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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Race

7 August 2024

3 min read

Racism is back on the streets

A ring-pull moment unleashes violence, what can be done?

Krish Kandiah

Krish is a social entrepreneur partnering across civil society, faith communities, government and philanthropy. He founded The Sanctuary Foundation.

Rioters confront police, one wearing a sinister Union Jack mask

Racist violence is back on the streets of Britain. Some say it never went away in the first place. Never mind that we have just had our first brown Prime Minister or that we have the most diverse cabinet in history. Just listen to the chants on the streets, watch a viral video of a lone black or Asian man being kicked to the ground by a gang of white men, or read the graffiti on the sides of hotels housing asylum-seekers who fled the Taliban because they dared to help the British army. Talk to those who feel afraid - most will agree: racist violence is back and it is unacceptable.

The riots on the streets of cities around the UK brings back all too painfully for me the memory of those dark corners of my school yard where I was trapped by bullies throwing insults and punches in my direction, just because my skin colour was different. Now once again, I, along with my friends and family, and all communities of colour, are beginning to think twice before we leave our homes or walk down our streets.

Back when I was just that kid in the playground, I once opened a can of cola that, unbeknown to me, had been shaken vigorously. As I heard the crack of the ring pull, I was immediately drenched by a fountain of black sugary liquid and an eruption of cruel laughter. That humiliating event of my childhood perhaps offers an insight into what is going on in the UK right now: the tragic incident on Hart Road in Southport where three young girls were murdered was the ring-pull moment that has unleashed the bottled-up frustration of disaffected people around the country – a frustration which has been deliberately and openly stirred up through divisive rhetoric over many years.

Cultural Christians are more unsympathetic to asylum-seekers than any other group of immigrants.

It is not only the rioters who are to blame for this wave of violence. We must also hold accountable those who have been shaking the can. Those who have stirred up anti-immigration sentiment for personal gain, spreading lies and misinformation. Those who have tried to win votes and build careers and influence or grab headlines by scapegoating those who have lost everything and sought sanctuary in the UK. Those who have not questioned as we have drained resources out of schools, cut youth services and failed to provide affordable housing or realistic job prospects. Those who have assimilated a hostility towards asylum-seekers.

Sadly, the can has also been shaken by some who call themselves Christians. Recent protesters in London have been heard using anti-Islamic rhetoric alongside their chants that “Christ is King”. A small number of Christian influencers have consistently contributed to the anti-immigration stance and undermined the importance of diversity and multiculturalism. Data from the Faith and Religion thinktank Theos reveals that cultural Christians are more unsympathetic to asylum-seekers than any other group of immigrants. This despite all the incredible amount the church in the UK has done to lead the way in the welcome of new arrivals from Hong Kong, Afghanistan, Syria and Ukraine. More poignantly, the hostility stands in stark contrast to the Christian virtue of hospitality that permeates every book of the Bible, and every moment of Jesus’ life and teaching.

Racism is unacceptable, and there is a part for all of us to play in ensuring that this message is heard loud and clear. For a start we can refuse to turn a blind eye and pretend it is nothing to do with us. We can challenge anti-immigrant rhetoric. We can counter misinformation with truth. We can choose to deescalate violence and defend those who have become targets and clamp down on those who stir up hate. We can show support for all those who are seeking to keep the peace, and we can choose to foster a more inclusive, generous and compassionate society every day with our words and actions.