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. 

Essay
Comment
Politics
10 min read

England needs a written constitution that defends against populism

A new resolution acknowledges what forges a sense of right and wrong.
A wide angle picture shows a king and queen on thrones before many people in ceremonial clothes.
The Opening of Parliament.
Roger Harris/House of Lords, CC BY 3.0, via Wikimedia Commons.

New Year is often a time for reckoning and resolutions. Nations, no less than individual persons, would benefit from such an annual reckoning with themselves.  

If in life we must always strive to find some Aristotelian ‘golden mean’, between recklessness and timidity so it is in the life of states and nations. Many countries have been brought into ruin by the excess of misdirected appetites and wrongly-ordered desires: demagogues inflaming the people; oligarchs seeking to turn the res publica – the ‘public thing’ – into their own personal fiefdom. Revolutions, corruption and public lassitude are the wages of such sins. Ultimately, it ends in the death of the state itself: the collapse of all legitimate authority into warring gangs, while refugees flee, if they can, to the borders. 

Many countries, conversely, go through their lives in cowed timidity, until they end up in an old age of regret, having never achieved their full potential. These nations do not necessarily collapse, but slowly decline – unable to reform themselves, locked in a vision of their past that was better than their present or any imaginable future.  

 England is at risk of both these dangers. On the one hand, a reckless reactionary populism, which has long laid dormant, but has been unleashed since 2016. It threatens to abandon all prudence and overthrow all restraint, to attack the civil service and the courts, to reject Human Rights, to corrode civic discourse, and to set aside all procedural propriety, until we end up sodden in the gutter of despotism. On the one hand, a persistent constitutional conservatism stands in the way of the necessary, long overdue, reforms which would breathe life and vitality back into an old, tired, country, and would give our institutions the strength to resist such destructive forces.  

Nations, like people, can experience decisive moments of what might be termed repentance. When they wake up in the gutter – their capital city bombed, their army disbanded, their people starving – they can turn from the paths which took them to that place, and find a newness of life, a new hope, embodied in a new constitutional order. This is what Germany, Italy and Japan did after 1945. They can also experience a kind of conversion, away from false principles to truer ones, as much of Central Europe did after the fall of the Berlin Wall.  

I am using theological language here to describe merely civic and political attitudes, which is always a dangerous thing to do. It would be a misreading of my intent if one were to conclude that I conflate a well-ordered polity with the Heavenly City. Nevertheless, a well-constituted polity, in which freedom and justice, peace and the common good, are not only treasured but actually – to some practical extent – achieved, is an inestimable blessing. We should strive to obtain it.  

A well-constituted polity is based upon the principle of ‘public government’. The state is a public entity, belonging to the public, in which public office is a public trust to be used for public ends, and where citizens in public life must be faithful stewards of the public good, for which they are responsible to the public. 

Democracy is our shorthand term for this arrangement, although it is a rather clumsy one. Democracy, properly understood, is not unlimited majority rule, nor the unconstrained rule of the person elected by the majority. It is, rather, a complex political system that combines representative and responsible government with civil liberties and the rule of law.  

Populism is a caricature of democracy. Populists attempt to undermine the barriers that restrain abuses of power. Their attempts to weaken the judiciary and civil service, sideline those who disagree with them, infringe fundamental rights, centralise power, and restrict public dissent, must therefore be seen as attacks on democracy. They put arbitrary power into the hands of particular persons. 

England’s position is not that of Germany in 1945. It might, in some ways, be analogous to that of Central Europe in the 1990s. Much of England today looks like I remember my first visit there then: the same grey faces, the same cheap clothes, the same visible effects of bad housing, bad food, and lack of opportunity. If anything, England is worse off, because at least those countries had hope of better days ahead. No one yet has imagined an English future better than its past.  

England has been let down by a failed ideology – that of neoliberal capitalism, which, as Dr Abby Innes points out, is every bit as rigid and doctrinaire as the official Marxist ideology of the former Communist states. England has been let down, too, by decades of corrupt, incompetent, short-sighted and careless government. The symptoms of misgovernment can be seen in England’s economic record, its social problems, its crumbling infrastructure and over-stretched public services.  Outside the Customs Union and the Single Market, England is isolated from its European neighbours.  The country is not living up to its potential.  

This should spur us to consider the weakness of English democracy. As currently established, the state often fails to serve the common good. The English do not live in a well-constituted polity with ‘public government’ as its foundation, but in a fiefdom-state that has been cut, privatised, deregulated into near oblivion.  

If it were only a matter of specific individuals, or of one party, the problem could easily be fixed. But the country has not only been let down by this government or that government, by this party or that Prime Minister. It is the system of government, the constitutional order as a whole, that has failed us. 

Restoring England’s hope for the future, its prosperity, and its quality of life, must begin, then, with the improvement of English democracy, and that with a refoundation of its constitution. This is hard to hear, because, as Mr Podsnap put it in Charles’ Dickens 1864 novel Our Mutual Friend, ‘We Englishmen are very proud of our constitution, Sir. It was bestowed upon us by Providence. No other country is so favoured as this country.' It is hard to admit that something is broken, when once it was so highly prized – indeed, so intrinsically bound up in England’s sense of national identity. 

