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
Character
Comment
Education
Fun & play
5 min read

Is your child school ready?

What really matters as a child develops
A teacher looks on as a young child concentrates on writing.
Department for Education.

In the coming weeks, those little critters will start to emerge, easily identified by their autumn plumage of coloured sweatshirts and oversized backpacks. Anxious parents and caregivers can be spotted, shepherding their young along paths and pavements, casting worried glances left and right at the pelican crossings. Listen carefully and you may hear the squeak of uncomfortable new shoes and juveniles complaining about the wearing of a coat, as adults of the species re-establish social bonds with cries of, “Back to school already, I can’t believe how fast it’s gone!”   

As they congregate upon the tarmac staging ground, some will be taking part in this ritual for the very first time. Neophytes who have maintained social bonds throughout the pre-school years might be seen to greet their fellows cordially, “Did you have a good summer? Can Flo make it to Izzy’s party?” Others will stand alone, scanning the playground for a half-remembered face from the bygone days of antenatal classes. That was only five years ago, but it feels like a millennium. The faces are changed; everyone looks more…tired. 

The world has been turned upside down in those past five years. It’s been said so often that it is almost trite, but nonetheless true: nothing prepares you for becoming a parent. In the UK, new parents increasingly raise their children without the immediate support of extended family, coupled with the tyrannous expectation that one will retain one’s employment rank and contribution to the labour market alongside this new and 24/7 full time job of looking after baby. The Key Performance Indicators of parenting are ambitious. Deliverables for the first five years include toilet training, instilling speech and language skills, establishing basic recognition of 26 alphabetical characters (including the child’s ability to recognise the alphabetical sequence that spells their own name) and ensuring the recognition of and (ideally) ability to correctly sequence numbers 1 to 20.  If your child can do all of this by the age of 5, whilst also learning not to punch, kick or bite other children, not to eat food off the ground, and not to stick rocks up their nose, then congratulations! Your child is school ready

It may comfort some readers to know that very few 5-year-olds manage to hit absolutely all of these milestones. As the education secretary, Bridget Phillipson, commented recently – parenting is too hard. She is working to establish a new iteration of Labour’s ‘Sure Start’ programme (rebranded as ‘Family Hubs’) to offer parents more support in the community. As part of her rationale she states, “When one in four children are leaving primary school without having reached a good level of reading, then something’s gone seriously wrong in those early years that has to go beyond the school gate.”  

Whilst I’m keen to see more support for new families – I’m intrigued by this particular rationale for it. Ability to read well by a certain age seems an unlikely metric by which to measure whether a child has had a positive experience of childhood; it appears indicative of what autism-researcher Anne McGuire calls “The normative time of childhood,” in which the success is measured against an imagined future of economically productive years. By this metric, if a child learns to read at a prodigiously young age this is taken as an indicator that they will enter the workforce with greater velocity than their peers, essentially that they will have “more future-yet-to-be-realized” than those around them. McGuire writes, “In a neoliberal regime where ‘time is money’, the child is figured as ‘time-rich’ and so represents a good investment opportunity indeed.”  

McGuire’s analysis is piercingly accurate of how we often talk about our children, despite knowing all too well that it represents a fallacy. There are multitudinous stories of adults who have gone on to make staggering contributions to human flourishing, despite being placed (literally or figuratively) under the dunce’s cap at school. But even without focusing on those who go on to excel, those who attract fame, fortune, or both, we don’t have to look far to find cause to re-evaluate what it means for a child to be school ready.  

My son’s year group recently finished their own primary school journey, and a quick glance through some of the leavers’ books reveals that children are very good at valuing each other for what is here in the present, without recourse to an imagined economic future. As children wrote goodbye messages for each other they said things like,

“Thank you for always having such good ideas for games to play.”

“You helped me on my first day when I got lost.”

“You’re a great house captain and you always help the teacher.”

No one was particularly keen to predict fame and fortune for the future of their friends, and there was an understandable indifference towards academic milestones. As a literary corpus, the leavers’ books were testament to the old adage that people will not remember you for what you say or do but will remember you for how you make them feel.  

One the subject of childhood, Jesus once said something that defies easy explanation. He was out, teaching in the open air, surrounded by crowds of adults including important religious leaders and wealthy individuals who wanted to ask complex and deep theological questions, but in the midst of it all there were parents bringing their children, elbowing their way to the front of the crowd to ask Jesus to pray for their little ones. When some of Jesus’ followers tried to usher the children away, Jesus said, “Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these.” The precise meaning of this utterance has eluded thinkers and theologians for centuries – what exactly is it about childhood that Jesus was alluding to?  

I wonder if it is something about the capacity of children to live in the immediate, and therefore to value what really matters – justice, kindness and friendship. In primary school, yes it helps in some ways for children to arrive aged 5 with a certain command of the alphabet and the ability to finish the day wearing the same set of underwear that they arrived in. But perhaps what matters more is children arriving ready to enter the fray of friendships – being kind, being helpers, having the self-confidence to know that they have something to give to the learning community that they are joining, whatever their learning speed might be. Such things are gloriously untethered to economic potential or a future-yet-to-be-realized, but they are closely tethered to a child’s understanding of themselves as a valuable and important person. If Labour’s intention to offer new parents more help in the community goes some way towards communicating to our pre-school children that they have that have – and will always have – value, regardless of what they will or won’t attain to academically or economically, then it will help many more children reach the milestone of being school ready.  

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