Article

Assisted dying

Care

Comment

Death & life

Suffering

27 November 2024

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 Tomlin

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

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

Freedom of Belief

Politics

20 October 2025

5 min read

The UN promised freedom of belief — but 80 years later, it’s still elusive

Flawed, fragile but still vital to those without a voice

Steve Dew-Jones

Steve is news director of Article 18, a human rights organisation documenting Christian persecution in Iran.

Trump addresses the 80th session of the United Nations General Assembly.

The White House.

It’s been 80 years since the United Nations was founded, at the end of the Second World War, primarily in an attempt to avoid a third global conflict.

So on that score, at least, I suppose one must accept that the UN has achieved its primary objective. But why, then, does the overall feeling towards the organisation today seem negative?

The UN’s founding charter outlined three other major goals alongside maintaining “international peace and security”: developing “friendly relations” among nations; international cooperation in solving economic, social, cultural or humanitarian problems; and respect for human rights and fundamental freedoms, “without distinction as to race, sex, language or religion”.

Given that the UN is comprised of 193 countries, it is perhaps little wonder that “friendly relations” and “cooperation” between all sides have not always been forthcoming, and that instead clear cliques have formed between Western countries on the one hand, and much of the rest of the world on the other. (Perhaps the clearest such clique at the moment is the 2021-founded “Group of Friends in Defence of the UN Charter”, the identities of whose members - China, North Korea, Iran, Russia, Venezuela, et al - may lead one to wonder what exactly it is in the UN charter they wish to defend. Short answer: “sovereignty”, code for doing whatever they wish, without interference.)

As for the pursuit of “human rights” - my primary focus as an employee of an NGO - perhaps the greatest obstacle remains the lack of a truly united consensus over which rights should be included in the definition.

The closest that the nations of the world have come to an agreement on this score was the adoption in 1948, three years after the founding of the UN, of the Universal Declaration of Human Rights (UDHR), which was backed by 48 of 58 member states at the time, but which failed to secure the support of others, including apartheid South Africa, the former Soviet bloc, and Saudi Arabia.

A primary objection in the case of Saudi Arabia was to Article 18 of the declaration - the bit about religious freedom and which includes the claim that everyone should have the right to change their religion or belief, an issue that remains problematic for many of the not-so-united nations of the world today.

The UK, meanwhile, was happy to ratify the UDHR but expressed frustration at its lack of legal force, and it was nearly 20 years before another treaty, the 1966 International Covenant on Civil and Political Rights, attempted to correct this.

But while the 174 signatories to the ICCPR - including Iran, Russia, Cuba and China (though the latter two without ever ratifying the treaty) - are at least on paper legally obliged to uphold this international treaty, the challenge of enforcement remains. For example, while the signatories of the ICCPR are obliged to provide freedom of religion as defined by Article 18 of the covenant, which closely resembles the same article of the UDHR, few practical tools exist to hold to account any state that fails to meet its obligations.

In the case of persistent violators like Iran - the focus of my work - it seems the best we can currently hope for is to see a “resolution” passed by the majority of member states, outlining the ways in which the particular violator has failed to provide its citizens with the religious freedom (among other things) that should be their right according to the international treaties it has signed, and calling on them to do better.

But when pariahs like Iran can merely continue to deny that such failures exist, call them “biased” and “political”, and all the while prevent access to the country to the independent experts (“Special Rapporteurs”) best able to ascertain the veracity of the allegations, such “resolutions” can at times appear rather hollow.

At the same time, for advocates of human rights in non-compliant countries like Iran, the public shaming offered by such resolutions at least provides an opportunity for otherwise voiceless victims to be heard on the international stage. And when real change inside the country can sometimes appear nigh-on-impossible, you tend to take the small wins, such as hearing the representatives of member states mentioning the names of individual victims or groups in the public arena.

Many mentions are made, for example, about the plight of the Baha’is during every UN discussion of human rights in Iran, and while it is less common to also hear about my own area of interest - the persecution of Christians in Iran - there is usually at least one mention, which for us advocates (and we hope also the victims we represent) provides some comfort and hope for future change.

So 80 years since the establishment of the UN, it is clear the organisation has much room for improvement, but I remain persuaded by the argument that if we didn’t have the UN, we’d have to invent it.

“Friendly relations” - a helpfully loose term - between our disunited nations will always be a challenge, but increased economic ties globally over the past 80 years have also provided potential pressure points for those who fail to follow the rules. (If, for example, Iran wishes to see sanctions removed, Western countries can and should continue to demand improvements in the area of human rights.)

As for the UN’s endeavour to see increased “respect for human rights and fundamental freedoms”, the question of what such rights and freedoms should entail will continue to be debated, with persistent areas of challenge including not only religious conversion but also abortion and same-sex relations.

It is not uncommon, for example, to hear representatives of Muslim states such as Iran questioning what Western nations really mean by “human rights” and accusing them of using the term only as a “pretext” for their own “biased” agendas.

But for all its challenges, 80 years after its establishment the UN continues to offer the only forum today where countries of contrasting beliefs can come together to discuss their differences on the world stage.

Whether that is a worthwhile exercise remains a matter for debate, but to the degree that it is, the UN remains the primary channel through which such conversations can take place.

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