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

The ethical principle of double effect.

Tom Dove

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…

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Middle East

27 September 2023

4 min read

The harsh reminder of our common humanity

Iran’s latest sanctions on protestors are a harsh reminder of the importance of diversity, solidarity and our common humanity, writes Krish Kandiah.

Krish Kandiah

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

A protester holds a red placard bearing the name and image of Mahsa Amini

It has been a year since the widespread protests across Iran sparked by the death of Mahsa Amini. The courageous 22-year-old was killed in prison for refusing to wear the hijab headscarf. To mark the anniversary of her death the Iranian government issued new legislation increasing the punishment to women who are deemed “inappropriately dressed” from a previous punishment of 10 days in prison to a maximum 10-year incarceration sentence.

According to the World Economic Forum, Iran is ranked 140 out of 144 countries in the area of gender equality. Iran’s current leadership suppresses not just the clothing of women but their voices, skills, perspectives and decisions too. Women choosing to forego the hijab had previously been a way to peacefully push back on the inequality they are facing. This symbolism of resistance is now not only forbidden, but criminal. Even business owners who serve women who are not wearing the hijab are liable for prosecution under the new laws.

As a father of three daughters, I find Iran’s new laws deeply disturbing. I cannot even imagine the desperation of Amjad Amini, Mahsa’s father, who this week was put in prison in an attempt to short-circuit any protests of his daughter’s death. He faces not just the trauma of the state murder of his daughter, the risk to his own life and the inability to grieve in peace, but also the devastating consequence of her death on 49 million other women in Iran with the tightening of the very laws his daughter was protesting against.

It could learn a lot from Jesus who went out of his way to welcome those that others looked down on.

As a Christian I find these oppressive laws deeply troubling too. One of the most revolutionary marks of the Christian faith is that it recognises the absolute equality and intrinsic value of all human beings. No matter what our age or race or gender or sexuality or nationality or ability or immigration status or political persuasion or faith, all are made in the image of God. I believe it is therefore an essential element of my faith to speak up for the rights of my fellow human beings, particularly when they are being marginalised, tyrannised, dehumanised or disempowered.

This means the oppression of Muslim women in the Middle East matters to me. Although we come from different cultures, live on different continents and hold different views about God and how to worship him, I believe we are connected by our common humanity.

Sadly, our common humanity is not always recognised either by Christians or those outside of the church. The church in the UK has too often been guilty as charged for misogynist, homophobic and racist attitudes. It could learn a lot from Jesus who went out of his way to welcome those that others looked down on. He was not afraid to face criticism for spending time with those the religious folk of the time had traditionally mistreated. It is time for the church to follow his example and take a lead in treating everyone with compassion and in standing up for the basic human rights of women, those in the LGBT community, and those from other countries.

Our common humanity is becoming overlooked too in our polarised world as it further divides over identity politics. There is a developing norm to focus less on the things that unite us and more on what differentiates us. Our latest culture wars are pitting women’s rights against trans rights, telling us that the rights of black people are opposed to the rights of white people, or that the rights of immigrants are at odds with the rights of settled passport-holders. But that is not the way things have to be or should be.

I believe that the opposite is true: that the world can be better for all of us, that there is strength in solidarity, that diversity is genuinely good for everyone.

This is why I recently turned up at a campaign calling for the rights of Afghan women and girls to be respected, why I publicly advocate for refugees and care-experienced young people, and why I insisted on greater representation of the LGBT community in my work with government. This is why I offer race and faith literacy training to government bodies, churches and businesses. This is why I have opened up my home to foster children and refugee families. This is why I set up my charity, Sanctuary Foundation, to advocate for those who do not feel safe in their own country. This is why I call the church to action and compassion for all whose rights have been taken away or are being eroded. This is why, in as far as it depends on me, I will champion equality for all.

And this is why I will continue to be calling on the government to open safe and legal routes for all those who are being oppressed and persecuted in the countries where they live. I would like the government to offer our country as sanctuary to women from Iran whose lives are endangered, whose human rights are being denied. I would like our country to offer asylum and hospitality to those who have had to flee Iran after daring to challenge the brutality of the current regime. I would like our churches to lead the way in warmly welcoming all those from Iran and anywhere else who have never experienced unconditional love and acceptance.