The Westminster Model of democracy is not without its virtues. Its origins can be traced far back into English history. Yet it did not develop into maturity in England alone. Bagehot was carried around the world, read under palm and pine, and drilled into the ruling classes from Vancouver to Colombo. The Westminster Model owes much to Magna Carta and Simon de Montfort’s ‘Model Parliament’ of 1295, but it owes just as much to the developments of the Victorian age: (nearly) universal suffrage, political parties, manifestos, and the establishment of a permanent, professional and non-partisan civil service.  

The transformation of Empire to Commonwealth ended British rule, but not the British way of ruling. Westminster Model democracy had to be set down, of course, into a written, supreme-and-fundamental law, through which all the essentials were faithfully reproduced. If you want to discover the Westminster Model of democracy at its peak, read the constitutions of Belize or the Solomon Islands.

The rejection of written constitutions has been a prevailing English conservative principle since Burke. However, it leaves us defenceless against authoritarian reactionary populism. 

The irony is that those who are most comfortable with the imperial legacy are also those who are doing most to destroy public government at home. While fetishizing ‘The British Constitution’ and ‘Our Eight Hundred Years of Unbroken History’, the populist right rejects the principles and the values upon which that achievement rested. Just as they seek to create a pastiche of 1950s Britishness (absent of strong workers’ rights, strong unions, a generous welfare state, and publicly owned utilities and services), so likewise they seek to create a pastiche of the 1950s British Constitution, without the self-restraint, moderation, decorum, public service ethos, and high levels of social trust and cohesion, which made that system of complex unwritten rules work.  

The Blair-Brown reforms of 1997-2010 are a particular target of reactionary ire. The Human Rights Act mitigated, although it did not remove, the absolutism of Parliament. It gave the people who have little voice under a purely majoritarian system – ‘the weird, the wicked, the weak’ – a means by which to challenge the exercise of power. Devolution broke the prevailing English notion of British uniformity: it not only allowed Scotland and Wales to have a (muted) political voice and some (tightly constrained) freedom to craft their own policies, but also forced England into a reckoning with its own national identity. So far, this has played out mostly through the doubling-down on what the former Labour MP and scholar of English identity John Denham calls ‘Anglo-centric British nationalism’. The Tory – and Reform UK – constitutional agenda is obsessed with restoring the unlimited power of Parliament and of reinforcing the Anglo-centric British state. 

As we can see, from every NHS waiting list to every pothole in the road, the Anglo-British state is no longer working very well. It has all the vices of its past, and few of its virtues. A return to the pre-1997 status quo ante is impossible – it would be like trying to retake Hong Kong. Parliamentary absolutism tempered by the ‘good chaps’ theory is no longer a viable option. Either we must accept an untampered absolutism – which is the agenda of the reactionary populist right – or else we must deepen constitutional reform, and arrive at a new constitutional settlement which accepts that the British Imperial state, oriented to the needs of maritime imperial commerce, is over, and that an English nation-state, oriented to the common good of the ordinary people of England, is now needed.  

This entails a new, democratic, constitutional foundation. Small-c conservatives might baulk at this. The rejection of written constitutions has been a prevailing English conservative principle since Burke. However, it leaves us defenceless against authoritarian reactionary populism. Moderate, sensible, responsible conservatives should learn to think differently about written constitutions. Paradoxically, constitutionalism strengthens the state. By bounding and limiting state power, and providing a robust system of responsibility, accountability, and restraint, constitutional government actually enables the state to draw upon a deeper well of public legitimacy.  

What would English identity look like, if it were forged between the Channel and the Tweed, and not between the Nile and the Irrawaddy? What might an English constitution look like, and what values and principles might inform it?  

A constitution for England must recognise that England is a society of many faiths and none. It is, however, an acknowledgment that Christianity has forged and formed not only our institutions, but also our understandings of right and wrong. 

In addressing the last of these questions, the Christian tradition has much to add to the conversation.  

Christian theologians and political philosophers have spilled a lot of ink, in the past two millennia, on questions of good government, on the relationship between church and state, and what it means to be a Christian and a citizen of an earthly state.  

There seems to be an assumption – amongst both supporters and opponents of written constitutions – that a written constitution would have to be based on secular values. This stems, in part, from our ignorance of our own Westminster Model constitutional tradition. The constitutions of the United States and of France might be strictly secular, but the constitution of Antigua and Barbuda claims to be ‘founded upon principles that acknowledge the supremacy of God’, while that of Tuvalu explicitly refers to ‘respect for Christian principles’.  

This is not a bid for theocracy. A constitution for England must recognise that England is a society of many faiths and none. It is, however, an acknowledgment that Christianity has forged and formed not only our institutions, but also our understandings of right and wrong. To give all that up would produce an ethical vacuum in society, which will be filled only with ever more grotesque forms of exploitation.  

The cardinal ethical principle of constitutional democracy is a recognition of human dignity. At the origin and foundation of all institutions, and laws, and norms, we find ourselves having to cling to the fundamental command that Christians call the Golden Rule: ‘Do unto others as you would have others do unto you’. If we abandon that principle of human dignity, there is no solid ground on which to build a decent, well-ordered, democratic polity. Perhaps then we can build a new ‘Jerusalem’ in England’s grey and drizzly land. 

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