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. 

Snippet
Care
Comment
Education
Hospitality
3 min read

University turmoil makes the case for chaplains

Creating space, offering time, across cultures.
A cup of coffee is offered across a table to a hand that is hesitant.
Priscilla Du Preez 🇨🇦 on Unsplash.

As the university sector convulses, what’s the point of their chaplains? 

The university chaplains fulfil a role which calls for a unique set of skills, including pastoral imagination, flexibility, and creativity as they respond to various, often unpredicted, challenges. Chaplains occupy a place between highly professional Students Services colleagues at the university - think counsellors, experts on emigration and finances, and local parishes representing diverse theological viewpoints.  

Every year, while meeting and greeting international students, one of the earliest tasks for the chaplains is to explain their role, as in non-European languages and cultures there is no equivalent of a “chaplain”. Are the chaplains sort of “spiritual gurus”, “life coaches”, “champions of wellbeing”? What is the real difference for the students and the staff in a secular academic institution, between approaching a chaplain and a professional counsellor?   

In addition to all these initial questions that a student might ask, other observers question the role of chaplains in a secular academic institution, for being counterproductive. Why provide and finance a chaplain without any measurable outcomes of his or her work? Whether it is counting confirmations, ensuring Christian faith and values as clearly pronounced, or/and conducting regular acts of worship for the students and staff? 

Looking at my daily engagement with the international, diverse community of the students and the staff, there are at least three areas of presence (rather being than doing, adapting famous Gabriel Marcel’s distinction), which illuminate this unique type of vocation.  

First, currently British universities are going through a very painful, dramatic time of saving money and redundancies. Chaplaincy is becoming a visible space for emotional support to those who are worried about their immediate future. Students and staff are going through a period of uncertainly, if not confusion, so chaplaincy holds the unique space on the campus to show empathy to those who cry, and to offer time for those who need to speak about their pain.  

Secondly, chaplaincy has the privilege of being very creative in the ways of engaging with the local academic community. The memorial services for the students and the staff who died recently are not the formal funerals: yet they allow the participants to speak, play the music, show videos about the departed.  There is a real celebration of life, brings consolation to academic colleagues, families and relatives.  

Thirdly, unlike other professional services, only chaplaincy is able to show the generosity of time to anyone who comes through the door. That’s because those  individuals are welcome as the ‘image’ of God. The rest about that individual is accidental, he or she finds ‘home away of home’ in the space of chaplaincy, because through the eyes of Christian faith: he or she is precious and unique. 

What about proclaiming the message about Jesus Christ? There is a story about St Francis of Assis who said to his brothers, while approaching an Italian city: “now we will proclaim the Gospel to all who live in this city”. After that he and his companion marched through the streets in silence. When they left the city, one of his brothers, rather surprised by lack of preaching, asked: “Francis, when did we proclaim the Good News?”. “Our way of walking was the proclamation of our faith”. The way how we greet, spend time with students, talk, joke and pray – reflects that proclamation.     

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