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
Community
Freedom
Politics
4 min read

From councils to conclaves, there's a vital common ingredient

Church and state alike need pluralism.

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

A gate to a churchyard displays a sign saying polling station.
A polling station through a churchyard.
Southwark Diocese

Rumours that Donald Trump may suspend the US constitution in order to seek a third term as president and yet darker threats that his regime may even harbour autocratic ambitions have reminded the West that we should not take democracy for granted. 

Parliamentary democracy, we have widely assumed, is A Good Thing. It’s so good that we not only want to share it but impose it on other populations. The Iraq war on which the UK and US embarked in 2003 was fought, we were told, for freedom and democracy, but it didn’t quite work out like that. 

By democracy, we tend to mean political accountability, through which parties of government exercise power through the will of the people they serve, expressed in regular plebiscites which ensure that no one can cling unchallenged to power. The recent English council elections are a small example of what we mean by that. 

The Trump phenomenon, though, begins to point towards the prospect of a popular will that is in favour of a form of government that doesn’t correspond to our usual liberal assumptions. There are voices, among them that of the writer Margaret Atwood, which anticipate a suspension of US democracy as a consequence of the President’s insanity. 

Most of us in the UK might argue that democracy need to be more than a system in which majorities have their way. We want our governments to be under the law too. And then we have to decide not only what law, but whose law. For those of religious faith, that question will partly and significantly be answered by God’s law, on which arguably western civilisation is built. 

This is where pluralism comes in, without which democracy can’t operate effectively. A state is a collection of political and civic communities, in which individuals have rights and duties, which are protected in law. 

This model is based on Roman legislature, intensely centralised and systemically suspicious of private societies, which is why early Christians were persecuted under it. The collapse of that empire left a legalistic vacuum, into which stepped nation-state kingdoms and the early medieval Church.  

Unlike political parties, we don’t compete for control, but form a community that points towards a saved and healed world. 

It was this latter organ of state that inherited the basic principles of Roman law, centralised, universal and sovereign, under the Pope. And it is that organ that will meet in conclave to elect a new Pope. To describe that election as democratic is more than a stretch, in that the demos, as in common people, are uninvolved and arguably unrepresented. 

So the Church is not a democracy, any more than God is accountable to his creation. Rather the other way around – some denominations speak of God’s “elect”, those he chooses for salvation. In Christian thought, God is a servant king, but nonetheless an absolute and, some who oppose the divine might say, tyrannical authority. 

How are we to respond to an undemocratic deity? One answer to that might be found in that pluralistic characteristic of democracy. We’re not good, frankly, as recognising pluralism in our faith systems. At best, we operate in a kind of absolute duopoly – you believe, or you don’t. A pluralistic model would be one in which we learn of the divine will through the entirety of creation, all manifestations of belief and unbelief, rather than simply our own. 

Pluralism is healthy, in secular politics as well as in religious observance. It has been observed that the old UK political duopoly of Labour and Conservative has been broken in these local elections by Reform UK and resurgent Liberal Democrats and Greens. It’s the polar opposite of the gathering autocracy in the US and gives a voice to a range of worldviews. 

This is not an argument for theocracy, but it is to claim that the Christian tradition rests on the principle that no political order can claim the authority of God other than the Body of Christ. And the Body of Christ incorporates all members of the human race. Unlike political parties, we don’t compete for control, but form a community that points towards a saved and healed world. 

The choice here is between a kind of secular citizenship, a form of multi-culturism which strikes an accord between varied communities on universally enlightened principles. Or we can respond to the energy on which that secular utopia might be founded, in building communities of the willing towards global justice and peace. That is a diversity mission for the Church. 

So, it’s less about democracy than pluralism. And that pluralism has to become a recognisable characteristic of the body of the faithful, which it all too often historically hasn’t been. One can only hope and pray that it might be a mission that is also at the heart of the deliberations that lead to a puff of white smoke from the Sistine Chapel in the coming days. 

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