Article
Assisted dying
Care
Comment
Death & life
6 min read

What do you make of Esther?

A campaigner’s call to change an assisted dying law got family calling MND sufferer Michael Wenham. Here he shares why such legalisation will increase people’s fear of dying.
An image of a woman wearing formal clothing is overlaid by a BBC logo, a programme logo, a sound wave illustration and a caption.
Today Programme post about Esther Rantzen's comments.
BBC.

"What do you make of Esther Rantzen?" asked my brother. 

I knew what he was talking about, as no doubt all listeners of Radio 4's Today Programme would have done. Clearly the advocates of assisted dying, or specifically suicide, have launched the next round of their campaign, even enlisting the late Diana Rigg, whose resemblance to my wife was once commented on by an old welsh policemen, as a witness. The Today Programme devoted a great deal of airtime to the subject over a number of days.  

My reply to my brother was that I thought it was a good thing if we were more open about the subject of death and dying. After all they are events everyone without exception will come in contact with at some point or another. So, the sooner we stop treating it as a taboo subject the better. However, the dangers of legalising assisted suicide, are proved by places like Canada and Belgium. 

I don’t see any way to protect us from such coercion, internal or external, except to demonstrate through legislation that every life, however tenuous, is equally important.

In January this year I made a submission to the Parliamentary Health and Social Care Committee consultation on assisted dying/assisted suicide. Here’s some of that submission. 

“I am writing as an individual who was diagnosed with a rare form of Motor Neurone Disease (MND) twenty-two years ago and who has experienced the condition’s relentless deterioration since then. There are a number of my contemporaries who have survived that long. That, and witnessing the ravages of the disease on friends in our local MNDA branch plus an Ethics qualification from Oxford, is the extent of my expertise.” 

“My first observation is how positively my contemporaries, with short or longer prognoses, with the disease seize hold of life. Clearly there are some who, like Rob Burrows, devote themselves to fund-raising and creating awareness; while others enjoy the opportunities of life that come their way. What might have seemed a death sentence has proved a challenge to live. 

"Secondly, I have recently discovered myself how expert professional care can enhance what is often portrayed as undignified dependence. Good caring can in fact add to quality of life. The sad thing however is that it is not something which the state will normally provide. Along with terminal palliative care, domestic social care must surely be a spending priority for any government that cares about the well-being of all its citizens. I’m fortunate to live an area of excellent MND provision and good, though not abundant, palliative care. But I understand that this is not equally spread through the country. If it were, I suspect it would reduce the fear of dying which must be a major motivator for assistance to ending one’s life. 

"Ironically, in MND, according to the Association’s information sheet, How will I die?, those fears are greatly exaggerated: 

In reality, most people with MND have a peaceful death. The final stages of MND will usually involve gradual weakening of the breathing muscles and increasing sleepiness. This is usually the cause of death, either because of an infection or because the muscles stop working. 

Specialist palliative care supports quality of life through symptom control. practical help, medication to ease symptoms and emotional support for you and your family. 

When breathing becomes weaker, you may feel breathless and this can be distressing. However, your health care professionals can provide support to reduce anxiety. 

You can also receive medication to ease symptoms throughout the course of the disease, not just in the later stages. If you have any concerns about the way medication will affect you, ask the professionals who are supporting you for guidance. 

Further weakening of the muscles involved in breathing will cause tiredness and increasing sleepiness. Over a period of time, which can be hours, days or weeks, your breathing is likely to become shallower. This usually leads to reduced consciousness, so that death comes peacefully as breathing slowly reduces and eventually stops.

"So, this is a third and subtle danger of legalising assisted dying/suicide. It would increase people’s fear of the inevitable fact of death and dying. I think this can be one factor in explaining why, in jurisdictions which have introduced it, we see it being extended beyond the first strict limits. It is held out as an answer to this fearful fact, death, whereas in fact death and dying should be talked about in realistic terms, as normal, as concisely outlined by Dr Kathryn Mannix. As she says, normally dying isn’t as bad as we think

If the government should be doing anything, the first thing it might well do, is to promote informed education about dying of the sort exemplified by specialists such as Dr Mannix, as well as adequately funding her former specialism of palliative care. It should start with schools’ curricula. After all every child will have encountered death at some stage. 

