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
Justice
7 min read

Just where does the arc of history bend towards today?

What happens when the optimism bubble bursts.

Roger is a theologian and author with a particular interest in the relationship between faith and culture.

The feet and legs of someone walking on a white rug, beside the words Justice and Government woven in to it,
Obama's Oval Office rug.
The White House, via Wikimedia Commons.

"Yes we can! 

Yes we can! 

Yes we can!"

There was something magical about hearing Barak Obama speak to a crowd. The rhythm of his sentences, the rhyme of his words and the melodic cadence of his baritone delivery had the ability to hold you spellbound. It felt so positive, so uplifting, so inspiring.  

The call and response with the audience only underlined the positivity of the impression: ‘Yes we can!’  

It was listening to Obama that I first heard the quote: 

 ‘The arc of history is long, but it bends towards justice.’ 

I loved it. Obama used it a lot, and so did I.  

It seemed to epitomise the hopefulness his presidency embodied. Implicitly, it advocated the qualities of patience and persistence that are so important in working for a better world. It doesn’t happen overnight. It also acknowledged his rootedness in what had gone before, ‘As Dr King used to remind us …’. Obama was borrowing the line from one of his own heroes. 

In fact, the quote was with him all the time in the Oval Office of the White House, to the right of his desk. Along with four other quotes it was woven into the perimeter of a 23 by 30-foot oval rug that almost filled the room. 

The one-liner still delivers a punch, just as it did for Martin Luther King. However, I am increasingly convinced that it doesn’t stand scrutiny. As much as I want it to be true, and long for it to be true, I do not believe that it is. 

The sentiment was of its time. Not the 1950s and 60s of Dr King, but the 1850s of the Unitarian minister Theodore Parker from Massachusetts. The germ of an idea originated with him in a sermon entitled, ‘Of Justice and the Conscience’. At this point it was a complicated paragraph rather than a pithy one-liner. 

‘You see a continual and progressive triumph of the right. I do not pretend to understand the moral universe, the arc is a long one, my eye reaches but little ways. I cannot calculate the curve and complete the figure by the experience of sight; I can divine it by conscience. But from what I see I am sure it bends towards justice.’ 

Parker was also responsible for ‘government of the people, by the people, for the people’ that Abraham Lincoln would go on to cut and paste into his famous Gettysburg Address during the Civil War. It also appeared on Obama’s rug. 

The intellectual circles of the 1850s were alive with many new ideas like progress, equality and the abolition of slavery, and ‘transmutation’ (or evolution as it would become known). In science, industry and social life things were moving forward and getting ever better. 

As the century moved on this conviction continued to grow and become more widespread. By the early years of the twentieth century Parker’s thought itself had been distilled down into the single line we’re familiar with and included in popularly published collections of aphorisms. 

Prosperity and progress informed the narrative of Western culture and ideas of evolution were imported into other disciplines. In anthropology, for example, this gave rise to ‘social evolutionism’ and the categorisation of societies into a developmental sequence ranging from ‘primitive’ to ‘civilised’.  

Of course, it doesn’t take much imagination to recognise that there was a darker side to such notions. Here was also an underpinning for a colonial worldview and an intellectual justification for racial hierarchy. Western culture was more ‘evolved’.  

These views were epitomised in psychology where, for example, in Freud’s Totem and Taboo (1913) he speaks of indigenous people as ‘the most backward and miserable of savages’, comparing the way they live with features of a neurosis and mental disorder. 

The carnage of the First World War effectively popped the bubble of an overly optimistic ‘progressivism’. I do wonder whether we are now at another ‘bubble popping’ moment in the West. 

Is your ‘bubble of optimism’ in danger of popping, or has it even popped already, like mine? 

In the decades since the Second World War we have succumbed to our own narrative of progress. We have witnessed amazing technological advances and stunning scientific discoveries. The forward movement is obvious, and the promise of an even better future is clear. 

Then, supported and monetised by the market economy, our lives are tempted, enhanced and festooned by the latest products and services that our money can buy. From smart doorbells to wearable tech and TikTok to ChatGPT our world is constantly changing and upgrading and the movement forward is undeniable. 

