Article
Assisted dying
Care
Comment
Death & life
Suffering
5 min read

Why end of life agony is not a good reason to allow death on demand

Assisted dying and the unintended consequences of compassion.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A open hand hold a pill.
Towfiqu Barbhuiya on Unsplash.

Those advocating Assisted Dying really have only one strong argument on their side – the argument from compassion. People who have seen relatives dying in extreme pain and discomfort understandably want to avoid that scenario. Surely the best way is to allow assisted dying as an early way out for such people to avoid the agony that such a death involves?  

Now it’s a powerful argument. To be honest I can’t say what I would feel if I faced such a death, or if I had to watch a loved one go through such an ordeal. All the same, there are good reasons to hold back from legalising assisted dying even in the face of distress at the prospect of enduring or having to watch a painful and agonising death.  

In any legislation, you have to bear in mind unintended consequences. A law may benefit one particular group, but have knock-on effects for another group, or wider social implications that are profoundly harmful. Few laws benefit everyone, so lawmakers have to make difficult decisions balancing the rights and benefits of different groups of people. 

It feels odd to be citing percentages and numbers faced with something so elemental and personal and death and suffering, but it is estimated that around two per cent of us will die in extreme pain and discomfort. Add in the 'safeguards' this bill proposes (a person must be suffering from a terminal disease with fewer than six months to live, capable of making such a decision, with two doctors and a judge to approve it) and the number of people this directly affects becomes really quite small. Much as we all sympathise and feel the force of stories of agonising suffering - and of course, every individual matters - to put it bluntly, is it right to entertain the knock-on effects on other groups in society and to make such a fundamental shift in our moral landscape, for the sake of the small number of us who will face this dreadful prospect? Reading the personal stories of those who have endured extreme pain as they approached death, or those who have to watch over ones do so is heart-rending - yet are they enough on their own to sanction a change to the law? 

Much has been made of the subtle pressure put upon elderly or disabled people to end it all, to stop being a burden on others. I have argued elsewhere on Seen and Unseen that that numerous elderly people will feel a moral obligation to safeguard the family inheritance by choosing an early death rather than spend the family fortune on end of life care, or turning their kids into carers for their elderly parents. Individual choice for those who face end of life pain unintentionally  lands an unenviable and unfair choice on many more vulnerable people in our society. Giles Fraser describes the indirect pressure well: 

“You can say “think of the children” with the tiniest inflection of the voice, make the subtlest of reference to money worries. We communicate with each other, often most powerfully, through almost imperceptible gestures of body language and facial expression. No legal safeguard on earth can detect such subliminal messaging.” 

There is also plenty of testimony that suggests that even with constant pain, life is still worth living. Michelle Anna-Moffatt writes movingly  of her brush with assisted suicide and why she pulled back from it, despite living life in constant pain.  

Once we have blurred the line between a carer offering a drink to relieve thirst and effectively killing them, a moral line has been crossed that should make us shudder. 

Despite the safeguards mentioned above, the move towards death on the NHS is bound to lead to a slippery slope – extending the right to die to wider groups with lesser obvious needs. As I wrote in The Times recently, given the grounds on which the case for change is being made – the priority of individual choice – there are no logical grounds for denying the right to die of anyone who chooses that option, regardless of their reasons. If a teenager going through a bout of depression, or a homeless person who cannot see a way out of their situation chooses to end it all, and their choice is absolute, on what grounds could we stop them? Once we have based our ethics on this territory, the slippery slope is not just likely, it is inevitable.  

Then there is the radical shift to our moral landscape. A disabled campaigner argues that asking for someone to help her to die “is no different for me than asking my caregiver to help me on the toilet, or to give me a shower, or a drink, or to help me to eat.” Sorry - but it is different, and we know it. Once we have blurred the line between a carer offering a drink to relieve thirst and effectively killing them, a moral line has been crossed that should make us shudder.  

In Canada, many doctors refuse, or don’t have time to administer the fatal dose so companies have sprung up, offering ‘medical professionals’ to come round with the syringe to finish you off. In other words, companies make money out of killing people. It is the commodification of death. When we have got to that point, you know we have wandered from the path somewhere.  

You would have to be stony-hearted indeed not to feel the force of the argument to avoid pain-filled deaths. Yet is a change to benefit such people worth the radical shift of moral value, the knock-on effects on vulnerable people who will come under pressure to die before their time, the move towards death on demand?  

Surely there are better ways to approach this? Doctors can decide to cease treatment to enable a natural death to take its course, or increase painkillers that will may hasten death - that is humane and falls on the right side of the line of treatment as it is done primarily to relieve pain, not to kill. Christian faith does not argue that life is to be preserved at any cost – our belief in martyrdom gives the lie to that. More importantly, a renewed effort to invest in palliative care and improved anaesthetics will surely reduce such deaths in the longer term. These approaches are surely much wiser and less impactful on the large numbers of vulnerable people in our society than the drastic step of legalising killing on the NHS. 

Article
Books
Comment
Film & TV
Morality
6 min read

Murder we wrote: how cosy crime and psycho-thrillers carve our minds

Our reactions have changed from heart-wringing cries to merely puzzle-solving

Theodore is author of the historical fiction series The Wanderer Chronicles.

Elderly amateur sleuth stand by their pinboard.
The Thursday Murder Club convenes.
Netflix.

We love murder. 

That seems to be the only reasonable conclusion when you look at the sales figures of Richard Osman’s record-busting murder mystery series, which opened with The Thursday Murder Club back in 2020. In UK sales alone, it sold over a million copies within the same year as its release, something no other book has ever done.  

This was more than a bestselling debut novel, this was a cultural event in UK publishing. And no doubt Netflix are hoping for something equally seismic when their film adaptation of The Thursday Murder Club goes live. 