Finally, the dangers of coercion, in my experience, are not so much external as internal. It’s often rightly observed that prolonged pain is worse for the engaged spectator than for the sufferer. If you care for someone, seeing them struggling is barely tolerable. You may wish to see their struggle over, but underlying that wish is your own desire to be spared more of your own horror show. The person who is ‘suffering’ however has that strong survival instinct, common to all humans, and is more concentrated on living than dying. Having said that, when you are depressed, as might be natural, that instinct gets temporarily eclipsed. Then you need protection from your own dark sky. It is at such times that your other inner demons emerge: your sense of being a burden - to your family, to your friends (if you have any), to the NHS and to the state purse; your fear of losing your savings and of leaving nothing to your loved ones; your fear of pain and of dying (exaggerated by popular mythology), and your sense of suffering, heightened by your depression.  

"For most of us with long incurable diseases, it’s these internal perceptions that are most coercive, although they can be easily compounded or even exploited from outside. I don’t see any way to protect us from such coercion, internal or external, except to demonstrate through legislation that every life, however tenuous, is equally important to our society and worth caring for. ‘Any man’s death diminishes me...’ and so we will value it to the end." 

I'm grateful that when I received my 'motor neurone disorder' diagnosis, which was initially frightening, I couldn't be tempted to opt for an early death. Instead of one Christmas with my family (as I warned them), I've enjoyed 22 more Christmases. That was the law against suicide fulfilling its safeguarding function, protecting the vulnerable, as I was then. Contrary to my preconceptions, my form of MND (PLS) is very gradual and I've been able to live a full if increasingly limited life, thanks to my wife, Jane, who cares for me 100 per cent. 24 hours a day, seven days a week.  

My view is still that legalising assisted dying/suicide has more cons than pros. The better choice is to invest in hospice and palliative care, so that everyone may have access to pain and symptom care in the last years of their life. 

Essay
Comment
Identity
Nationalism
Politics
15 min read

Could a constitution capture the essence of Englishness?

A proposal for St George’s Day.
A St George's Cross flag flutters on a tower.
St Helen's Church, Welton, Yorkshire.
Different Resonance on Unsplash.

Somewhere behind the concrete-and-glass façade of modern official Britain, one can still find some traces of England: folklore and folk music, country customs and local traditions – wassailing, maypoles, cheese rolling and bounds beating – that neither brutal 19th century industrialisation nor callous 20th century deindustrialisation could completely erase.  

This idealised ‘Quaintshire England’ lurks somewhere in the psycho-geographic triangle formed by Anthony Trollope’s Barchester, Thomas Hardy’s Casterbridge and Geraldine Granger’s Dibley. It is always indeterminately, reassuringly, old. It has a lot of past, but not much future. Yet its traditions are neither stagnant nor dying. Take, for example, the recognition of St George’s Day. Once upon a time, and not so very long ago, St George’s Day came and went with hardly anyone noticing. It was relegated to handful of nasty, shaven-headed, right-wing cranks. Now St George’s Day is marked by respectable newspapers and by the media classes, through the annual ritual of the Great Debate About Englishness.  

For those not familiar, the Great Debate About Englishness takes the form of a stylised conflict between two sides: the Guardians and the Telegraphs. The Guardians start, with a stick-knocking assault on Saint George and all his works: he was Turkish (or, better still, Palestinian); he never visited England (which is just as well, because, as they are eager to insist, England does not really exist anyway, and if it did it would be hopelessly white and racist). Then the Telegraphs move forward, with Scruton bells on their toes, to lament the fact that we no longer celebrate St George, and how all the ills of the world are the fault of the kind of people who say ‘Mumbai’ when they mean ‘Bombay’. At this, the Guardians caper forth, wielding Billy Bragg quotes about ‘progressive Englishness’ in an intricate manoeuvre known to afficionados as a ‘Full Toynbee’. This done, the Guardians retreat before the onslaught of the Telegraphs, who counter-attack with the clincher than English is an ethnic marker, which necessarily excludes anyone whose ancestors were swarthier than a Flemish Huguenot. So concludes the ritual, which is then forgotten about until the following year. 

England, becoming everything, has thereby become nothing. It is the only nation in the United Kingdom without a political life of its own. 

These cathartic ritual confrontations rarely acknowledge that debating the nature of Englishness is itself a symptom of the English nation’s statelessness. Like Kashmiris, Kurds and Uyghurs, the English must debate the nature of their existence because England is – to borrow the term used by Austrian Chancellor Metternich to refer to pre-unification Italy – ‘a geographical expression’.  

The institutions, symbols, and icons of political identity are all British. Despite its historical position at the core of the Union and the Empire, England remains a curiously under-developed nation in constitutional terms. It has almost no formal recognition as a national community. Indeed, England’s dominance over the United Kingdom has had the paradoxical effect of denying England – as England ­– a voice in its own affairs. England, becoming everything, has thereby become nothing. It is the only nation in the United Kingdom without a political life of its own. There is no English Government, nor English Parliament. Even the banal markers of national identity that people might have in their pockets, like coins, stamps, and passport, are British, not English. The absence of such markers means that English identity has high barriers to entry. In other words, we obsess about the ethnic and cultural boundaries of Englishness, because there is no English civic, legal, or political community – let us call it a ‘constitutional community’ – of which one can be a member as a matter of legal right.  

