Snippet
Assisted dying
Care
Comment
Ethics
2 min read

Who holds the keys of death? The logic of assisted dying

The ethical principle of double effect.

Tom has a PhD in Theology and works as a hospital physician.

white pills form an angle on a blue background
Hal Gatewood on Unsplash.

Healthcare hinges on the principle of double effect. This ethical principle makes the vital distinction between intent and effect. That is, one’s intent does not always result in a single intended effect, whether foreseen or not. In taking a patient’s blood, for example, my intent is to acquire information to aid treatment. An additional effect of this process is that—almost inevitably—this patient will experience pain, albeit minor. This principle of single intent and multiple effects applies throughout the practice of caring for human bodies, in all those instances where caring for those bodies involves physical interference, from prescribing medications to surgical procedures. And, in some instances, identifying and treating symptoms (such as terminal breathlessness) involves the use of medications that, as an unintended effect, result in death. 

In the case of assisted dying, the distinction is important. The intent of assisted dying is to end pain and suffering by ending life. The ending of life is the treatment used to relieve pain and suffering. The intent is not to isolate and treat particular symptoms associated with a condition. The intent is to bring the condition itself to an end—which requires bringing the patient’s life to an end. This is not to make any judgment whatsoever about whether such a course is “right” or “wrong”, but rather to draw out the simple observation that this course involves an unprecedented change in medical practice. Assisted dying involves the categorical adoption of ending life as a possible treatment for a condition. 

This is not quite the same as the slippery slope argument; it is about the logic of assisted dying. The point I am making is this: once ending life is introduced as a treatment, the key ethical step has already been taken. Applying that treatment in other instances of “suffering” (be they mental illness or ageing, for example) does not involve any new ethical steps. It simply involves the further application of a principle that has already been adopted. Despite the considered safeguards of the bill, therefore, the moral-ethical arguments against applying this treatment more widely will, at best, stand on shaky ground. For who could be so bold as to insist on what constitutes “suffering” for an individual?  

Should the bill hold out the keys of death in this way? I can only think of One who is strong enough to wield those… 

Article
Comment
Mental Health
Politics
4 min read

Rachel Reeves’ tears: public life still mocks those who show anything but the positive

‘Mental health awareness’ is failing, our words are not matched by our actions

Rachael is an author and theology of mental health specialist. 

 

 

A woman sits and holds back a tear.
Rachel Reeves on the front bench.
Parliament TV.

It’s a bad day at work. Everyone is on high alert, and tempers are frayed. You have your own reasons for being extra ‘on edge’, but now isn’t the time to get into it because it’s the big weekly meeting and everyone is going to be there - worse still, the cameras are going to be there. Despite this, you take a deep breath and take your seat (which, although an honour, is regrettably in the front row).  

But as the fractious meeting begins, you feel the ache of impending tears at the back of your throat, and to your horror, your eyes fill. You do your best to wick them away, but you know they’ve been spotted when someone opposite announces how miserable you look. 

Many of us will have been in a similar, if probably less public, situation at some point in our careers when the emotions we stuff down in the name of professionalism spill out - but I doubt any of us will have done so in the House of Commons with cameras trained on every movement and a less than friendly crowd opposite.  

There have been countless articles already speculating about the reason for the tears of the Chancellor, Rachel Reeves, during Prime Minister’s Questions - but most seem devoid of sympathy or empathy, concerned only with the political implications, but not the person at the centre of this story.  

Our reaction to Rachel’s tears is an echo of the sentiment behind the Welfare Reform Bill, which seems to say that need is unacceptable and we should all be able to don that famously British ‘stiff upper lip’ and just get on with life.  

Regardless of what you think of the Welfare Reform Bill, the way it has been briefed and communicated has raised anxiety and fear amongst the disabled community (me included).  

The main message has been that too many people are receiving Personal Independence Payments (PIP) for mental illnesses such as anxiety and depression, with even the former Prime Minister Tony Blair telling people to ‘stop diagnosing themselves’ to combat out rising welfare bill - despite the fact that accessing PIP requires rigorous assessments and support from medical professionals. (It also has a 0.01% fraud rate and was designed to compensate people for the extra cost of being disabled which is estimated to be up to £1000 a month.) 

This tableau is emblematic of how ‘mental health awareness’ is failing in this country; our words are not matched by our actions. 

We know, 27 years after the first ‘Mental Health Awareness Week’, that mental health is important, that emotions are natural and valid - and yet we mock any leader who shows anything but positive emotions.  

We know that people suffer, are disabled by and killed by mental illnesses, and yet we seek to strip support from those who need it most, claiming that they are diagnosing themselves. 

We need a different approach, both to how we handle emotions in public life and the way we talk about those who need extra support due to their mental illnesses.  

Emotions aren’t bad - they help us connect, keep us away from danger and allow our bodies to release unbearable tension, as in the case of crying, whereby tears of pain are intricately designed to help us cope. The tears we shed when faced with chopping a pile of onions are chemically different to those that fall when we are grieving, angry or in pain. Tears of pain should inspire us to reach out to the one in pain with compassion not contempt.  

The way Jesus led 2,000 years ago shows us another way, both of leading and emoting.  

Jesus consistently welcomed those most in need; from healing the woman who had bled for twelve years, considered unclean and rejected by her community, to healing a paralysed man lowered through his roof by friends.  

And yet his ministry was not just one characterised by miracles and might, but demonstrated humility and humanity as he wept over the death of his friend Lazarus and allowed himself to be stripped of all strength as he hung on a cross made for criminals.  

The night before he died, he gathered his friends and through tears and blood-soaked sweat submitted to the Father in the most painful way, and I, like many others, draw comfort and strength from Jesus’ willingness to cry.  

As preacher Charles Haddon Spurgeon said, "A Jesus who never wept could never wipe away my tears."  

So perhaps rather than mock Rachel’s tears, they should cause us to rethink how we approach need and recognise none of us are immune.  

Perhaps, we may even join with Paul’s words in his letter to the Corinthians: “For when I am weak, then I am strong.” 

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