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
Comment
Justice
5 min read

Facing up to justice

The crimes and sentencing of baby-murderer Lucy Letby is driving fresh conversations about justice. Edward Smyth examines the confusion and contradictions within them.

A writer and speaker in the field of criminal justice and faith, Edward Smyth is now pursuing doctoral research on the 'through-the-gate' experiences of individuals who have found faith while in prison.

A prisoner looks into the camera.
Lucy Letby's Police file photograph.
Cheshire Constabulary.

‘Christians need to be ready for the inevitable moment when Lucy Letby declares that she’s found Jesus in prison.’  

So read one of many tens of thousands of tweets posted on the day Letby was sentenced to spend the rest of her natural life behind bars. I probably saw several hundred of those tweets that day; yet this one has lingered, niggling away at me whenever my mind is drawn back to a consideration of the appalling facts of a case that surely takes its place amongst the worst ever to have been prosecuted in this country.  

One of the things about the Letby trial which has caused the most consternation has been her refusal to appear in court for some of the verdicts, and for her sentencing hearing. The strength and volume of the response to what is being almost universally termed her ‘cowardice’ has some challenging things to say about what contemporary society means – or thinks it means – when it talks of ‘justice’. And, as I write, the Government’s response has been to force criminals to appear. An interrogation of these responses might just help us all begin to be able to think through where this leaves us, too.  

The sense seems to be that in refusing to enter the dock at Manchester Crown Court for her sentencing, Letby has somehow evaded what we might term her ‘just deserts’; and that her victims and their families – and indeed society – have been cheated out of some of the justice to which they feel entitled. If the act of receiving the sentence is viewed as itself part of the punishment (not an assumption by which I am wholly persuaded, but one which sits at the heart of this argument) then the outrage caused by Letby’s avoidance of her sentencing speaks to a certain weighting of the importance of that one morning in court as against the next forty or even fifty years Letby will spend in prison. What this boils down to, then, is retribution pure and simple. We think offenders should be made to listen to the impact of their offending because we want them to feel all the things that we believe they deserve: guilt, shame and pain. We want this because of some innate, deep-rooted sense of balance and fairness which dictates that an appropriate response to the imposition of pain is, in turn, the imposition of pain.  

Our legal system exists, in part, to ensure that this remains proportionate: the state censures offenders to avoid the inevitable disproportionate vigilante or retaliatory action which would otherwise ensue, exercising what some criminologists refer to as its ‘displacement function’. Prisons, of course, are out of sight and usually out of mind which perhaps explains the importance of the sentencing hearing in cases like this: it is the only opportunity we have to see the convicted person suffer – and we need to see it with our own eyes to make sure that, even if we think ‘prison is too good’ (i.e. insufficiently painful), we have at least seen the convicted person suffer some pain. 

Letby may have avoided being deluged by the waters of justice rolling down upon her ... in the dock, but we should be in no doubt that those waters are rising from the floor of her prison cell as we speak.

For Christians, though, the elephant in the room is that Letby has been sentenced to a ‘whole life order’. In passing that sentence the state is saying ‘we have no interest in your rehabilitation’; and that is something which should give all pause for thought especially Christians. I do not think there is a ‘correct Christian response’ to this issue, as it happens: personally, I would rather we didn’t have whole life orders, but equally I have no objection to someone spending the rest of their life in prison if that is the only safe course of action. If we were designing a Christian system of criminal justice, then whole life orders would be indefensible on the grounds that we have no right to make impossible redemption; but we’re not designing – or operating under – a Christian system of criminal justice; and redemption in the theological sense is still possible in prison. I struggle – particularly in light of cases like this one – to get too worked up about it.  

But perhaps that’s the point. Perhaps the fact that my own theology opposes whole life orders but, when exposed to the facts of a case like Letby’s, I find it difficult to care very much is exactly the kind of confusion and contradiction of which I spoke at the outset of this article. And in that confusion and contradiction perhaps we find what it is to be a Christian, our instinctive and culturally conditioned human responses coming up against the teaching of the ultimate countercultural being and, so often, overwhelming it in our hearts.  

Those hearts ache for the victims of Lucy Letby and their families. Have they received justice? She will spend the rest of her life in prison: I think they have. Is that justice compromised because she did not appear for her sentencing? I think it is not, on both secular and Christian grounds. Secularly speaking the state has performed its ‘displacement function’ and the punishment is being carried out whether she was there to hear it or not. The victims have – for better or worse – been removed from the conversation, which is why criminal cases are listed as ‘The King v. ...’ rather than ‘[Victims’ names] v … .’ Theologically speaking Letby may have avoided being deluged by the waters of justice rolling down upon her (as Justice is described in the Bible) in the dock, but we should be in no doubt that those waters are rising from the floor of her prison cell as we speak, and she will be soaked through soon enough. 

The case of Lucy Letby – as with any case of great evil – is a violent challenge.  For the Christian, it is one which can only be met with prayer, thought, and introspection. In short: they must pray their way to their own response. But whilst they are doing that as Christians in an increasingly secular world; a world where the responses that they know their faith obliges them to make are so quickly and easily monstered – I can only hope that they and we find in our Church an institution willing to preach that countercultural, unpopular Gospel.    

'Modern man often anxiously wonders about the solution to the terrible tensions which have built up in the world and which entangle humanity. And if at times he lacks the courage to utter the word “mercy”, or if in his conscience empty of religious content he does not find the equivalent, so much greater is the need for the Church to utter this word, not only in her own name but also in the name of all the men and women of our time.'  
Pope John Paul II