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
Culture
Death & life
Politics
3 min read

Is a funeral the right backdrop for diplomacy?

Where there's an unavoidable collision between the universal and the individual.

Jamie is Vicar of St Michael's Chester Square, London.

Trump and Zelensky sit and face each other.
Ukrainian Presidential Press Service.

There’s an episode of Yes, Prime Minister where a state funeral provides an opportunity for negotiations with the French over the Channel. As ever, this particular satire has aged well. Most of the coverage of Pope Francis’ requiem mass has focused on either the ‘spectacle’ or the chance for world leaders to connect. It's tempting to think that the main stage of St Peter's Basilica was actually a sideshow to the fringe events of politicians carving up the world. With all the planning and confections that go into usual geopolitical summits, Vatican City has provided a spectacular impromptu backdrop. 

As an Anglican priest, I have mixed feelings about this. All the photos world leaders have been pushing out seem not a million miles away from the shocking taste of selfies in front of an open casket (any casket, for that matter). On the other hand, when there’s matters of life and death to discuss, there’s no better venue than a funeral. 

Of course, this presupposes that leaders have the presence of mind to acknowledge the dead body before them (not 'passed away'), rather than simply going through the motions and thinking about the photo op. But the cogs of death cannot be avoided. 

Tim Hamer, writing for the Lowy Institute, says, ‘bitter rivals can acknowledge the rituals of mortality.’ Some of the figures about leaders attending recent funerals are staggering. Pope Francis' funeral was no different. Along with those Francis prioritised - those pushed to the margins - there was also a critical 'mass' of those at the very centre of society. There were 170 delegations, including 50 heads of state, 15 heads of government and 12 reigning monarchs. Emeritus Professor of International Relations at the University of Leicester, Geoff R. Berridge writes that: 

 “Because death is always with us … there is little doubt that the working funeral is now the most important ceremonial occasion in the world diplomatic system”.   

Therefore, the off chance of bilateral diplomacy must be taken to its full advantage. 

It is precisely because, while the bodies are lowered, funerals elevate us out of the everyday, the 24 hour news cycle and the doomscrolling, that they provide us with an opportunity to connect with what really matters. Less than 24 hours before he died, the pope delivered the words on Easter Sunday: 'Christ is risen! These words capture the whole meaning of our existence, for we were not made for death but for life… God created us for life and wants the human family to rise again!' As our multilateral world order falters, the human family just might be able to rise again when the powers-that-be meet at a funeral.  

We will have to wait and see if there is any fruit from the geopolitical meetings that have taken place. We can live in hope. If world leaders learnt any lessons from the enigmatic late pontiff, they would see that he was like Teflon to the political labels people tried to pin on him. You get the impression that he was aiming for something more lasting than soundbites, quick wins and popularity. 

I would also add that funerals are for the living. Once we've brushed aside any theological quibbles over the efficacy of praying for the dead, funerals are there to help us to grieve. They help us to process loss, which is why the 'mortal remains' remain. The ancient declarations, the homily, the breaking of bread and pouring of wine, yes even the theatrics help us to situate our own lives on a world stage where we are both bit parts as well as worthy of the undivided attention of many onlookers.  

In a world where geopolitics threatens to depersonalise and dehumanise countless millions of people, funerals unavoidably collide the universal with the individual. The context of worship and thanksgiving also lifts us out of the orbital pull of the ephemera of nation-states and our own lives to discover the possibility of revolving around Someone far grander and steadfast. Just like conducting diplomacy, there's no better place to consider death than a funeral. 

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