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

The ethical principle of double effect.

Tom Dove

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…

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Faith

15 August 2024

4 min read

Faith is no longer a dirty word in publishing

Sarah Perry’s comments suggest a reawakening of concern for its observation.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A woman being interviewed gestures with a hand in front of her

Sarah Perry.

Waterstones.

If there’s one thing anyone who has ever written a novel can’t stand, it’s having to congratulate a successful novelist. So, it’s through gritted teeth that I warmly welcome the words of Sarah Perry (The Essex Serpent) that religious faith is ceasing to be a subject of embarrassment in published fiction.

It’s about time. Perry told the Edinburgh International Book Festival that, for her latest book Enlightenment, she was asked to put in more theology: “I assumed that everybody knew what the doctrine of predestination meant.” Bless.

The cause of my pathetic envy as I applaud her is that I had my first (and, to date, only) novel published in 2017, to almost universal disinterest. I like to tell people that it was well received – all three people who actually read it said they enjoyed it and only one of them was a family member. It actually did a bit better than that, but you get my drift.

It was an unashamedly religious psychological thriller, titled A Dark Nativity. Brace position, here comes a one-sentence synopsis: The narrator, Reverend Natalie Cross, is a frustrated former aid worker who undertakes a mission to Israel, is kidnapped and held hostage, murders her way to freedom, discovers she was the victim of an Anglo-American plot, wreaks her terrible revenge and (spoiler alert!) gives birth to a son of uncertain paternity.

See what I did there? As well as the latter-day Nativity resonance, thematically I was interested in what redemption looks like in Israel and Palestine. I know, I know – but even I thought it would be distasteful to try to cash in on what’s happened there since.

Enough of the plug for a seven-year-old novel. My point is that its religious themes actively militated against it at the time. Novels addressing Christian faith (or any other kind) occupied a particular publishing niche – a harsher word might be ghetto. To try to break out of it was pointless. The great Christian novelist Penelope Wilcock told me (very kindly) that my book was too religious for the secular market and too secular for religious readers.

Perry’s observation that faith is no longer a dirty word in publishing might yet suggest a reawakening of serious concern for its observation.

The restricted area to which religion was confined had its stylistic rules. There was the cathedral close romp, which authors such as Catherine Fox had made their own. The vicarly whodunnit (lately updated by Reverend Richard Coles). Magic realism with its daemons and Philip Pullmans. And anything, in the wake of Dan Brown’s The Da Vinci Code, involving ancient plots that might make a movie, with hooded figures walking in slo-mo through cloisters.

Vicars had to be evil or silly. I may be both those things at times, but I’d like to think there is other stuff going on here for cultural exploration. My narrator, Nat Cross, was driven, often funny and more than a little mad. So like a lot of Anglican clergy.

If she’s right – and I very much hope she is – it’s why what Perry has to say is so hopeful. Because it begins to suggest that religious faith is slowly beginning to be accepted back into polite society. Whisper it softly, it might even become a cultural norm. If Richard Dawkins can describe himself as a “cultural Christian” and the historian Tom Holland, in his book Dominion, can claim that Christianity is the entire foundation of western civilisation, then there is everything to play for. And, indeed, write for.

It’s not as if cathedral frolics and the revelation of Jesus’s wife in Leonardo’s Last Supper was anything other than a fictional diversion of post-modernism. Religion and specifically Christianity had been a staple of the novel in English.

I hesitate to mention their names in the same column as the authors above (including me, most obviously), but Graham Greene’s exposition of Catholic guilt in The End of the Affair and Evelyn Waugh’s of the impossibility of moral reformation in Brideshead Revisited are probably the best religious novels of the twentieth century.

Further back towards the birth of the English novel, the Reverend Edward Casaubon in George Eliot’s Middlemarch is perhaps the most tragic portrait of a clergyman who is neither evil nor silly. He stand as a warning from history to today’s Church of England.

And it’s to that, the established Church, that Perry’s remarks ultimately turn our attention. We’re told that there has been a five per cent spike in church attendance recently, but that of itself isn’t sufficient to suggest a renaissance in our religious culture. Our arts and culture will only ever really reflect what we care about.

Perry’s observation that faith is no longer a dirty word in publishing might yet suggest a reawakening of serious concern for its observation. If so, that’s good news for the religious, as well as for religious authors. And I might just get a sequel out of it.