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…

Article

Ambition

Comment

Death & life

Economics

20 May 2025

4 min read

Forget the Rich List, wealth needs deeper foundations than money

Your neighbourhood might be cool or gentrified now, but where will you go when you die?

Jamie Mulvaney

Jamie is Vicar of St Michael's Chester Square, London.

A red Ferrari parked on a posh London Street

Parked Ferrari off Belgrave Square, London.

John Cameron on Unsplash.

To drive from Clapham to north of the river in London, you go past a warning sign. It's not an LED flashing one, instead it's painted on a Victorian building in uneven serif lettering:

'For what shall it profit a man, if he shall gain the whole world, and lose his own soul?'

It implies that the man (or the woman) on the Clapham omnibus, whatever their wealth, ignores it at their peril.

I recently made that same journey from living in Clapham – a place of relative wealth to one of alleged extreme wealth, in Belgravia. My initial reflections are that people are people, and that wealth doesn't resolve all our problems. There's actually far more poverty, both physical and spiritual, than meets the prejudice.

But that Victorian sign speaks to our aspirations, for those with a little, and those with a lot. We think that more is more. Cities feed the striver, and in that pursuit of wealth some argue that our cities are losing their souls. While South-West London might not be the most drippingly cool places in London, they have historically been places for those who are in professions that are cool-adjacent. Of those involved in academia or journalism, Josiah Gogarty wrote in the New Statesman:

'These professions never promised luxury, but they did deliver a respectable middle-class lifestyle for even the moderately successful. But try buying a house in centralish London today off an income that isn’t made in, or by servicing, the City.'

As it happens, this week I heard one journalist on the radio saying a comfortable amount to have in his bank would be £7 million. How much is enough?

But for grads in service professions with healthy cashflows and bonuses, you can still rent in ‘centralish’ London. No doubt the affluent who house-share have buoyed Clapham Common Westside into the position of having the highest average household wealth of anywhere in the UK, at over £100k. Gogarty continues:

'Call it Claphamisation, after the London neighbourhood of choice for graduates with dependable jobs and straightforward tastes. Gentrification took your money, or forced you to care about money more than you would’ve done otherwise. Now Claphamisation is coming for your cool.'

In other words, gaining the world means losing your soul.

Both riches and coolness are irrelevant as the casket is lowered into the ground.

But even those markers of mainstream wealth and its own version of cool are uncertain as the annual Sunday Times Rich List over the weekend reflected. Your heart mightn't bleed for those falling off their perches, with a threshold of £350 million. But economic turbulence also unsteadies the presumed foundations of wealth.

Wealth needs a deeper foundation than money. And soul needs a warmer foundation than cool. Harvard Professor Dr Arthur Brooks, says that love is

'what the human heart really, really wants. And a lot of people are thinking, you know, if I have the money, and I buy the stuff, then I'm going to get more love.'

Wealth, and I would argue coolness, are intermediaries to this love.

Tending to our souls means opening ourselves to a love that is far richer than what's on the surface. That's not to say that Christian theology denies the physical, however. It teaches an embodied understanding of our souls. I was all too aware of this standing by a coffin, taking a funeral this week. We are material beings and made of material. But our inner settled-ness in what drives us and what we are devoted to far outweighs the trappings of life.

I have seen people dazzled by their own wealth and others seriously unimpressed by it. And while most of us would quite like the chance to find out for ourselves that wealth is an imposter, both riches and coolness are irrelevant as the casket is lowered into the ground.

Those serif letters on that sign on the edge of Clapham are easily ignored. They seem out of place as the cars and Lime bikes zoom past. But the words aren't disembodied: they were spoken by someone. When a rich young man, sure in his own good living and upstandingness, turned his back on Jesus, he was sad, holding onto his wealth. The eyes that looked on him still loved him.

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