Such a ‘constitutional community’ could take two forms. It might take the form of an independent England, re-founded as a nation-state after Scotland, Wales and Northern Ireland have freely gone their separate ways. Alternatively, given the need for collective defence and international clout in a dangerous world, it could take the form of an England which remains one of four constituent states in a voluntary, equal, confederal Union.  

Either way, an English constitution, understood as a codified supreme and fundamental law, should establish political institutions of England’s own: an English Parliament, an English government, an English judiciary, and an English civil service. Only by this constitutional means can England, now that the British Empire is no more, become a normal nation, make peace with itself, and re-find its place in Europe and the world.  

In part, this is a matter of good government. As the great post-war Commonwealth constitutional scholar Sir Ivor Jennings famously put it, ‘A Constitution is but a means to an end, and the end is good government.’ An English constitution would enable the renewal of a system of government that has become too centralised, too top heavy, and long overdue for reform. It would clarify the rules of political life where these have become contested, reinforce the boundaries of power where these boundaries have been pushed to breaking point, and restate the principles of public ethics which have been neglected. It would protect democratic institutions and norms from erosion by unscrupulous authoritarian populists.  

A list of priorities for consideration in an English constitution, enjoying support across the broad centre of the political spectrum, might include devolution to English cities and counties, electoral reform, reform of the Lords, codification of parliamentary conventions to limit the abuse of Crown Prerogatives, strengthening of the civil service and rebuilding of lost state capacity, restoring standards in public life, and better protection of civil liberties.  

If you are reading this in England...  you are probably not very far away from a place where old stones echo with the words and songs, the faith and the prayers, that have held the English nation together. 

Yet constitutions are more than dull, dry, legal charters of government. They are also national covenants. They set out a vision of who we are, who we want to be, what we stand for, and what we will not stand for. Aside from all the mechanical, institutional, provisions one expects to find in a written constitution, constitutions also contain what we might call metaphysical provisions: those that bear the identity, and bare the soul, of the nation. An English constitution would help to anchor English identity in the midst of changing times. 

While the mechanical constitution is in need of reform, England’s ‘metaphysical constitution’ is not so lightly to be tinkered with. It represents a mystical union of past, present and future, embodying an idea of English nationhood – and English statehood – stretching back to Anglo-Saxon times. At the heart of this metaphysical constitution is the ideal of Christian monarchy, institutionalised through constitutional relationships between the church, state, Crown and nation.  

While the institutional structures of the mechanical constitution are British – and essentially imperial, rather than national, in character – the metaphysical constitution has remained steadfastly English. The Church of England is the only major all-England public institution. The General Synod, which has power to enact Measures having the force of law in England in relation to ecclesiastical matters, is the only England-wide legislative body. England (not Britain, nor the United Kingdom, nor the British Empire, but something older and deeper) can most readily be found in its great cathedrals: Salisbury, Norwich, Wells, Lincoln, Ely, Gloucester, Hereford, Durham. It can be found, too, in the abundance of ancient village parish churches with hand-tapestried hassocks, musty smells, memorial plaques and an almost tangible presence of congregants gone by. England is etched in the moss and lichen of their old gravestones. It is haunted by the Ghosts of England Past, speaking the words of the Book of Common Prayer and the King James Bible. If you listen carefully, you can hear them. If you are reading this in England, even in the midst of a busy city, you are probably not very far away from a place where old stones echo with the words and songs, the faith and the prayers, that have held the English nation together over the centuries. 

Confusion arises, however, from the failure to distinguish between the mechanical and the metaphysical aspects of constitutions. 

That heritage is valued not only by Christians, but also by those who are not believing or practising Christians, but who are pleased to belong to a culture that has been shaped by Christianity. Cutting the Church totally loose from the state, by disestablishment, would abandon custody of this cultural and social heritage to a merely private organisation, having no public recognition, patronage, or connection to the national community. That would be a particularly savage form of cultural privatisation. 

