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
Culture
Death & life
Digital
Easter
4 min read

Do you have a right to be remembered?

Our desire to be in control might not survive our demise.

Jack is a graduate of Peterhouse, University of Cambridge and Blackfriars, University of Oxford. He writes, and also works in local government.

A composite show a smiling woman next to a small illustrate of someone walking off into the distance.
Kristyna Squared.one on Unsplash .

“Madam, those that are about to die salute you.”  

Words attributed to Roman captives and criminals fated to die before the emperor, were used (ironically) by Councillor Kieron Mallon at the last Council meeting of this term of Oxfordshire County Council last week. ‘Madam’ was the Council’s Chair, wishing everyone well. Elections are on the way. 

Easter is also on the way, and in the period leading up to the commemoration of the resurrection of Christ from the dead, nearly 2,000 years ago, Christians are invited to think about their own mortality. ‘Remember that you are dust, and to dust you will return’ were words my priest intoned to me as he marked a cross with ashes on my forehead on 5 March, Ash Wednesday. 

Ash already emblemizes a belief in rebirth, even before the power of the story of the Christ’s resurrection is considered. I for one felt immensely hopeful on Ash Wednesday this year. Having just secured a new place to call home, and one year into my job as Democratic Services Officer to Oxfordshire County Council, looking after the likes of Councillor Mallon, life felt pretty swell. 

My priest and I spoke about the ways in which death and hope are joined at the hip. The ancient Greeks believed that a phoenix obtains new life by rising from the ashes of the one before it. So do we. I have found myself, so far this year, visiting people and places I strongly associate with former lives, from friends I lived with as an undergraduate to a town I went on holiday as a child to the beach where my late Granny’s ashes were scattered. ‘Ashes to ashes, dust to dust.’ 

More specifically, the Christian believes that ‘whoever loses their life for [Christ’s] sake will find it’, in the sense that true self-discovery arises when we let go of the ego, when we allow ourselves to be changed. Thinking about mortality, therefore, changes life, in so far as we are better equipped to surrender and salute the Saviour. That worldview has shaped public servants in years gone-by. 

An overwhelming majority of people in the course of human history have been forgotten.

I recently heard Dr Ian McGilchrist, the psychiatrist, describe the desire to control everything in life as the ‘besetting sin’ of the age in which we live. The desire to be remembered, rather than reborn, captures it better in my mind. Mankind has always wanted to remain in control. Souls will always be reluctant to surrender. However, what we have now is a world in which people feel uniquely entitled to make impact. 

People feel that they have a right to be remembered, but it is not so. An overwhelming majority of people in the course of human history have been forgotten. Moreover, the past can be especially compelling when we have a window into a world in which people did not necessarily expect to make any kind of worldly impact whatsoever. Theirs was a happier place. 

The twentieth century was described by Philip Rieff in 1966 in terms of the ‘Triumph of the Therapeutic’. He wrote, ‘Religious man was born to be saved’, but ‘psychological man is born to be pleased.’ ‘Psychological man may be going nowhere, but he aims to achieve a certain speed and certainty in going’. Therapy enables that objective. But therapy to what end? 

Counselling can be construed as a device to regain control. The counselled, if fixed, can go about trying to change the world, trying to make an impact, resuming the rather pleasing but never-ending mission to be remembered. For anyone of a religious sensibility, however, that is not the objective. Rather, new life is given only for the whole resurrection story in our own lives to be repeated. 

Around the time that Rieff wrote his book, the historian Herbert Butterfield, a Christian, wrote this. ‘Those who lived when the world was static – when the silhouette of the ploughman against the horizon hardly changed in the passage of a thousand years – may have something to teach us, who only know a breathless, rapidly changing world and who seem to be having to pluck what we can from life while running at full speed.’ 

Social media has surely exacerbated this condition because it connects us to others at the cost of contemplation about what life – and death – really entails. It is a place where we try to evidence to others the impact we are having, where we write our own eulogies and our own epitaphs and have access to the whole world whom we expect to read the same. 

Life changes to a much greater extent these days, in this place, than it did for the ploughman in the passage of a thousand years, or captives and criminals in the Roman world, including Jesus Christ who was identified as one such. However, if we can somehow create conditions to focus less on having impact in and on a volatile world, and being someone who ought to be remembered, we will find that we have more hope. 

In turn, we will change the world for the better, but despite ourselves, and for me that is what this period leading up to Easter is all about. We may find that others who are about to die salute us too, for the good deeds we have done that may well be forgot. 

Celebrate our 2nd birthday!

Since Spring 2023, our readers have enjoyed over 1,000 articles. All for free. 
This is made possible through the generosity of our amazing community of supporters.


If you enjoy Seen & Unseen, would you consider making a gift towards our work?


Do so by joining Behind The Seen. Alongside other benefits, you’ll receive an extra fortnightly email from me sharing my reading and reflections on the ideas that are shaping our times.


Graham Tomlin
Editor-in-Chief