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

Digital

Work

24 January 2025

4 min read

Back to the office! The suspect motives behind the bosses calling for it

Working From Home isn’t the end of the world.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

An office wall displays a huge motto reading 'punch today in the face'

Really?

Johnson Wang on Unsplash.

If we’d been working from home in 1980, I wouldn’t have met my wife (as she, of course, then wasn’t). The slow demise of the office romance may not exclusively be driven by WFH, when a clumsy or unwanted speculative pass will likely precipitate a visit from the HR police. But it’s sure harder (I’m told) to chat someone up over Zoom than a water-cooler.

There are some things you just, well, have to be there for. And it’s not just a matter of curating the gene pool for the future of the human race, which is hardly the top priority for most employers. Much more immediate commercial demands are served by employees being bodily present at work. They can check colleagues’ body language, be mentored more spontaneously, gossip about work, read the room and go outside for a fag with a friend. None of that works on a laptop at the kitchen table.

And yet these aren’t aspects of working life that are much, if ever, cited by opponents of WFH. Yup, for these bosses, it’s always about productivity, which allegedly slumps like the shoulders of a college-leaver told to re-write their CV, when staff work from home. So companies as diverse as Amazon, Boots and JP Morgan are demanding that their workers work five-day weeks at the office again.

Except, two things: One, that productivity point isn’t true. Professor Nicholas Bloom, an economist at Stanford University, has demonstrated empirically that a hybrid working model of three days at the office, plus two at home, is every bit as productive as fully office-based work overall. And, two, bosses may be shocked to learn that it’s their job to manage productivity, which is just as measurable at home as in the office. But then you don’t get to shout as much.

And there I think is the real point. Bosses might not be shouty, but their motives for office work are more than suspect. They may be obsessed with control. They need to see their staff working for them for proof of productivity. They want to sit in a big glass-walled office watching them. And, perhaps most of all, if staff aren’t in the office then what’s the point of being a boss? It might bring their own productivity management and role into sharper focus.

People who are privileged to manage their own time, or lack of it, in an office really shouldn’t be in the business of lecturing people who are not.

Furthermore, it’s been a long time, if ever, since some of those with the loudest voices calling for a return to the office have ever worked an ordinary job themselves. Lord Rose, formerly CEO of Marks & Spencer and chairman of Asda, told BBC’s Panorama that home working was part of the UK economy’s “general decline” (not true – see above).

And Sir Jacob Rees-Mogg, formerly business secretary (remind me, how did that go?), continues in opposition to fight the bad fight to get civil servants as well as the private sector permanently back at the office. Hilariously, he most recently did so in a video from the drawing room of his mansion in Somerset. Though, to be fair, having lost his seat at the last general election and seeing his investment company sliding down the pan, he’s not so much working from home as just... at home.

The serious point is that people who are privileged to manage their own time, or lack of it, in an office really shouldn’t be in the business of lecturing people who are not. They really don’t know – or have forgotten - what it is to have your life demanded of you from 9am-6pm from Monday to Friday in a location that is less than comfortable to work in. Is that so complicated to take aboard?

And there’s another very big thing here. To demand office slaves is to commoditise people, to make them chattels (and, if some of these bosses were honest with themselves, that’s what they want). Staff become just another asset, not unlike the freehold of the office building in which you put them and watch as they make you money every day.

To put it bluntly, that is a sin. To treat human beings as tradeable commodities is to debase their dignity. And for those of faith, that dignity is vested in each unique one of them bearing the image of God. As a good Catholic, Rees-Mogg should be familiar with the doctrine of Imago Dei.

So there’s a holy, as well as secular, work-ethic at play here. The worker is worthy of his/her wage. That scriptural phrase usually focuses on the material value of the wage. But it’s also worth registering that the worker is “worthy”.

To treat staff like they have an inherent worth, rather than simply a productive asset, has a value way beyond the money they are paid. And the dividends on that investment will be immense. Respect them. Let them work from home.

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