England’s metaphysical constitution is mostly buried beneath the accumulation of ages. If you are good with the constitutional trowel, however, and know where to dig, it is not hard to unearth it. Sometimes it even pokes above ground, as easily seen as the billowy bench of bishops in the House of Lords. The topsoil of modernity is dramatically stripped away at the coronation, when the king swears not only to govern ‘according to the statutes in Parliament agreed on and the Laws and Customs of the same’, and to ‘cause law and justice in mercy to be executed in all [his] judgments’, but also to ‘maintain the laws of God, the true profession of the gospel, and the Protestant Reformed Religion established by law’. The King’s covenant with God and the nation is outwardly and visibly signified when, at the climax of the ceremony, he is anointed, by the Archbishop of Canterbury, with holy oil.  

Thus, the descendants, according to the flesh, of Anglo-Saxon kings, become at their coronation the descendants, according to the spirit, of David and Solomon. The birth of this metaphysical constitution can be traced to the baptism of King Aethelbert, the first Anglo-Saxon king to become Christian. As Bijan Omrani notes, in God is an Englishman, this act transformed the nature and expectations of English kingship, from pagan warlordism to a holy kingly office, responsible under God for bringing God’s peace and justice to England.  

All this is very strange, and easy to mock. To paraphrase a famous scene in Monty Python’s ‘Holy Grail’, ‘supreme executive power derives from the confidence of the House of Commons, not from some farcical aquatic ceremony’. From a purely mechanical point of view, that is of course quite right. As Walter Bagehot’s The English Constitution said of Sir Robert Walpole, the first modern Prime Minister, ‘he ruled England because he ruled that House’. Confusion arises, however, from the failure to distinguish between the mechanical and the metaphysical aspects of constitutions. Many constitutional conservatives, eager to uphold the metaphysical constitution of England’s Christian monarchy, set their face against even moderate and beneficial reforms to the mechanical constitution. On the other hand, many constitutional reformers, eager to mend the broken mechanical constitution, would pave over the metaphysical constitution with all the misplaced zeal of a solar farm company. 

The established church is a particular target of the reformers’ wrath, evidenced most recently by a proposed amendment to the House of Lords (Hereditary Peers) Bill, seeking to remove bishops from the upper House. According to Lord Birt, former Director-General of the BBC, ‘Embedding the Church of England in our legislature is an indefensible, undemocratic anomaly.’ There are only two countries in the world, so we are informed, where clerics sit of right as legislators: the United Kingdom and Iran. The clear implication is that this connection puts the United Kingdom in bad company, as if having a couple of dozen bishops in the House of Lords were comparable to the rule of Ayatollahs. 

Incidentally, remarkably incurious of comparative practice, the people who say this always forget about Belize: a relatively stable and well-functioning Westminster Model democracy, whose tiny upper House includes a Senator nominated by the Belize Council of Churches and Evangelical Association of Churches. They also forget about tiny Tuvalu, a democratic Commonwealth Realm in the South Pacific, where the established church was planted by the London Missionary Society. Perhaps these examples do not fit the narrative that insists that church establishment must inherently be regressive and anti-democratic. 

To those of us who must live also in the here-and-now, not only as Christians but also as citizens of a particular nation and polity, it all looks very bleak.

Even without deliberate abolition, we must nevertheless admit that the metaphysical constitution of England, no less than the material constitution, is in crisis. The most recent census showed that, for the first time since the conversion of Anglo-Saxon England, Christians are now a nominal minority. Of course, the invisible church of born-again Spirit-filled believers was probably always a minority of the population, in England as in any nation. Nevertheless, from the Early Middle Ages until just a few generations ago, nominal Christianity was the norm, and Christian ideas held sway over the narratives, ethics, and assumptions of English society. Not everyone conformed to a model of Christian holiness and goodness – far from it – but there was a common view, shaped by the pervasive cultural, social, and educational influence of Christianity, of what holiness and goodness looked like

That Christian consensus is what has been lost in the social and demographic change – some might call it, a cultural revolution – since the 1960s. The Church of England is still doing excellent work in parishes up and down the land, multiplying the loaves and fishes of its limited resources to provide everything from foodbanks and debt advisory services to parent-toddler groups and pensioners’ clubs, filling the social gap that a failing state no longer even tries to fill. Yet, numerically, the Church of England – except in a few bright pockets of revival – is in free-fall. In the lands of St Ethelbert, St Edmund, and St Cuthbert, empty church buildings have been turned into private houses, gyms, carpet warehouses, soft play centres, mosques, pubs and nightclubs. Looking at things through a spiritual rather than natural lens, we should not be discouraged. We can of course have confidence that the risen King has triumphed, is triumphing, and will ultimately triumph – reconciling all things to the Father, and restoring the whole cosmos to glory. Nevertheless, to those of us who must live also in the here-and-now, not only as Christians but also as citizens of a particular nation and polity, it all looks very bleak. It is a spiritual trial, but a civilisational tragedy. 

