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

Assisted dying

Death & life

Ethics

Politics

23 June 2025

4 min read

What will stop the culture of death that libertarian Britain has embraced?

Now we’re allowed to end life with impunity

Graham Tomlin

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

Diane Abbott speaks in the assisted dying debate.

Dianne Abbott MP speaks in the assisted dying debate.

Just a few days apart, two debates recently took place in the House of Commons concerning life and death. In the first, MPs voted to decriminalise late-term abortions. In the second, they voted for assisted dying. Both times, the reach of death grew a little longer.

Imagine a mother about to have a baby who is suddenly having grave doubts about whether she can manage a new child as the moment draws near. It’s not hard to sympathise with many in this situation, but rather than recommend she goes through with the birth, and perhaps putting the baby up for adoption for childless parents desperate to adopt, we now have passed legislation that allows us to terminate the baby’s life instead. Proponents argued this was to relieve a small number of women who had been prosecuted for late-term abortions. The reality is, however, that it will probably become more common. In the debate, Jim Shannon MP pointed out that in New Zealand, in the first year after their parliament voted the same way, late-term abortions increased by 43 per cent.

A baby a week before and a week after birth are virtually identical. Yet as a result of this bill, it will not be a criminal act to end the life of the first, but it will be to do the same to the second. What’s the betting that the logic of this will stretch before long to allowing parents to terminate the lives of newborn babies with a new limit – say up to one month after birth? The arguments will be exactly the same – sympathy for distressed parents who suddenly realise they cannot cope with a new life on their hands, especially if the baby is discovered to be flawed in some way. When emotional sympathy, personal choice and the rights of the mother over the baby become the only moral arguments, the logic is inevitable.

Despite the argument shifting rapidly against the Terminally Ill Adults Bill – the vote passed by 314 votes to 291, with 32 MPs apparently having changed their minds - it now looks likely that this second bill will pass into law in a few years’ time, despite scrutiny in the Lords.

Here on Seen & Unseen, we have scrutinised the arguments put forward for assisted dying over past months. We have argued about the unintended consequences for the many of permitting assisted dying for the few. In The Times a while ago, I argued that if ‘dignity’ means autonomy — my ability to choose the place, the time and the manner in which I die — there is no logical reason why we should refuse that right to someone who, for whatever reason feels their life is no longer worth living, however trivial we may feel their problems to be. With this understanding of dignity as unlimited choice, the slippery slope is not just likely, it is philosophically inevitable.

In both cases the logic of the arguments used means the march of our ability to bring about death will not stop with these measures, despite their proponents’ assurances that safeguards are in place.

These two votes reminded me of something Pope John Paul II once wrote. In an encyclical, Evangelium Vitae – the Gospel of Life - he warned that “we are facing an enormous and dramatic clash between what he called a “culture of death” and a “culture of life”.

He warned that this “culture of death” would be “actively fostered by powerful cultural, economic and political currents which encourage an idea of society excessively concerned with efficiency.” It is, in effect, he argued, “a war of the powerful against the weak: a life which would require greater acceptance, love and care is considered useless, or held to be an intolerable burden, and is therefore rejected in one way or another. A person who, because of illness, handicap or, more simply, just by existing, compromises the well-being or lifestyle of those who are more favoured tends to be looked upon as an enemy to be resisted or eliminated. In this way a kind of ‘conspiracy against life’ is unleashed.”

They were strong words, and in the UK at least, back in 1995, might have seemed alarmist. Yet I couldn't help thinking of them as these two bills passed through the UK’s national parliament. In both cases, the bills were introduced very rapidly with little time for serious moral deliberation. Both depended on emotional appeals to a small number of admittedly distressing cases without serious consideration for the wider cultural and philosophical ramifications of these seismic moves. Both encouraged the steady encroachment of death on demand.

What concerns me is what these bills say about the kind of culture we are becoming. MND sufferer Michael Wenham makes the point powerfully that this is all about autonomy and independence, a spurious kind of compassion, and the fact that palliative care is more expensive than subtly encouraging the dying to take their own life. Looking behind the arguments for compassion, it's not hard to spot the iron law of libertarian ideas of freedom, where individuals have absolute rights over their own lives and bodies that trump everything else. This is the kind of libertarian freedom that prizes personal autonomy above everything else and therefore sees our neighbours not so much as gifts to be valued and cherished, but limitations, or even threats to our precious personal freedoms.

Pope John Paul was right. It does seem that we are opting for a culture of death. And my fear is that it won’t stop here.

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