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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Justice

Redemption

15 May 2025

4 min read

The case of Peter Sullivan proves once and for all why we shouldn’t bring back the death penalty

It’s not the wrongly convicted who are redeemed when justice is done - it’s all of us.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A court sits, with judges raised above the others.

The Court of Appeal.

Judiciary.uk.

The quashing of the conviction this week of Peter Sullivan, who served 38 years in jail for a murder he did not commit – along with the release in 2023 of Andrew Malkinson, cleared of rape after 17 years inside – are deeply shameful. They are revolting stains not only on our judiciary, but on all those who politically invigilate it and on the rest of us who elect them. We should all be deeply ashamed.

As we peep through our fingers at these terrible travesties of justice and the lives that have needlessly been wrecked, it’s natural to ask what we do next. In the absence of time travel, we can hardly make it up to Messrs Sullivan and Malkinson.

But we can grapple with what they mean to us for the immediate future. Probably the first and easist thing to say is – if I may not so much mix a metaphor as summarily execute it – that they should hammer legislatively the final nail in the coffin of the death penalty.

Sullivan would doubtless have swung for the murder of florist Diane Sindall in 1986 that he did not commit, if execution by hanging (or by other means) had not been abolished in 1965. True, rape hasn’t been a capital offence since 1841, when the penalty became transportation (which was almost as irreversible as death).

But Malkinson’s case rather makes the point: The very fact that he was still incarcerated meant that he could be released. Let’s take a case in which no such remedy was available – Derek Bentley, say, who was hanged in 1953 for allegedly abetting the murder of a police officer and exonerated, a trifle late, in 1998.

The arguments of thornproof and white-knuckled proponents of the death penalty may be as swiftly dispatched as they would wish such innocent victims to be. They were probably “wrong ‘uns” anyway. Their sacrifice would have discouraged others from committing heinous crimes. The taxpayer shouldn’t have to pay for their decades in the slammer. Well, pah. Try telling any of that to the Sullivan family.

But these are not, to my mind, the biggest issues and, enormous as they are, that must make the biggest pretty gargantuan. I wish to address the business of redemption.

But we can ransom the present to redeem our future.

Now, when I mention this word to those holding the pitchforks, prodding people they despise towards the scaffold, they usually assume I’ve come over all pious and priestly. And I suppose I have. But they invariably misunderstand what we mean by redemption.

The assumption is that the victim of the miscarriage of justice can be redeemed if they are still alive. Their life is in some way redeemed from suffering. That’s true, so far as it goes, but it’s not really what we should mean by redemption in these circumstances.

The Latin root of the word refers to the buying back, or the paying of the ransom, of a slave to enable his or her freedom. The ancient scriptural usage of the word relates often to the saving actions of the Hebrews’ God, in redeeming his people from slavery in Egypt, and to the Christian culmination of that redeeming work at the cross (totally uncoincidentally, both events are commemorated at the Jewish Passover, that first divine covenant being, in Christianity, fulfilled in the second).

The debate down the ages has substantially concentrated on to whom the ransom of that latter redemption was paid. For some, it was paid to a vengeful and wrathful God, for others to a somewhat gullible Satan, who took the bait of pay-off. Either way, a debt was paid which released humanity from bondage and slavery.

The theology of this can only be satisfactory to a proportion of people who read it, whether believers or not. The important matter is to whom the act of redemption is of value. A slave who died building a pyramid for a pharaoh doesn’t seem to have been redeemed in any more meaningful sense than the young Bentley being pardoned 45 years after he was hanged. Exoneration isn’t redemption.

In the Christian tradition, it’s significant that the compilers of the gospels and the books thereafter develop less the idea of ransom to explain the cross, than the idea of deliverance from bondage that was its result.

And there the answer, rather than the victims, hangs before us. We can’t redeem the injustice of the past, anymore than we can give Sullivan and Malkinson back their lost years. But we can ransom the present to redeem our future.

To those who claim that murderers and rapists “get off” because of “loopholes” in the law, we say there are no loopholes, only the law. And we’re all enriched when we get the law right. So, ultimately, it’s not the wrongly convicted who are redeemed when justice is done and they’re finally released. It’s all of us.