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 is a physician and completing a theology doctorate. 

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
Character
Comment
Leading
4 min read

Carney’s call for character still resonates now more than ever

In both business and politics, the vocation of public service is at risk.

Emerson writes on geopolitics. He is also a business executive and holds a doctorate in theology.

Mark Carney sits between two other speakers, holding a mic.
Mark Carney on the campaign trail.

On May 27 2014, a group of business, political and faith leaders gathered in London for the inaugural Conference on Inclusive Capitalism.  

As a 23-year-old Masters student at Cambridge University at the time, it was a defining moment, this in the final months of my first stint in the UK. One of three young people invited, I had prepared carefully and waited impatiently in line in central London on a boiling summer evening.  

The most poignant moment of the conference, in hindsight, was less the attendees or the historic venue, but rather a particular speech that I continue to reflect on a decade later.  

The speech in question was one given by the then Bank of England Governor, the Canadian Mark Carney, and it was called ‘Capitalism: Creating a Sense of the Systemic’.  

It was, and remains, one of the most impressive speeches I have heard, and whose message is as important as ever.  

It is a message that Canadians today, as well as others living in Western democracies, need to hear as much as at any time in recent history.  

In the wake of the financial crisis, Carney raised a point that is seldom asked in business or political circles - that of responsibility, and more specifically, of vocation. It is as follows: 

"To build this sense of the systemic, business ultimately needs to be seen as a vocation, an activity with high ethical standards, which in turn conveys certain responsibilities." 

And soon after: "It can begin by asking the right questions. Who does finance serve? Itself? The real economy? Society? And to whom is the financier responsible? Herself? His business? Their system?" 

He references Michael Sandel, the philosopher who in his book What Money Can’t Buy: The Moral Limits of Markets takes aim at the "skyboxification" of American life.  

The example used by Sandel is taken from the sport of baseball. In the not-too-distant past, people from across all walks of life sat together in the stands, the low ticket prices allowing baseball to be the great unifier across divides.  

Today? Expensive box seats see the rich and poor seated in different areas, the rich even physically above - looking down on - others. The same goes for ice hockey, soccer, or other sports which no longer see diverse families, across income levels, sitting together.  

In short, if you impose a price on a good or increase the price of a good significantly (baseball tickets), the nature of value of that good changes, often irreparably so. Lost is a sense of fairness, and a reduction in the potential to repair divides.  

In short, the idea of public service - that to be first, you must come last - seems increasingly bizarre to people. 

We live in a world where immediate gratification and personal enrichment are particular cultural values. If there is any tell on the character of President Trump and his new White House, it is the launch of the Trump and Melania meme coins before the Presidential Inauguration: politics used for the advancement of personal interest.  

In short, the idea of public service - that to be first, you must come last - seems increasingly bizarre to people. (A conversation with a young person several weeks ago struck me especially on this front, in which I had to explain that the purpose of politics is to serve others, not yourself.) 

Carney's 'Creating a Sense of the Systemic' speech is therefore a reminder of what we need from political leaders: people who, outside of compelling rhetoric focusing on putting their nations first, actually consider their responsibilities toward others and who take these responsibilities seriously.  

These responsibilities are vocations to which we are called. The responsibilities are not about us but rather are part of the system (made up of people and institutions) of which we are a part, and beyond. 

In Canada, the potential election of Mark Carney as Leader of the Federal Liberals, and in turn as Prime Minister, is a step in the direction of a public service focused on responsibility and vocation. It is a step toward a more vocationally oriented public service, which our world needs.  Whatever one's partisan affiliations, having political leaders acting with a sense of responsibility toward people and a higher calling beyond themselves is something we should embrace.

If Carney is to channel the same energy, poise and focus of this May 2014 speech, then there is a good chance the Canadian Federal Liberals win a future term. This is because our world is, deep down, yearning for political leadership based on real character, sense of purpose and responsibility beyond the self. But there is equally an opportunity for Pierre Poilievre to do the same, emphasizing the need for character, purpose and responsibility toward Canadians.

For Canada, it is a focus on responsibility, a sense of the broader system and our calling as Canadians in the world that can serve as a foil to the leadership in the United States.

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