The combination of light humour, a clutch of charismatic octogenarians, tea and cake, and the odd violent death or two to keep them entertained, seems to have struck the motherlode of British cultural appeal. I can only imagine the stellar cast they have assembled for the film adaptation, led by Helen Mirren and Pierce Brosnan, will take the series’ success to new heights. 

As an author currently puzzling my way through my own contemporary murder mystery, I can only look on at the phenomenon in wonder and sigh for what may yet be.  

But murder has always been a tricky one for me as a) an author, and b) a Christian. Do those two facts mean I have to be a “Christian author”? And if so, what kind of limits does that put around what I should be writing about? It may not sound like much of a conundrum to you, but honestly I have wrestled with this question for a long time. There is darkness in the world: how much darkness should I explore in my books? (So far, if you ever read any of my historical novels, you’ll see the answer is: quite a lot.) 

Maybe I’m taking it all too seriously and murder is mere light entertainment now. Death is to be enjoyed with a nice cup of tea; evil, with slice of Victoria sponge cake. 

But somehow, I don’t think so. 

Recently, I was helped in my moral quandary by another crime author, Andrew Klavan. In his book, The Kingdom of Cain, published last month, Klavan explores the question of evil and specifically murder in what he terms a ‘literature of darkness’. It is a fascinating, if unusual, book. His approach is to take three murders that actually happened, and demonstrate how each has influenced a long succession of murder novels (and movies) up to the present day.  

Through this exposition, we witness the changing attitudes to murder over the last century and a half and in particular how those changes seem strongly linked to the ebbing tide of Christian faith in the West. 

For example, Dostoyevsky’s great novel, Crime and Punishment, was published in 1866. The double-murder, central to the plot, is carried out by a young student named Raskolnikov. He is an intellectual who is seeking to prove that the moral boundary beyond which murder lies is nothing more than a mere concoction, a social construct (or worse, a religious one) which he, being of superior intelligence, can transcend and therefore ignore. The entire novel is the story of how his conscience will not allow him to get away with this. Near the end, he confesses his crime to the young prostitute, Sonya, who responds to his confession in fearful horror: 

“What have you done? What have you done to yourself?” 

The second question is key. 

Dostoyevsky based the plot of his novel on a real axe-murderer, a Frenchman called Pierre François Lacenaire, who went to the guillotine in 1836. Lacenaire became an international sensation when, in court, he aired many of his own pseudo-intellectual justifications for his actions – that the murders he committed were a strike against the injustice of the elites and the iniquitous power structures of the day. Rather than what they appeared to be: a grubby little double murder for the sake of a few francs. Lacenaire set the tune which many still whistle today, I’m sorry to say. 

But Dostoyevsky was prophetic. He foresaw long before Nietzsche and others who would follow, that the tide of Christian faith was going out in Western civilization. And so it continued to do through the back end of the twentieth century and into this one. 

Before that, the notion that murder is wrong because every human being is made in the image of God was a long-held axiom, going back arguably to the first chapters of Genesis. And in killing the image of God, any image of God, this may therefore be the closest we can come to killing God himself. Seen in that light, murder is sacrilege on an appalling scale.  

But there’s the rub. That light has dimmed. The secular philosophies of the nineteenth and twentieth centuries have turned down the dimmer-switch, so that it is no longer axiomatic that humans possess an inherent sacred value. Instead, in varying guises and to varying degrees, the conclusion has been that humans are nothing but self-conscious lumps of meat. We (the state, the law) may ascribe them some value. “We are all equal,” yes - but as George Orwell anticipated, “some are more equal than others.” (Is intersectionality, for example, anything but the manifestation of that prediction?) 

Maybe this explains how the horror of murder has diminished from Sonya’s heart-wringing cry, into something more akin to a crossword puzzle. Don’t get me wrong, I love a good Agatha Christie. But her murder mysteries don’t waste much time on the philosophical implications of, say, the local doctor bumping off the parish priest. 

And from there, the genre of the murder mystery has split into two strains. On the one hand, we get the psycho-thriller, in which the horror of the act of murder is of less interest than the dark psychological state of mind of the killer themselves. But if that’s too dark, don’t worry. We can do light, too! And so on to cosy crime blockbusters, in which, if a murder was committed, it was because the victim had it coming – so let’s all calm down and have another slice of cake. 

There is no space here in which to explore how, as a culture, our collective historical experience may have helped to steer us in this direction, as well as our changing philosophy. But there is no doubt where we have ended up. We see death cults all around us. We see legislation being passed in our Parliament which would have been unthinkable until very recently. We see social justice where before we saw crimes.  

Think about how often the arch-crimes of history have been perpetrated on the ground of viewing the “other” as less than human, and certainly less than sacred. Then ask yourself, why should we see any human as more than a lump of meat? At what point does the rubber hit the road? - as surely it will. 

What have we done? What have we done to ourselves? 

I do wonder where all this goes. And yet, if the spiritual bellwethers are to be believed, perhaps we have reached low tide at long last – certainly it has revealed some pretty ugly creatures lurking at the bottom of the rock pool. Many, myself included, must hope that the tide of faith is truly on the turn. Let’s see. Certainly, if this proves to be the case, it seems to follow that our attitude to murder will change with that on-rushing tide. And so with it, the literature of darkness. 

Beyond The Thursday Murder Club, there may yet be other great stories told of murder; they, like Crime & Punishment, will be far truer, and in a paradoxical sense, far more beautiful. After all, at the heart of the gospel, there lies a murder. If God himself can take such a dark event and turn it into light, then, at a far inferior level perhaps, as His image-bearers, so might we. 

Which reminds me… back to my draft.

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