Challenging OCD on Christmas Eve

A night without usual fears allows faith to be reclaimed.

Paula Duncan

Paula Duncan is a PhD candidate at the University of Aberdeen, researching OCD and faith.

A nocturnal snow-covered scene of a tree, chapel and Christmas tree casting shadows.

A chapel in Krün Germany.

Andreas Kretschmer on Unsplash.

The display on my car tells me that it’s just gone 11pm on Christmas Eve, and the temperature is below freezing. It’s the sort of cold that catches your breath the minute you step outside. The trees are glittering with frost. The stars are sharp and clear in the sky. Everything feels still and clean. In the carpark, I can hear the muffled notes of the organ playing familiar Christmas carols. People in Christmas jumpers are trickling in through the main church door. I can see Santa hats, some reindeer antler headbands; some kids have woolly hats tugged down over their ears. I haven’t been to a Christmas Eve service since I was a child.

I take a deep breath and try to let go of some of the anxiety about being here. My Obsessive-Compulsive Disorder doesn’t take a break for the festive season. I have previously written about my experience with OCD: the way that it impacts my experience of faith and how it makes going to church feel difficult. I find it a challenge to sit with the doubt and uncertainty of not being 100 per cent sure that I believe in God but badly wanting to. I struggle with not knowing what verses of the Bible will be read and how I will feel. I worry about something sparking my OCD and then being held hostage by my own intrusive thoughts. This always feels worse when I’m tired, too. I am far more likely to engage with the intrusive thoughts my OCD offers up when I’m not well rested. But I’m here. Despite feeling nervous, I am happy to be here. The warm glow of the light inside the church is welcoming and the low hum of happy voices feels reassuring as everyone discusses their Christmas plans.

There is a flurry of chatter as we are all invited to wish one another a ‘merry Christmas!’ and then we fall into a restless and expectant silence as Christmas day begins.

I don’t have the usual fear of the unknown today. We are here for the carols and the watchnight service – eagerly awaiting midnight and the dawn of Christmas Day. I might not know exactly what the structure of the service will be, but I can almost guarantee that the reading will begin with words from the Gospel of Luke. We’ll be told of the census of the Roman world, and we’ll hear that Mary and Joseph would have to travel to Bethlehem. There will be no room in the inn. The baby Jesus will be born, and laid in a manger.

This story is one that I heard at childhood Christingle services. It’s the one that we were told every year in primary school with abundant colourful crafts to help us to remember the key points. I’m reminded of nativity plays – watching them and being part of them, and the slightly off-key renditions of ‘Away in a Manger’. I remember doing the reading as a Girl Guide – nervously practicing beforehand to make sure that I could pronounce all the words correctly. I remember being proud of myself for standing up and reading at all.

Armed with those memories as I cross the carpark, I know there is going to be nothing unexpected in the Christmas Eve service. My OCD still finds ways to make its presence known – I insist that I get to sit at the end of a row because that’s where I feel most comfortable. I read the order of service a few times to check that everything there is as I expect. I make some concessions to anxiety for the sake of being able to turn up at all. But I am here, and I feel safe.

The readings are exactly as I expected. I know all of the Christmas carols that we sing. At midnight, there is a flurry of chatter as we are all invited to wish one another a ‘merry Christmas!’ and then we fall into a restless and expectant silence as Christmas day begins and we wait for the minister to say a few words about what this means. I am with my family and there are familiar faces in the congregation – people I know from various places. It’s nice knowing that we are all here for the same reason and with the same intention.

There are many cheerful Christmas wishes as we leave the church and I’m proud of myself for being here. Maybe my faith is something I can reclaim from my OCD eventually, however slowly. For now, I look up to the sky as we head back out into the carpark and smile at the stars twinkling down at us. I feel perfectly fine.

Since that year, lockdown excluded, my family have been to the watchnight or the Christingle services most years. As a theology student, I sometimes feel a little self-conscious about how infrequently I go to church. I sometimes joke about being a Christmas Christian in terms of my church attendance and certainly in how I engage with the Bible. I like to read a little on Christmas day and I love watching the televised service on the BBC on Christmas morning. It’s the time of year where I am perhaps most active in my engagement with my faith. I look forward to going to the Christmas Eve church services now. It’s the one time where I don’t have to battle with anxiety about going to church and know that plenty of other people are here as infrequently as I am. My OCD comes along with me, certainly, but I feel safe to be here just as I am.

Article

Assisted dying

Comment

Justice

15 October 2024

5 min read

Will clinicians and carers objecting to assisted death be treated as nuisances?

The risk and mental cost of forcing someone to act against their conscience.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A tired-looking doctor sits at a desk dealing with paperwork.

Francisco Venâncio on Unsplash.

