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
Comment
Community
Sustainability
Wildness
5 min read

What my noisy, messy crow neighbours have taught me about how to live

We can’t control nature; we just need to become more porous to it

Joel Pierce is the administrator of Christ's College, University of Aberdeen. He has recently published his first book.

Crows caw and strut.
Meet the neighbours.
Townsend Walton on Unsplash.

Our neighbours hate our crows. I can’t blame them. The hundreds of crows that occupy the tops of the ancient pines which surround our rural manse are the noisiest and messiest residents I have ever lived near. They greet each sunrise with a din of caws and counter-caws, as if they are deeply concerned that anyone might miss this momentous daily event or the fact that it’s now happening before 5:30a.m. In nesting season, which lasts most of April and May, our car is easily identifiable in any carpark by the crusted grey spots with which the crows see fit to adorn it. Within a week of moving in, we gave up on the washing line so invitingly strung between two of the pines. Our pristine whites were too tempting a target for our crows. 

I do not attend the meetings of our local community council, but I hear whispers of what transpires there. Our crows, evidently, have been a regular topic of conversation. Multiple solutions have been proffered for driving them away. All have been tried and all have failed. Our crows cling fiercely to their homes and their determination is more than a match for any human efforts. If I have the vibe of my community right, at least some of its members feel that there’s something perverse, obscene even, about a flock of birds being allowed to upset our human right to create a serene, comfortable, and convenient habitation. Our clump of houses is surrounded by a visually stunning landscape; shouldn’t the aural landscape be equally beautiful?  

If my family does not mind our crows, it is because the treetop drama is just one more example of many natural encroachments on the house, some more welcome than others.  

Every year we celebrate the miraculous return to our eaves of house martins, home from their intercontinental peregrinations. We look forward to another summer spent watching their acrobatics and listening to their chicks in the nests an arm’s length from our windows.  

Clearing up the mess of our attic’s bats is an annual chore, one thankfully performed stoically by our church’s property convener, but there are compensations - such as the twilight shows they put on outside our living room window, performing impossible turns and reversals midair in their search for prey.  

Less welcome are the massive spiders, which are a perennial presence; the slugs, which seemed to apparate onto the hall carpet all through winter, the mice, two of whom sacrificed themselves to knock our dishwasher out of action by chewing through its hose; and the wasps who built a nest the size of a telephone box in the roof space above our back bathroom.  

Least fun of all has been what we call the Great Earwig Migrations, which have happened twice in our half-decade in the manse and which involve weeks of finding the little bugs under, seemingly, every object and on every surface.  

When we moved into the manse, we expected challenges, the high heating bills, the leaking roof, and the isolation of the countryside. What we did not expect was the experience of porousness; the shock of realising that we had so little control over what other forms of life saw fit to share our habitation with us.  

At first it felt to me perverse, obscene even, that a house, even a 120-year-old house, should be so vulnerable to incursions by animal creation. Shouldn’t our home, our space, be a haven where we can control who or what enters, who or what we feel comfortable with, and who or what we can exclude?  

If I had to give a name to this expectation, maybe it would be that of the buffered home, a play on philosopher Charles Taylor’s description of the modern self as buffered. Taylor contrasts the selves we aspire to be in modernity, ones able to control and order our bodies, our space, our lives, and our relationships so that they accord with our autonomous desires and actions, with those of our premodern ancestors. Medievals and ancients assumed porosity. Bodies were subject not just to biological infection, but spiritual infections too. Projects and plans were frustrated not just by mistakes or personal failings, but by the ever-fickle whims of the goddess Fortuna. Their lives, their bodies, their homes, existed in a perpetual state of vulnerability. The threat of everything falling apart was always on the horizon. 

We want nature to survive, flourish even, but not at the cost of our comforts or our sense of autonomy and security.

Modern technology has helped us tame the more unwelcome of these forces, but it has also given us an overly naive expectation that all that is inconvenient about nature can and should be gradually eliminated. This expectation frames the way we respond to worries about climate change and other creeping environmental crises. We want nature to survive, flourish even, but not at the cost of our comforts or our sense of autonomy and security. But as our ancestors might remind us, we are part of nature too, and, just as in any relationship, mutual vulnerability and sacrifice are needed if we are all going to survive. This is scary, but there are resources within Christianity - within other faiths too - to help us understand that there are benefits to affirming our vulnerability, our porosity. 

My daughters love our crows. They point in wonder as the crows flood into the sky at dusk, hundreds of them making a giant circle once, then twice round the garden, before settling down for the night. When, in late May, grounded fledgings appear, bundles of feathers shocked at the sudden inhospitality of the nest, too stunned to realise they can fly home, my daughters watch over them, anxious lest the local cats take advantage of their bewilderment.  

A few Sundays ago, my youngest, who struggles to stay quiet and well-behaved in Sunday School, pulled me out of church early. We sat on the church lawn staring up at the crows and soon were adapting the andante melodies of that Sunday’s hymns into imagined songs of praise that crows might sing. “No,” my youngest said, simpatico with the crows as she is, “I think they’d want something more upbeat.” And so we tried setting our own corvid-themed praise lyrics to Rosé and Bruno Mars’ song APT, while listening to the caw and counter-caw above. “Dad, how do you think God sees the world?” she asked me when we finished. I stumbled through my best theologically informed explanation of how God could be in every part of creation without being of it, before she stopped me. “I think it’s like a giant snow globe that he holds in his hands.” Watching the birds swirl around us, two stationary figures caught by the same currents of air that were sweeping them aloft, what could I do but agree? 

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