millions of children go hungry in a country that dares to call itself godly

The gospel of national greatness is less about grace and more about political grit

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

A sand drawing shows an unhappy child's face with the tide coming in from below
A sand drawing for a child poverty campaign.
Barnardos.

If anything, the UK – and more specifically England – is becoming a Christian country again. But not necessarily in a good way. The rise of Christian nationalism mirrors the American experience, with Christian symbols such as the cross weaponised against asylum seekers and the knuckle-draggers under them, marching as to war. 

But there are still many non-belligerents who would stake a claim to our Christian nationhood. Wiser counsels such as the historian Tom Holland. Or Danny Kruger MP, who spoke to a near-empty chamber in parliament recently, before defecting from the Conservatives to Reform UK, about a Christian restoration, envisioning a "re-founding of this nation on the teachings that Alfred made the basis of the common law of England." He may need to explain that slowly to Nigel Farage. 

But by what measure do we claim to be a Christian country? Here’s one: Child poverty. It’s very hard to make a case for a state being foundationally Christian in principle if significant numbers of its children go hungry. And the UK shamefully ranks among the worst of the world’s richest countries in this regard, with our children’s poverty rates rising by 20 per cent over the past decade – defined as those living in a household with less than 60 per cent of the national median income, so currently less than about £19,000 a year.  

That’s some 4.5 million living in poverty, or 9 in a typical classroom of 30. Unless action is taken the number will push five million by 2030. Anecdotal evidence from teachers is truly shocking. Children arrive hungry at school with empty lunchboxes to fill and feed family at home. The UK ranks below poorer countries such as Poland and Slovenia, which are currently cutting their child-poverty rates, and well ahead of other wealthy nations such as Finland and Denmark.  

It’s a national disgrace. Christologically, it also fails the minimum threshold for a nation that supposedly holds that the kingdom of heaven belongs to children. In damp and sub-standard housing this winter, lacking nutritious diet and prone to ill-health, heaven will have to wait for these British children. 

The same gospel tells us that the poor are always with us, which may make us resigned to it. But political complacency won’t do. If there is always relative poverty against great riches, then the true measure must be what we’re trying to do about it. The damning answer to that seems to be very little. 

It’s actually worse than that. The circumstance is one of our own deliberate, political making, exacerbated by the then chancellor George Osborne, who introduced the two-child benefit cap in 2017. That limited benefit payments for families claiming Child Tax Credit or Universal Credit for more than two children. It was part of Osborne’s pantomime wicked-squire act, as he repeatedly told us with a straight face that “we’re all in this together”. It was also borderline eugenics, because one of its effects was to limit the breeding of “lower orders”, the benefit cap disproportionately hitting the budgets of working and ethnic-minority families. 

With Osborne’s selective austerity and social-engineering drive long gone, it’s well past time for a Labour government to do something to rectify such social injustice. Current chancellor Rachel Reeves must abolish the two-child benefit cap in her November Budget. With other welfare cuts prevented by Labour’s summer backbench rebellion, the question inevitably squawked by right-wingers is how that will be paid for. 

 Opposition parties relish the prospect of Reeves welching on pre-election promises not to raise taxes on working families. And abolishing the two-child welfare cap could cost £3.5 billion a year. 

There are creative ways and means. Veteran chancellor and former prime minister Gordon Brown – the unsung hero of the 2008 worldwide financial meltdown, without whom we wouldn’t have an economy to do anything with – proposes fairly taxing the excess profits of the £11.5 billion gambling industry, which enjoys VAT exemptions and pays just 21 per cent tax, compared with 35-57 per cent in other industrialised  countries. And if more money is needed then remove some of the interest-rate subsidy enjoyed by commercial banks when they deposit money at the Bank of England. That is what social justice looks like (gambling also costs the NHS £1 billion-plus in harms, so it’s time for the industry to pay up). 

That points to some fiscal answers. There are other actions that must be taken this autumn, at political conferences and on any platform available to those with a public voice and conscience. It’s good to see Stephen Cottrell, Archbishop of York and stand-in primate of England in the absence of Canterbury, laying into the two-child limit and benefit cap. 

Both Cottrell and Brown tell heart-breaking stories of children’s poverty in the UK. We must fight it and ensure that Reeves’ forthcoming Budget does so. As the children’s commissioner for England, Dame Rachel de Souza said recently that millions of children are living in “almost Dickensian levels of poverty”. The irony is that in Dickens’ time we were called a Christian country. 

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