After a formal introduction to the House of Commons next Wednesday, MP’s will debate a draft Bill to change UK legislation on Assisted Dying. Previously, a draft Bill was introduced in the Scottish Parliament in March 2024, and is currently at committee stage. Meanwhile, in the House of Lords, a Private Member’s Bill was introduced by Lord Falconer in July and currently awaits its second reading. These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who wish to recuse themselves from carrying out a patient’s end of life wishes on grounds of Conscientious Objection.

There are various reasons why someone might want to conscientiously object. The most commonly cited are faith or religious commitments. This is not to say that all people of faith are against a change in the law – there are some high-profile religious advocates for the legalisation of Assisted Dying, including both Rabbi Dr Jonathan Romain and Lord Carey, the former Archbishop of Canterbury. Even so, there will be many adherents to various faith traditions who find themselves unable to take part in hastening the end of someone’s life because they feel it conflicts with their views on God and what it means to be human.

However, there are also Conscientious Objectors who are not religious, or not formally so. Some people, perhaps many, simply feel unsure of the rights and wrongs of the matter. The coming debates will no doubt feature discussion of how changing the law for those who are terminally ill in the Netherlands and Canada has to lead to subsequent changes in the law to include those who are not terminally, but instead chronically ill. The widening of the eligibility criteria has reached a point where, in the Netherlands, one in every 20 people now ends their life by euthanasia. This troubling statistic includes many who are neurodivergent, who suffer from depression or are disabled. It is reasonable that, even if a Conscientious Objector does not adhere to a particular religion, they can be allowed to object if they feel uneasy about the social message that Assisted Dying seems to send to vulnerable people.

“You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances”

Mehmet Ciftci

Conscientious Objection clauses can themselves send a social message. A response to the Scottish Bill produced by the Law Society of Scotland notes concern over the wording of the Conscientious Objection clause, as it appears to be more prescriptive in the draft Bill than in previous Acts such as the Abortion Act of 1967. In the case of any legal proceedings that arise from a clinician’s refusal to cooperate, the current wording places the burden of proof onto the Conscientious Objector, stating (at 18.2):

In any legal proceedings the burden of proof of conscientious objection is to rest on the person claiming to rely on it.

The Bill provides no indication of what is admissible as ‘proof’. Evidence of membership of a Church, Synagogue, Mosque or similar might be the obvious starting point. But where does that leave those described above, who object on grounds of personal conscience alone? How does one meaningfully evidence an inner sense of unease?

The wording of the Private Member’s Bill, currently awaiting its second reading in the House of Lords, provides even less clarity, stating only (at 5.0):

A person is not under any duty (whether by contract or arising from any statutory or other legal requirement) to participate in anything authorised by this Act to which that person has a conscientious objection.

Whilst this indicates that there is no duty to participate in assisting someone to end their life, there remains a wider duty of care that healthcare professionals cannot ignore. Thus, a general feature in the interpretation of such conscience clauses in medicine is that that the conscientious objector is under an obligation to refer the case to a professional who does not share the same objection. This can be seen in practice looking at abortion law, where ideas around conscientious objection are more developed and have been tried in the courts. In the case of an abortion, a clinician can refuse to take part in the procedure, but they must still find an alternative clinician who is willing to perform their role, and they must still carry out ancillary care and related administrative tasks.

Placing such obligations onto clinicians could be seen as diminishing rather than respecting their objection. Dr Mehmet Ciftci, a Researcher at the McDonald Centre for Theology, Ethics and Public Life at the University of Oxford comments:

You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances who are just preventing the efficient delivery of services. They are forced to refer patients on to those who will perform whatever procedure they are objecting to, which involves a certain cooperation or facilitation with the act.

This touches everyone, even those who (if the Bill becomes law) will still choose to conscientiously object. Therefore, it is important to consider that the human conscience is a very real phenomenon, which means that facilitating an act that feels morally wrong can give rise to feelings of guilt or shame, even if one has not been a direct participant.

Psychologists observe that when feelings of guilt are not addressed, if they are treated dismissively or internalised, this can significantly erode self-confidence and increase the likelihood of depressive symptoms. But even before modern psychology could speak to the effects of guilt, biblical writers already had much to say on the painful consequences of living with a troubled conscience. In the Psalms, more than one ancient poet pours out their heart to God, saying that living with guilt has caused their bones to feel weak, or their heart to feel heavy, or their world to feel desolate and lonely.

If the Conscientious Objection clauses of the new Bill being proposed on Wednesday are not significantly more robust than those in the draft Bills proposed thus far, then perhaps that is something to which we should all conscientiously object? There is much to discuss about the potential rights and wrongs of legalising Assisted Dying, but there is much to discuss about the rights and wrongs of forcing people to act against their consciences too.