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 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
Comment
Economics
Nationalism
Politics
4 min read

Millions of children go hungry in a country that dares to call itself godly

The gospel of national greatness is less about grace and more about political grit

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

A sand drawing shows an unhappy child's face with the tide coming in from below
A sand drawing for a child poverty campaign.
Barnardos.

If anything, the UK – and more specifically England – is becoming a Christian country again. But not necessarily in a good way. The rise of Christian nationalism mirrors the American experience, with Christian symbols such as the cross weaponised against asylum seekers and the knuckle-draggers under them, marching as to war. 

But there are still many non-belligerents who would stake a claim to our Christian nationhood. Wiser counsels such as the historian Tom Holland. Or Danny Kruger MP, who spoke to a near-empty chamber in parliament recently, before defecting from the Conservatives to Reform UK, about a Christian restoration, envisioning a "re-founding of this nation on the teachings that Alfred made the basis of the common law of England." He may need to explain that slowly to Nigel Farage. 

But by what measure do we claim to be a Christian country? Here’s one: Child poverty. It’s very hard to make a case for a state being foundationally Christian in principle if significant numbers of its children go hungry. And the UK shamefully ranks among the worst of the world’s richest countries in this regard, with our children’s poverty rates rising by 20 per cent over the past decade – defined as those living in a household with less than 60 per cent of the national median income, so currently less than about £19,000 a year.  

That’s some 4.5 million living in poverty, or 9 in a typical classroom of 30. Unless action is taken the number will push five million by 2030. Anecdotal evidence from teachers is truly shocking. Children arrive hungry at school with empty lunchboxes to fill and feed family at home. The UK ranks below poorer countries such as Poland and Slovenia, which are currently cutting their child-poverty rates, and well ahead of other wealthy nations such as Finland and Denmark.  

It’s a national disgrace. Christologically, it also fails the minimum threshold for a nation that supposedly holds that the kingdom of heaven belongs to children. In damp and sub-standard housing this winter, lacking nutritious diet and prone to ill-health, heaven will have to wait for these British children. 

The same gospel tells us that the poor are always with us, which may make us resigned to it. But political complacency won’t do. If there is always relative poverty against great riches, then the true measure must be what we’re trying to do about it. The damning answer to that seems to be very little. 

It’s actually worse than that. The circumstance is one of our own deliberate, political making, exacerbated by the then chancellor George Osborne, who introduced the two-child benefit cap in 2017. That limited benefit payments for families claiming Child Tax Credit or Universal Credit for more than two children. It was part of Osborne’s pantomime wicked-squire act, as he repeatedly told us with a straight face that “we’re all in this together”. It was also borderline eugenics, because one of its effects was to limit the breeding of “lower orders”, the benefit cap disproportionately hitting the budgets of working and ethnic-minority families. 

With Osborne’s selective austerity and social-engineering drive long gone, it’s well past time for a Labour government to do something to rectify such social injustice. Current chancellor Rachel Reeves must abolish the two-child benefit cap in her November Budget. With other welfare cuts prevented by Labour’s summer backbench rebellion, the question inevitably squawked by right-wingers is how that will be paid for. 

 Opposition parties relish the prospect of Reeves welching on pre-election promises not to raise taxes on working families. And abolishing the two-child welfare cap could cost £3.5 billion a year. 

There are creative ways and means. Veteran chancellor and former prime minister Gordon Brown – the unsung hero of the 2008 worldwide financial meltdown, without whom we wouldn’t have an economy to do anything with – proposes fairly taxing the excess profits of the £11.5 billion gambling industry, which enjoys VAT exemptions and pays just 21 per cent tax, compared with 35-57 per cent in other industrialised  countries. And if more money is needed then remove some of the interest-rate subsidy enjoyed by commercial banks when they deposit money at the Bank of England. That is what social justice looks like (gambling also costs the NHS £1 billion-plus in harms, so it’s time for the industry to pay up). 

That points to some fiscal answers. There are other actions that must be taken this autumn, at political conferences and on any platform available to those with a public voice and conscience. It’s good to see Stephen Cottrell, Archbishop of York and stand-in primate of England in the absence of Canterbury, laying into the two-child limit and benefit cap. 

Both Cottrell and Brown tell heart-breaking stories of children’s poverty in the UK. We must fight it and ensure that Reeves’ forthcoming Budget does so. As the children’s commissioner for England, Dame Rachel de Souza said recently that millions of children are living in “almost Dickensian levels of poverty”. The irony is that in Dickens’ time we were called a Christian country. 

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