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. 

Explainer
Culture
Gaza
Israel
Politics
5 min read

Politics is the only way to solve the tragedy of Gaza

Trump is not the first person to want to create a Riviera by the Mediterranean.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A sign projected on to the Houses of Parliament reads: how many is too many.
A projection protest sign, London.
Christian Aid.

Whichever side you take in the Israel-Gaza conflict, the stories can't help bring a sense of desperation. Images of starving children, the fate of Jewish hostages still held in darkness - either way, this remains a place of unimaginable suffering. And meanwhile, the bombs keep dropping, people die, and Hamas retains its hold. 

Among Israel’s friends, voices have been murmuring a radical solution to the problem of Gaza. Donald Trump’s plan was to raze the territory to the ground, shift 50 million tonnes of debris and displace its people to neighbouring countries to build the ‘Riviera of the Middle East’ in what had until now, been Gaza. The plan might have been met with some amusement when it was aired, but it gave permission for many within Israel to think similar thoughts.  

Bezalel Smotrich, the Israeli finance minister, recently claimed that after the Israeli operation, “Gaza will be entirely destroyed” and its Palestinian population will “leave in great numbers to third countries.” Many within Israel seem to think the stubborn, Hamas-ridden enemy living next door needs to be eradicated. To a population weary of decades of conflict, fearing that there will never be peace while Hamas remains in Gaza, and aware of how difficult it is to winkle out the Islamic terrorist group while the Palestinian population remains there, you can understand the attraction of this radical solution. 

However, the Israelis might have good reason to be cautious. And that is not a counsel from their opponents - but from their own history.  

In the early 130s AD, the boot was on the other foot. It was the mighty Gentile Roman Empire that ruled over the same patch of land, which they were soon to call Palestina. Jews were a minority, but they still harked back to their long roots in the land, the days of Joshua and King David, and even more recently to the Jewish Hasmonean kingdom 200 years before - the last time before the modern state of Israel that Jews were in control of the land. 

The emperor at the time, Hadrian, passed through Jerusalem in 130 AD, along with his entourage and his lover, the young slave boy Antinous. He started to paganise the city, erecting statues of gods and emperors, even of his young favourite, all of them offensive to Jewish sensibilities. The smouldering resentment soon erupted with a revolt led by a fierce and determined Jewish fighter, Bar Kokhba. This was the second Jewish uprising after the earlier one in the 60s that had led to the destruction of the great Jewish Temple in Jerusalem by Titus, under the reign of the emperor Vespasian in 70 AD. For the Romans, one revolt might just be tolerated, two was too much.  

Hadrian came to the same conclusion as Bezalel Smotrich – a rebellious territory had to be erased from the map, although this time, it was Jerusalem that was to be eliminated, not Gaza. Its Jewish population was to be scattered, its name deleted, and memories of past glories buried for good.  

And so, in 135 AD, the bulldozers moved in. Jerusalem was effectively flattened, and a Roman city built on its ruins. Aelia Capitolina was its new name, a smaller city, yet decadently built around the worship of Greek and Roman gods, with splendid gates, pagan Temples, a classic Roman Forum, expansive columned streets – not quite the Riviera of the middle east, but maybe the Las Vegas. ‘Jerusalem’ was scrubbed from the map. 

At the centre of the sacred Jewish Temple Mount, Hadrian erected a statue of himself. He deliberately planted a statue of Aphrodite over the very spot where the early Christians insisted that the death and resurrection of Jesus had taken place – where the Church of the Holy Sepulchre stands today. Circumcision was outlawed, many Jews were killed, and those remaining were banned from the city, dispersed anywhere where they could find shelter. In fact, the map of the Old City of Jerusalem today is still marked by this design, with the two main Hadrianic streets diverging south from the Damascus Gate, with archaeological remains of the Roman city still visible for visitors. 

Yet of course it didn’t work. No-one calls it Aelia today. People's attachment to land goes deep. The Jews could not forget their roots in this patch of the earth's surface. As Simon Sebag Montefiore put it: “the Jewish longing for Jerusalem never faltered”, praying three times a day throughout the following centuries: “may it be your will that the temple be rebuilt soon in our days.” 

Palestinian attachment to land is similarly strong. Nearly 80 years after the creation of the state of Israel in 1948, families still cling on to the keys to homes that were taken from them during that traumatic period. Like the Jewish yearning for Jerusalem, they too, like people across the world, have a deep attachment to ancestral lands, which go back to the ‘Arabs’ mentioned in the book of Acts, to whom St Peter preached in the early days of the Christian church.  

Executive decisions by distant rulers such as the emperor Hadrian or President Trump might seem like neat solutions to intractable problems. But they seldom work in the long term.  

The famous biblical injunction ‘an eye for an eye, a tooth for a tooth’ was meant not as an encouragement to violence but the exact reverse. It was mean to set a limit to the development of blood feuds, which could, out of anger and trauma, so easily lead to disproportionate reaction and never-ending vendettas. When St Paul wrote “Beloved, never avenge yourselves, but leave room for the wrath of God; for it is written, ‘Vengeance is mine, I will repay, says the Lord’”, he was recalling an ancient piece of Jewish wisdom that set limits on human capacity to sort out intractable problems by violence. He knew a better way: “Do not be overcome by evil, but overcome evil with good.” 

Luke Bretherton, Regius Professor of Moral Theology at Oxford and a Seen & Unseen writer, argues that there are really only four ways you can deal with neighbours who prove difficult: you can try to control them, cause them to flee, you can kill them, or you can do politics – in other words, try to negotiate some form of common life, as ultimately happened in Northern Ireland, South Africa, and so many places of long-standing conflict. 

Politics, the business of learning how to live together across difference, is messy, complicated and hard work. Especially so when there are deep hurts from the past. Yet, as the failure of Hadrian’s radical solution shows, there is no real alternative in the long term. 

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