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

Character

Comment

Leading

18 February 2025

4 min read

Carney’s call for character still resonates now more than ever

In both business and politics, the vocation of public service is at risk.

Emerson Csorba

Emerson Csorba works in deep tech, following experience in geopolitics and energy.

Mark Carney sits between two other speakers, holding a mic.

Mark Carney on the campaign trail.

On May 27 2014, a group of business, political and faith leaders gathered in London for the inaugural Conference on Inclusive Capitalism.

As a 23-year-old Masters student at Cambridge University at the time, it was a defining moment, this in the final months of my first stint in the UK. One of three young people invited, I had prepared carefully and waited impatiently in line in central London on a boiling summer evening.

The most poignant moment of the conference, in hindsight, was less the attendees or the historic venue, but rather a particular speech that I continue to reflect on a decade later.

The speech in question was one given by the then Bank of England Governor, the Canadian Mark Carney, and it was called ‘Capitalism: Creating a Sense of the Systemic’.

It was, and remains, one of the most impressive speeches I have heard, and whose message is as important as ever.

It is a message that Canadians today, as well as others living in Western democracies, need to hear as much as at any time in recent history.

In the wake of the financial crisis, Carney raised a point that is seldom asked in business or political circles - that of responsibility, and more specifically, of vocation. It is as follows:

"To build this sense of the systemic, business ultimately needs to be seen as a vocation, an activity with high ethical standards, which in turn conveys certain responsibilities."

And soon after: "It can begin by asking the right questions. Who does finance serve? Itself? The real economy? Society? And to whom is the financier responsible? Herself? His business? Their system?"

He references Michael Sandel, the philosopher who in his book What Money Can’t Buy: The Moral Limits of Markets takes aim at the "skyboxification" of American life.

The example used by Sandel is taken from the sport of baseball. In the not-too-distant past, people from across all walks of life sat together in the stands, the low ticket prices allowing baseball to be the great unifier across divides.

Today? Expensive box seats see the rich and poor seated in different areas, the rich even physically above - looking down on - others. The same goes for ice hockey, soccer, or other sports which no longer see diverse families, across income levels, sitting together.

In short, if you impose a price on a good or increase the price of a good significantly (baseball tickets), the nature of value of that good changes, often irreparably so. Lost is a sense of fairness, and a reduction in the potential to repair divides.

In short, the idea of public service - that to be first, you must come last - seems increasingly bizarre to people.

We live in a world where immediate gratification and personal enrichment are particular cultural values. If there is any tell on the character of President Trump and his new White House, it is the launch of the Trump and Melania meme coins before the Presidential Inauguration: politics used for the advancement of personal interest.

In short, the idea of public service - that to be first, you must come last - seems increasingly bizarre to people. (A conversation with a young person several weeks ago struck me especially on this front, in which I had to explain that the purpose of politics is to serve others, not yourself.)

Carney's 'Creating a Sense of the Systemic' speech is therefore a reminder of what we need from political leaders: people who, outside of compelling rhetoric focusing on putting their nations first, actually consider their responsibilities toward others and who take these responsibilities seriously.

These responsibilities are vocations to which we are called. The responsibilities are not about us but rather are part of the system (made up of people and institutions) of which we are a part, and beyond.

In Canada, the potential election of Mark Carney as Leader of the Federal Liberals, and in turn as Prime Minister, is a step in the direction of a public service focused on responsibility and vocation. It is a step toward a more vocationally oriented public service, which our world needs. Whatever one's partisan affiliations, having political leaders acting with a sense of responsibility toward people and a higher calling beyond themselves is something we should embrace.

If Carney is to channel the same energy, poise and focus of this May 2014 speech, then there is a good chance the Canadian Federal Liberals win a future term. This is because our world is, deep down, yearning for political leadership based on real character, sense of purpose and responsibility beyond the self. But there is equally an opportunity for Pierre Poilievre to do the same, emphasizing the need for character, purpose and responsibility toward Canadians.

For Canada, it is a focus on responsibility, a sense of the broader system and our calling as Canadians in the world that can serve as a foil to the leadership in the United States.

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