Review
Ageing
Assisted dying
Culture
5 min read

For love there is no charge

Out of mind old people are at the centre of Allelujah! Sian Brookes reviews the film adaptation of Alan Bennett’s play.

Sian Brookes is studying for a Doctorate at Aberdeen University. Her research focuses on developing a theological understanding of old age. She studied English and Theology at Cambridge University.

In a hall decorated for a celebration a person stands in front of a seated group, all have their arms raised in celebration.
Jazz hands at the hospital.
BBC Films.

Spoiler alert – this film review reveals significant elements of the plot. 

Allelujah! is not a film that shies away from the big issues. In fact, you would be hard pressed to find a big issue this comedy/political commentary/drama/part-thriller doesn’t at least make reference to (and yes, it spreads itself across all of these genres too). With such an eclectic approach it is difficult at times to keep up with the narrative, and the deeper meaning of the film. Based on the Alan Bennett play, the plot centres around The Bethlehem, a small northern hospital for geriatric patients, which is facing closure due to the Tory government’s efficiency drive. It focuses on two members of staff, Alma Gilpin, a stoic and matter-of-fact but seemingly excellent nurse who has served the hospital her entire career, and a younger Dr Valentine. Other protagonists include an ex-miner patient and his son, a management consultant who has “made it” to London and is currently advising the Health Secretary to close hospitals such as the one in question for the sake of government finances. 

Whether it’s politics or the personal, this film has it all. It deals with levelling up, the cultural and economic gap between the north and south, the challenges of budget cuts in the NHS, the problems of a national health service claiming to 'care' but with managers more preoccupied by Westminster’s economic priorities. It depicts families waiting for older relatives to die in order to grab their inheritance, the broken relationship between an ageing man and his son, and those all-important stories of the older patients’ lives well-lived. And yet as the story line develops, a plot twist emerges which comes to overshadow the entire film, and in the process speaks to what is perhaps the most poignant of the many discussions it raises. Nurse Gilpin, who, until now has appeared consistently caring and committed to her patients, has been quietly administering fatal beakers of milk and morphine to those who she deems to be on “her list” of those who most need relief from their situation. When confronted by the doctor she justifies her actions with a multifaceted answer based on the requirement to provide more beds to a broken healthcare system, but also insisting “I had ended someone’s suffering”.  

When Dr Valentine remarks, “I like old people” a visitor responds “not even old people like old people”.

The manner in which Nurse Gilpin goes about what is effectively enforced euthanasia, is deeply chilling. And yet her reasoning is not entirely foreign to us – to end suffering could be deemed a noble cause. In fact, the need to simply delete the reality of suffering, particularly the suffering of the old is one that perhaps is not so uncommon. Throughout Allelujah!,we are reminded of our tendency to run from, to detest, to reject the suffering of the elderly in our society. When Dr Valentine remarks, “I like old people” a visitor responds “not even old people like old people”. A teenage intern declares to a patient “I hope I never live to be your age”. At the same time, characters look back on the days “when the elderly weren’t farmed out”, and questions are asked of families “if they love them, why do they put them away?”. A very good question. Of course, care needs are often too great for families to endure, yet it is still important to ask why the suffering of the old has become a professionalised service, which most of us avoid at all costs. Perhaps the answer to this is that we don’t like to watch the old suffer, we don’t like to watch them die, because their suffering and their death remind us of our future selves, our future suffering, our future death. In our sanitised, anything-is-possible-with-medicine-and-science society, death and the suffering that comes with it, is something from which we flee at all costs. Instead of acknowledging and working with it, we would rather pretend it wasn’t there at all.  

And yet, even as we try to avoid it, suffering and death are both certain parts of all our futures. 100% of us will die. For Nurse Gilpin, the solution to this is to bring on death prematurely, to erase the pain, overcome the misery by offering a false hope – that it doesn’t need to exist at all. In direct contrast to this, in a film which is littered with Christian references (Allelujah, The Bethlehem), there is a different approach taken by a messiah-type figure who seems to get everything right. Dr Valentine is compassionate and understanding. He not only challenges the political systems which undermine those most at the margins of society, but also has the kind of bedside manner we would all hope for in a doctor. In a closing monologue Dr Valentine utters the words of the doctors in the NHS, “We will be here when you are old, and we would die for you, we are love itself and for love there is no charge”.  

It is this suffering with which is so compelling, this suffering with which is truly sacrificial.

Nurse Gilpin and Dr Valentine offer two fundamentally different approaches to end of life care. One hastens the end quickly, deletes the suffering as efficiently as possible in order to make way for those in less pain. The other sits with those who suffer, holds their hand, gently cares for the human person that is in front of them. Even more, and perhaps most significantly Dr Valentine does not only watch from afar, but is willing to suffer himself for the sake of those in pain - working tirelessly, giving himself over day after day, fighting on with little sleep for limited pay just to make things a little less painful. It is this suffering with which is so compelling, this suffering with which is truly sacrificial, this suffering with which speaks of something much greater than politics, efficiency or inheritance, this suffering with which is indeed “love itself”, completely free of charge.  This is the logic that Christians see in the ancient notion of the incarnation, celebrated every Christmas, of God with us. This is what our older people need, this is what we will all need when we grow old. Let us only hope that when we get there, we find the one who is willing to offer it.

Article
Assisted dying
Care
Comment
Politics
5 min read

Suicide prevention groups are abdicating their responsibility on assisted dying

Not speaking out is a dereliction of duty to vulnerable people

Jamie Gillies is a commentator on politics and culture.

