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
Migration
Politics
Romance
5 min read

Families like mine are impossible now, thanks to the idol that is the net migration target

Politician priests are making pointless sacrifices on the altar of numbers

Joel Pierce is the administrator of Christ's College, University of Aberdeen. He has recently published his first book.

A Border Force officer wears body armour with Immigration Enforcement written on the back
UK Border Force.

Let me tell you a love story. Eighteen years ago, in a time before politicians had taken to immolating their values on the altar of the semiannual net migration totals, I fell for the pretty Scottish bridesmaid at my sister’s wedding. The romance presented some challenges for an American like me, but none that were insurmountable. She found a year-long internship near me in Seattle and, just before she returned home, I popped the question.  

The process of applying for a UK visa was just another bit of the tedious logistics of an overseas move, the kind of thing a romantic comedy skips over with a ‘One Year Later’ movie subtitle so that it can end with a joyous wedding ceilidh in a picturesque Scottish locale. Our first few years together in Edinburgh were lean ones. Having takeaway coffee more than once a week felt like a scandalously indulgent luxury. Even so, I was able to progress seamlessly from my marriage visa to indefinite leave to remain, to citizenship.   

None of this would be possible if we were young twentysomethings in love today. We would fail every test of what the Home Office now considers to be acceptable romance.  

During our first year of marriage, the stipend my wife received while training for ministry would have been well short of the £18,600 income threshold introduced in 2012 for a sponsoring spouse, let alone the £29,000 required now. While we did have some savings, they were nowhere near the £88,500 now needed to waive the income requirement, and, in any case, would have been substantially drained by the £5,000 in fees and health surcharges that a two-and-half-year spouse visa now costs. It is little wonder Brits who have found love abroad, even ones in a substantially better financial and professional position than we were then, are now finding it impossible to move back to the UK.  

What is the cause of these new barriers? A hint can be found in the title of a recent Guardian article about recommendations for a slight relaxation of the income threshold to between £23,000 to £25,000. ‘Lowering UK’s income requirement for family visas ‘would increase net migration’, the piece was headlined. When even the most left wing major daily in Britain can’t report on the possibility of things being marginally easier for Brits who have the temerity to love a non-citizen, without framing it in terms of net migration, it’s a sign that we have all fallen captive to this singular statistic.  

Net migration is a number created by humans and yet it has come to play the role of an angry god which demands sacrifices every time it is reported. The right of working class people to marry a non-citizen spouse, the economic viability of our universities, and the proper staffing of the NHS are all victims its politician-priests have offered up in hopes that they would satiate its hunger. Net zero maybe next. 

There is no particular reason to think totting up the total number of people who arrived in the UK with the intention of staying here for a year and then subtracting the total number who left with the intention of staying abroad for a similar duration is a particularly meaningful exercise. It conflates people like me, who came here with every intention to settle and start a family, with students coming for a one-year master’s, doctors filling vital roles in NHS with children try to stay with with a migrant parent and Afghan refugees seeking long-term sanctuary with oil workers serving time in Aberdeen before moving on to Calgary or Brunei.  

The dominance of this statistic in our discourse has warped our moral discernments. 

There are perfectly legitimate reasons to think carefully about how much of each form of migration to allow, but when they are all grouped together under this single measure a peculiar logic sets in. Want to do the right thing by welcoming refugees from Ukraine and Hong Kong? Well, then, we’ll have to offset that with restricting visas for overseas students and throwing our higher education sector into chaos. Need more highly skilled programmers working in banks in London? Well, maybe we can balance that by demanding care workers abandon their kids if they want to look after someone in Nottingham. There is no reason to weigh the needs of these different sectors against each other, and yet the logic of this statistic demands that we do. 

The Bible has a word for human-made things which take on their own singular, violent logic. It calls them idols. While that word may conjure images of golden calves, the accusation which biblical writers consistently make against idolaters, that their idols blind them to what is really important and numbs their critical thinking, applies equally well when the idol is a statistic. The dominance of this statistic in our discourse has warped our moral discernments. It has made us unable to say what should be said without glancing nervously at its imposing shadow. It causes us to say things that should never be said and not notice how absurd they are. 

Instead, we should be able to celebrate that hundreds of thousands of people want to come to study at our universities (the vast majority of whom return home after finishing their studies)  and, hopefully, someday also be able to celebrate when hundreds of thousands of refugees are able to return to a peaceful and liberated Ukraine without having to calculate that the former will raise and the latter lower our totals. We should be able to welcome easing of income restrictions on spouse visas without noting that it will lead to a marginal increase in net migration. We should be able to see that sending an eight- and eleven-year-old back to Brazil without their parents is not, in the words of a Home Office official, “a degree of disruption in family life” which is “proportionate to the legitimate aim of maintaining effective immigration control”, but rather a gross violation of human decency. 

Migrants are not just numbers on a balance sheet. The diversity of our lives, what we give to the UK, what we receive in return, cannot be summed up in a single annual figure. And yet every six months, as the figure comes out, politicians express disappointment and announce measures to put that little bit of extra pressure on us, so that maybe a few more of us who can leave will. In the process they are sacrificing to this idol not just the peace of mind and the economic well-being of many migrants, but also much of the vitality of the nation as a whole. The Bible has a solution for idols. They are only fit to be melted down, destroyed, and forgotten. It is time to consider giving this one a similar treatment. 

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