The narrative runs in our wider life too. We celebrate the triumph of the suffragettes, the defeat of fascism and the collapse of old-school communism. Francis Fukuyama may have been premature declaring the end of the Cold War as the ‘end of history’ in 1989, but it did seem like Western-style liberal democracy was what the world was striving for. 

Then there are the advances in our shared life together in Britain. If Acts of Parliament in some measure illustrate the pulse of the nation, the direction is clear. Take, for example: 

  • the Sexual Offences Act 1967 
  • the Sex Discrimination Act 1975 
  • the Race Relations Act 1976 
  • the Childrens’ Acts of 1986 and 2004 
  • the Disability Discrimination Act 1995  
  • the Human Rights Act 1998 
  • the statutory instruments protecting against discrimination in employment on grounds of religion or belief (2003), sexual orientation (2003) and age (2006) 
  • the Gender Recognition Act 2004 
  • the Equality Act 2010 
  • the Marriage (Same Sex Couples) Act 2013 

This list isn’t exhaustive and there are campaigners who are very keen to add to it. But we live inside this narrative, and we know the plot. It is familiar to us. And it would be so easy to be seduced into a new myth of inevitable progress, ‘The arc of history is long, but it bends towards justice’. 

‘Social evolutionism’ was so deeply embedded in late Victorian culture that its ‘self-evident’ truth went largely unchallenged. The vast majority believed their own hyperbole and complacently embraced the fruits of burgeoning industry and an expanding empire. They lacked the self-critical capacity to comprehend the flaws in their worldview and to understand what their world was capable of in the infernal, apocalyptic catastrophe that was unleashed in 1914. 

Maybe, embracing a more contemporary myth of progress has a similar effect on us. We presume that our way of life will inevitably continue moving forward unchallenged. That we have a right to experience a tomorrow that will always be better than yesterday. And that those who do not subscribe to our notion of ‘progress’ are clearly inferior, ill-informed or backward in some way. But such a mindset also lacks a culturally self-aware and critical edge and is oblivious to how easily things could fall apart. 

At this moment in time the world seems far less secure than at any point in my lifetime. Our community hosts refugees from Ukraine and Hong Kong, a friend has only recently returned from working with a voluntary agency in Israel and I am about to meet up with another friend who has just flown in from the United States.  

Populist, anti-democratic and disruptive forces are more blatantly at work around the world than for many a long year. Developments in AI, cyber-terrorism and digital warfare create a disembodied sense of ‘existential threat’. And then there is the climate crisis. Fires in California, floods in Europe and the unprecedented sequence of six tropical cyclones in the Philippines in late 2024 seem to have had little impact in accelerating the response to global warming. 

Is your ‘bubble of optimism’ in danger of popping, or has it even popped already, like mine? 

Of late I have found helpful insight in observations made by Jesus. Rather than fixating about what might happen in the future, he encouraged those who had attached themselves to him to live in the moment, 

'Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.'  

For those who were concerned about what might be happening and felt the world was falling in around them, he offered reassurance. He counselled that such events did not signal the end of the world. Rather, this was simply the kind of thing that happened.  

'You will hear of wars and rumours of wars, but see to it that you are not alarmed. Such things must happen … these are the beginning of birth pains.'

Rather, the early Christian ethic was rooted in God’s loving, supporting and strengthening presence during unstable times.  

Writing to the Christian community that had formed itself in Rome, the apostle Paul was convinced that whatever befell them – trouble, hardship, persecution, famine, nakedness, danger, or weaponised violence – that nothing would be able to ‘separate us from the love of God that is in Christ Jesus our Lord.’  

And right at the base of this ethic that Jesus advocated was an unswerving commitment to ‘love your neighbour as yourself’ 

Which takes us back to Obama’s rug and the West Wing office. 

On the left-hand side of his desk was a quote from President Theodore Roosevelt: 

'The welfare of each of us is dependent fundamentally upon the welfare of all of us.'

And that really is it. History may not bend towards justice, and hard-won progress we’ve achieved can likewise be lost, but our future will always hang on the ‘welfare of all of us.’  

Well said Mr. President! 

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