Article
Assisted dying
Death & life
Ethics
Politics
4 min read

What will stop the culture of death that libertarian Britain has embraced?

Now we’re allowed to end life with impunity

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

Diane Abbott speaks in the assisted dying debate.
Dianne Abbott MP speaks in the assisted dying debate.

Just a few days apart, two debates recently took place in the House of Commons concerning life and death. In the first, MPs voted to decriminalise late-term abortions. In the second, they voted for assisted dying. Both times, the reach of death grew a little longer.

Imagine a mother about to have a baby who is suddenly having grave doubts about whether she can manage a new child as the moment draws near. It’s not hard to sympathise with many in this situation, but rather than recommend she goes through with the birth, and perhaps putting the baby up for adoption for childless parents desperate to adopt, we now have passed legislation that allows us to terminate the baby’s life instead. Proponents argued this was to relieve a small number of women who had been prosecuted for late-term abortions. The reality is, however, that it will probably become more common. In the debate, Jim Shannon MP pointed out that in New Zealand, in the first year after their parliament voted the same way, late-term abortions increased by 43 per cent.

A baby a week before and a week after birth are virtually identical. Yet as a result of this bill, it will not be a criminal act to end the life of the first, but it will be to do the same to the second. What’s the betting that the logic of this will stretch before long to allowing parents to terminate the lives of newborn babies with a new limit – say up to one month after birth? The arguments will be exactly the same – sympathy for distressed parents who suddenly realise they cannot cope with a new life on their hands, especially if the baby is discovered to be flawed in some way. When emotional sympathy, personal choice and the rights of the mother over the baby become the only moral arguments, the logic is inevitable.

Despite the argument shifting rapidly against the Terminally Ill Adults Bill – the vote passed by 314 votes to 291, with 32 MPs apparently having changed their minds - it now looks likely that this second bill will pass into law in a few years’ time, despite scrutiny in the Lords.

Here on Seen & Unseen, we have scrutinised the arguments put forward for assisted dying over past months. We have argued about the unintended consequences for the many of permitting assisted dying for the few. In The Times a while ago, I argued that if ‘dignity’ means autonomy — my ability to choose the place, the time and the manner in which I die — there is no logical reason why we should refuse that right to someone who, for whatever reason feels their life is no longer worth living, however trivial we may feel their problems to be. With this understanding of dignity as unlimited choice, the slippery slope is not just likely, it is philosophically inevitable.

In both cases the logic of the arguments used means the march of our ability to bring about death will not stop with these measures, despite their proponents’ assurances that safeguards are in place.

These two votes reminded me of something Pope John Paul II once wrote. In an encyclical, Evangelium Vitae – the Gospel of Life - he warned that “we are facing an enormous and dramatic clash between what he called a “culture of death” and a “culture of life”.

He warned that this “culture of death” would be “actively fostered by powerful cultural, economic and political currents which encourage an idea of society excessively concerned with efficiency.” It is, in effect, he argued, “a war of the powerful against the weak: a life which would require greater acceptance, love and care is considered useless, or held to be an intolerable burden, and is therefore rejected in one way or another. A person who, because of illness, handicap or, more simply, just by existing, compromises the well-being or lifestyle of those who are more favoured tends to be looked upon as an enemy to be resisted or eliminated. In this way a kind of ‘conspiracy against life’ is unleashed.”

They were strong words, and in the UK at least, back in 1995, might have seemed alarmist. Yet I couldn't help thinking of them as these two bills passed through the UK’s national parliament. In both cases, the bills were introduced very rapidly with little time for serious moral deliberation. Both depended on emotional appeals to a small number of admittedly distressing cases without serious consideration for the wider cultural and philosophical ramifications of these seismic moves. Both encouraged the steady encroachment of death on demand.

What concerns me is what these bills say about the kind of culture we are becoming. MND sufferer Michael Wenham makes the point powerfully that this is all about autonomy and independence, a spurious kind of compassion, and the fact that palliative care is more expensive than subtly encouraging the dying to take their own life. Looking behind the arguments for compassion, it's not hard to spot the iron law of libertarian ideas of freedom, where individuals have absolute rights over their own lives and bodies that trump everything else. This is the kind of libertarian freedom that prizes personal autonomy above everything else and therefore sees our neighbours not so much as gifts to be valued and cherished, but limitations, or even threats to our precious personal freedoms.