Three posters with suicide prevention messages.
Samaritans adverts.

On Friday, Kim Leadbeater’s assisted suicide bill will return to the Commons for a second day of report stage proceedings – when MPs consider amendments. Third reading, when the House votes on the bill itself, is expected to take place the following Friday. Opponents of this controversial bill will be hoping that enough MPs feel uneasy about it to say ‘this far and no further’. They will need around 30 MPs to have changed their minds since a vote last year in order for a defeat of the legislation to be assured. 

As politicians have weighed this issue, there’s been a conspicuous silence from one constituency you’d expect to have been outspoken: suicide prevention organisations. People might be surprised to know that Samaritans, perhaps the best-known suicide prevention charity in the UK, a cornerstone of prevention efforts since the 1950s, did not submit evidence on the bill before Westminster or a separate bill at Holyrood. Other groups like Suicide Prevention UK (SPUK) and Papyrus have also been silent. One has to wonder why, given the bearing a law change would have on their work. 

Suicide prevention charities and their volunteer counsellors do incredible work. Over the years, millions of people in desperate circumstances have received life-changing support. Today, every person contacting a suicide prevention helpline is told that their life has value, and that there is hope in the bleakest of circumstances. Every caller without exception is also told not to harm themselves. But this couldn’t continue under an assisted dying law. A two-track approach would have to be devised, depending on a caller’s circumstances. A scenario helps to illustrate this point: 

Caller: “I am thinking about ending my life”. 

Adviser: “Please know that there is hope. I’m here to listen and I can offer support, so you don’t have to make that choice.” 

Caller: “Well, I have terminal cancer you see…” 

Adviser: “Oh, sorry, I need to put you through to a colleague. Your situation is a bit more, err, complex. You need to know your legal rights”. 

Some proponents of assisted dying are quick to dismiss concerns about suicide prevention, arguing that assisted dying and suicide are wholly separate categories. However, this argument doesn’t hold water. Whilst campaigners use euphemistic terminology and employ Orwellian rhetoric about ‘exercising choice at the end of life’, and people ‘shortening their deaths’, it is clear that the bills they promote would permit suicide with the enablement of the state. 

An assisted dying law would see doctors prescribing lethal drugs to certain patients which they can take to end their own lives. The dictionary definition of suicide — “the act of killing yourself intentionally” — has not changed. Neither has legislation giving expression to this idea. Logically and legally then, assisted dying involves suicide. 

Samaritans is clear on this. A ‘policy brief’ on assisted dying published in November — the most recent statement on the issue by the organisation — begins by saying that it usually applies to terminally ill people and involves “assisting the person who is terminally ill to hasten their own death”, adding: “The act that kills them is performed by the person themselves”. Their death is a suicide, in other words. 

You might assume an organisation that says, “every suicide is one too many”, whose stated aim is to see “fewer people die by suicide”, would be opposed to assisted dying - or at the very least concerned about it. However, Samaritans goes on to say that it does not “take a position on whether assisted dying is right or wrong, or on what the law should be on this matter”. Why? Because it “would involve making a range of judgements” that could compromise people’s “perception of our ability to provide non-judgemental emotional support”. 

Samaritans and other suicide prevention organisations should be intensely interested in what the law says. The introduction of assisted dying in any part of the UK would mean suicides being condoned and enabled in healthcare settings for the first time — a radical departure from the existing approach. Professionals always counsel against suicide, no matter a person’s motivation for wanting to end their life. Every citizen is precious, and every life worth saving. 

Prevention organisations must also realise that a change of this gravity will have a wider impact on culture. Research shows a rise in non-assisted suicides in countries that have introduced the practice. Sending a message that some suicides are permissible might make their prevention work harder. Organisations saying nothing in the face of all this is astonishing. 

As noted above, assisted dying poses practical questions as well as philosophical ones. If the law changes, organisations will no longer be able to adopt a universal approach to suicide prevention. A call to a suicide prevention helpline from a terminally ill person will have to be handled differently to a call from a person who is not terminally ill. For some, suicide would be a healthcare ‘right’. How will organisations navigate this? Doesn’t it concern them? 

There has been some advocacy from individuals engaged in suicide prevention, if not from organisations. In February 2024 psychiatrists wrote to The Times to warn that the Westminster assisted dying Bill would “undermine daily efforts to prevent suicide”, particularly among the elderly. Louis Appleby, the UK Government’s suicide prevention adviser has also spoken against a change in the law, arguing that it would harm efforts to drive down suicides. 

Appleby explained, “once the principle behind suicide prevention has been set aside, once any part of the ground has been ceded — not only to allow suicide but to assist it — we have lost something we may not get back. There are countless causes of irremediable hardship, many reasons people may want to make despairing choices. Could they become exceptions to suicide prevention too?” This principled position is exactly what you’d expect from someone whose job is protecting hurting people, no matter their personal situations. 

I’m loath to criticise suicide prevention groups as I deeply appreciate their work. However, by not contributing to the debate on assisted dying, they are abdicating their responsibility to shape a policy that would impact their mission, and the people they serve. A policy that would lead to state-sanctioned suicides and impact culture in profound ways. It’s terribly sad to see groups that fight to end suicides failing to stand against a policy that would harm their work. Failure to speak today may be viewed as a dereliction of duty in years to come. 

With a final vote on Kim Leadbeater’s Bill days away, and the decisive vote on Scottish plans not due for months, there is still time for suicide prevention groups to enter the fray. I pray that they will.

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