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
Romance
5 min read

Getting hitched should benefit more than the advantaged

Marriage’s decline impacts outcomes for all.
A bride dressed colourfully stands next to her groom, dressed similarly, as he sits in a wheelchair.
Ellie Cooper on Unsplash.

Of all the dramatic changes to Britain in the last half century, one of the least discussed is the extraordinary decline in marriage.  

The marriage rate has fallen by two-thirds in the last 50 years. It was just above six per cent in 1972 and has now been under two per cent since 2017. 

This remarkable decline has corresponded with a rise in a relatively new relation type: cohabitation. Cohabitation was extremely uncommon before the 1960s, and even by 1986 just 10 per cent of new mothers were cohabitants. It is, however, rapidly becoming the mainstream. Now 35 per cent of babies are born to cohabiting mothers, and the total number of UK cohabiting couples increased from 1.5 to 3.7 million between 1996 and 2022.  

Much of this is due to couples delaying marriage: 84 per cent of religious and 91 per cent of civil marriages are now between couples that already live together, and the average age when first marrying has climbed by 10 years since the early 1970s. But it is also due to many more couples not marrying at all. 

Opinions understandably differ on this social transition away from marriage and towards cohabitation. It is a point of progress worth celebrating that the previous societal shunning of those, especially women, who had children outside of marriage has been left in the past. However, such progress has not been without consequences. Cohabitations are less stable, on average, than marriages. Cohabiting parents are around three times as likely to separate in the first five years of their children’s life as married couples.  

This stability is not simply because wealthier, more highly educated people tend to have stable families and also tend to marry. Studies by World Family Maps and the Marriage Foundation have shown marriage to be a larger factor in family stability than either education or income.  

Nor does the stability come from couples staying together miserably.  Studies undertaken in 2017 and 2024 looked at the outcomes of couples 10 years on from considering their relationships to be ‘on the brink’. In the initial study, while 70 per cent of cohabiting couples had separated in the decade since considering themselves ‘on the brink’, 70 per cent of the married couples had remained together. Perhaps even more crucially, just seven per cent of those married couples that had stayed together were unhappy in their relationship a decade on. The 2024 study found none of the sample of married couples that had stayed together were still unhappy 10 years on. For those that had stayed together, things had improved. 

This family instability that the decline of marriage has caused is also unevenly distributed. Affluent couples – often those most likely to criticise the concept of marriage – are much more likely to marry than disadvantaged ones.  

Looking at socioeconomic groups, seven in ten mothers from the most advantaged group are married, while just a third of those from the two most disadvantaged groups are. The effect is geographic, too. Institute for Fiscal Studies research has found parents having children are more likely to be married if they are living in better educated areas. For the advantaged, it is compassionately affirmational to suggest that every relationship is equal, even though the advantaged themselves choose the most secure option of marriage: a hypocrisy only tolerated due to the potent fear of seeming judgemental. 

The consequence of this is deepening inequality: disadvantaged families are rendered more likely to breakdown, while children from affluent backgrounds are disproportionately likely to enjoy the ‘the two-parent privilege’, the substantial emotional and developmental advantages of growing up in a stable home. Melissa Kearney coined the phrase, and her evidence shows how children grow up, on average, to have better educational outcomes, better emotional and physical wellbeing, and higher incomes if they are raised in two-parent homes. 

Stable families are foundational to a stable society, and marriage is crucial to stable families.

So, why are marriage rates so much higher among wealthier couples than poorer ones, and why is this gap growing? 

We can isolate three reasons in particular, each more solvable than the last.  

Most challenging is the feedback loop effect: people whose parents, role-models, and friends have not married are unlikely to do so themselves. The demographic trend compounds itself.  

Second, and easily addressable if only the will was there, is the public messaging effect: politicians – and to some extent celebrities – have consistently told the public that marriage is unimportant. In 2017, Marriage Foundation research found that it had been a decade since a cabinet member had discussed marriage in a speech. This has hardly changed in the years since. In 2024, the only major party whose manifesto even mentioned marriage was Reform; even then the focus in the relevant section seemed to be less on marriage and more on getting ‘people trapped on benefits back into the workplace’. 

Third is the cost of weddings. A quick flick through top wedding magazines suggests that the average wedding costs upwards of £20,000. Survey evidence from both Marriage Foundation and the Thriving Center of Psychology have found that most young people view weddings as unrealistically expensive. 

This financial problem is solvable: much of the costs relate to venue hire. Unless they are having a religious marriage, a couple will need to find a venue that has gone through the bureaucratic process of becoming an ‘approved premises’. The cheapest of these are register offices which, including all expenses, still cost about £500. 

This is eminently mendable. The Law Commission proposal to reorganise wedding law around the officiant, not the venue, opens the door for a future of more affordable weddings by removing the regulatory barrier. It will also bring the law in line with that of other home nations. 

This proposal will not work by itself, though, it will need to be supported by creativity in wedding planning.  

Wedding costs can be substantially reduced by taking a DIY approach. Food, drinks, and decorations can often be coordinated amongst enthusiastic (and appropriately competent!) guests.  

Booze free weddings are a growing phenomenon, and especially good for weddings with children.  

Such ‘group-effort’ approaches often have a unique feel thanks to the high participation of guests, and people are more likely to remember events that they feel a sense of ownership of, having helped make them happen. 

Alongside this is a recommendation by the Centre for Social Justice. It proposes subsidising the necessary statutory fees for the poorest couples, up to £550 per couple. An inexpensive and hugely beneficial adjustment to improve wedding accessibility for the least fortunate.  

Stable families are foundational to a stable society, and marriage is crucial to stable families; perhaps it is time for all of us to make tying the knot easier.  

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