Pope John Paul was right. It does seem that we are opting for a culture of death. And my fear is that it won’t stop here.

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Article
Assisted dying
Comment
4 min read

Assisted Dying logic makes perfect sense but imposes a dreadful dilemma

The case for assisted dying appeals to choice and autonomy, yet not all choices are good. It means vast numbers of people will face a terrible choice as their life nears its end.

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

A black and white picture shows a woman head and shoulders, she is looking up and to the side in an unsure way.
Anastasiya Badun on Unsplash.

Two broad cultural trends have led us to our current debate over assisted suicide. 

One is the way consumer choice has come to be seen as the engine of successful economies. Emerging from Adam Smith’s theories of rational choice based on self-interest, given a boost by Reaganomics and Thatcherite thinking in the 1990s, the provision of a range of choice to the consumer is usually argued, with some logic, as key to the growth of western economies and the expansion of freedom.  

The other is the notion of individual autonomy. Articulated especially in the past by figures such as John Locke and John Stuart Mill, the idea that individuals should be free to choose to dispose of their property, their time and their talents as they choose, as long as they don’t harm anyone else, has become standard moral fare in the modern world.  

Put these two together, and the logic of assisted dying makes perfect sense. What can be wrong with offering someone a choice? Why should the state restrict individual freedom to end your life in the way you might decide to do so? 

Yet expanding choice is not always good. Forcing an employee to choose between betraying a colleague or losing their job is not a fair choice. There are some choices that are unfair to impose upon people.  

Assisted dying will lead us to this kind of choice. Imagine a woman in her eighties, living in a home which is her main financial asset, and which she hopes to leave to her children when she dies. She contracts Parkinson’s or dementia, which will not kill her for some time, but will severely limit her ability to live independently (and remember about of third of the UK population will need some kind of longer-term care assistance as we get older). At present, her only options are to be cared for by her children, or to sell her house to pay for professional care.  

With the assisted suicide bill, a third option comes into play – to end it all early and save the family the hassle - and the money. If the bill passes, numerous elderly people will be faced with an awful dilemma. Do I stay alive, watch the kids’ inheritance disappear in care costs, or land myself on them for years, restricting their freedom by needing to care for me? Or do I call up the man with the tablets to finish it soon? Do I have a moral duty to end it all? At present, that is not a choice any old person has to make. If the bill passes, it will be one faced by numerous elderly, or disabled people across the country. 

Even though the idea may have Christian roots, you don’t have to be religious to believe the vulnerable need to be protected.

Of course, supporters of the bill will say that the proposed plan only covers those who will die within six months, suffering from an “inevitably progressive condition which cannot be reversed by treatment.” Yet do we really think it will stay this way? Evidence from most other countries that have taken this route suggests that once the train leaves the station, the journey doesn’t end at the first stop - it usually carries on to the next. And the next. So, in Canada, a bill that initially allowed for something similar was changed within five years to simply requiring the patient to state they lived with an intolerable condition. From this year, there is a proposal on the table that says a doctor’s note saying you have a mental illness is enough. In the same time frame, 1,000 deaths by assisted dying in the first year has become 10,000 within five years, accounting for around 1 in 20 of all deaths in Canada right now. Some MPs in the UK are already arguing for a bill based on ‘unbearable suffering’ as the criterion. Once the train starts, there is no stopping it. The logic of individual choice and personal autonomy leads inexorably in that direction.  

Of course, some people face severe pain and distress as they die, and everything within us cries out to relieve their suffering. Yet the question is what kind of society do we want to become? One where we deem some lives worth living and others not? Where we make numerous elderly people feel a burden to their families and feel a responsibility to die? In Oregon, where Assisted Dying is legal, almost half of those who opted for assisted dying cited fear of being a burden as a factor in their decision. Or would we prefer one where the common good is ultimately more important than individual choice, and where to protect the vulnerable, we find other ways to manage end of life pain, putting resources into developing palliative care and supporting families with dependent members – none of which will happen if the option of assisted dying is available.  

Even though the idea may have Christian roots, you don’t have to be religious to believe the vulnerable need to be protected. Changing the law might seem a small step. After all, doctors routinely administer higher doses of morphine which alleviate pain and allow a natural death to take its course. Yet that is a humane and compassionate step to take. To confront numerous people, elderly, disabled and sick with a dreadful dilemma is one we should not impose upon them.