Christianity – in particular in the form of mainline Protestantism - has provided the moral, ethical, sociological and institutional props on which constitutional democracy in the Anglosphere was built. Remove those props, and the whole edifice becomes a lot less stable. When we look at the egregious behaviour of Trump and his ilk, we get a taste of how rotten pagan politics would be, unseasoned and unpreserved by the salt and light of Christianity. 

This is, of course, is not to say one cannot have democracies in societies where Christianity has been less historically prevalent. Democracy can exist in a wide range of religious cultures, including in majority Muslim, Hindu and Buddhist societies. Nevertheless, at least within the Westminster Model, it depends upon an institutional subculture - a set of norms, values, traditions, expectations - which, even if successfully transplanted and adapted to different contexts, owe a lot to the kinds of Christianity that emerged from the English Reformation. The restoration of England’s Christian metaphysical constitution is, therefore, integral to restoring the health of the democratic mechanical constitution. By the works of the law – even constitutional law – shall no flesh be justified. Any constitutional refoundation of English democracy worthy of the name must be led and accompanied by a revival of the English Church and by the re-evangelisation of the English people.  

The cross atop the crown represents the principle that public authority has itself been humbled and crucified; the state exists not to be served but to serve the public

his case must be made with careful nuance. It could be misconstrued as an apology for Christian nationalism. Sadly, those who make the most noise about ‘Christian values’ all too often seem, judging by their attitudes and actions, to be reading a different gospel – one from which the Magnificat and the Sermon on the Mount have been expunged. It is galling to watch far-right authoritarian reactionaries parading their Christianity for public display, while pursuing compassionless policies that hurt the poor, the disabled, and outsiders.  

A restoration of England’s Christian metaphysical constitution would not limit freedom of religion, nor diminish the equal rights of all citizens regardless of their religion or lack thereof. The principles of religious liberty and non-discrimination, which go back to Catholic Emancipation and to the repeal of the Test and Corporation Acts in the early nineteenth century, should be guaranteed. Rather, establishment would simply give honourable public recognition to the place of Christianity in the nation’s heritage, grounding the state upon a core of shared Christian values, norms and traditions. If that core is maintained, tolerance and diversity can be built upon it, without undermining the nation’s historic character. In practice, this might involve a more prominent role for Christianity in public life. Public authorities might pay more attention, in their official pronouncements, to the church calendar, and less to those of other faiths, or of post-Christian causes. There might be a more obvious Christian influence in education. One of the by-products of the 1960s cultural revolution is that the clergy have retreated into a narrowly defined churchy role: the academic and the school master in holy orders have all-but vanished. Public broadcasting, too, might return to the broadly Christian assumptions of Lord Reith.  

One of the constitutional functions of an established church is to act as a reminder: to remind the King, Ministers, parliamentarians, civil servants, judges, magistrates, councillors, police constables, teachers, opinion-formers, and every citizen, that to govern is to serve. The cross atop the crown represents the principle that public authority has itself been humbled and crucified; the state exists not to be served but to serve the public. Without such a concept of ethically responsible servant leadership – grounded upon truth, justice, and compassion – democracy can easily deteriorate into cruel, crude, and crass populist perversions of itself.  

Another constitutional function of an established church is to remind us what freedom is for. If applied as mere abstractions, shorn from the Christian root from which they have sprung, and the teleological objectives towards which they point, human rights – valuable as they are – can produce absurd results, actually harming, rather than protecting, freedoms of conscience and expression. Taking the metaphysical constitution seriously again would certainly mean interpreting and enforcing our human rights laws in ways congruent to the Christian principles upon which they are based. After all, it is very odd, in a country where the king has sworn to maintain the true profession of the gospel, that people are being arrested for silent prayer, and that local councils are trying to ban street evangelism. 

Finally, the metaphysical constitution, no less than the mechanical, needs checks and balances. The church cannot perform this constitutional function, as the ethical conscience of the state, if it is – like, say, the Russian Orthodox Church – dependent upon the state. The establishment of the church must not, therefore, compromise the autonomy of the church, to govern itself synodically, and to choose its own bishops. The current process of episcopal selection through the Crown Nominations Commission might leave much to be desired, but going back to the days of political appointment by the Prime Minister is not a viable option. Rather, the principle should be acknowledged, at a constitutional level, that – in the words of Magna Carta - Anglicana ecclesia libera sit: the Church of England shall be free. If we can create constitutional rules that enable judicial independence, and the impartiality of bodies such as the Electoral Commission, we should be able to square this constitutional circle, too.