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.

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Justice

20 June 2024

5 min read

Mercy of any magnitude is scarce

Today’s cynicism, means justice really needs tempering.

Natalie Williams

Natalie is the chief executive of Jubilee+ and an author.

In a court room a judge looks out across it as a lawyer standing addressing her turns his head to look.

Rhoda Griffis and Michael B. Jordan in Just Mercy.

My friend Jo was killed by a lorry driver while she was cycling to work. She was thirty-four. The driver wasn’t paying attention. A couple of distracted minutes had tragic consequences. One life was lost; many others would never be the same again.

Months later, in court, the driver pled guilty to causing death by careless driving, and the judge warned him that he was facing time in prison. But between the verdict and the sentencing, Jo’s parents wrote to the judge asking him to show mercy.

So he did. The driver didn’t go to jail. He was spared the punishment that our legal system says he deserved. He admitted his guilt, and he didn’t ask for leniency or mercy or forgiveness, but Jo’s parents showed it anyway. They even made a point of going over to him to tell him clearly that they forgave him for taking their daughter’s life.

The court case was covered by national and local media, with one newspaper summing up what had happened with the headline: ‘Death driver shown mercy.’

It made national news because mercy of this magnitude is rare in society today. In fact, mercy of any magnitude is scarce. We live in an increasingly polarised world, where our desire for justice eclipses the beauty of mercy because we cannot see how both could exist at the same time. We want justice, and rightly so. We want people to pay for harm they have caused and we especially cannot abide it when the obviously guilty use their power, wealth or status to get them off the hook.

Extending mercy seems to us to come at the expense of justice. If we forgive, somehow that seems to deny the damage caused.

But cancel culture is rapidly turning our society into a place where anyone with a remotely public profile needs to live in fear of saying or doing anything wrong. We increasingly err on the side of cynicism when someone says they are sorry. We dismiss apologies, even when accompanied with tears and distress, as a stunt or ‘too little too late’ or more to do with being caught than with the original offence. We have become predisposed to assume the worst.

We start by recognising that justice in its purest form, at its best, is inherently merciful because it wants repentance more than it wants retribution.

I wonder if we have strayed beyond the necessary and right fight for justice into an insatiable appetite for vengeance, which leads us to a place where there is no space for contrition. If guilt is irredeemable, punishment must be permanent and absolute.

We argue that mercy is not deserved. And we are right. But it never is. If it were deserved, it wouldn’t be mercy. The very definition of mercy is that it is undeserved – to receive mercy is to receive kindness, compassion and forgiveness that you have no right to, no claim on, no reasonable grounds to expect.

But a bigger problem with our desire for justice over mercy is that we are not consistent. I know that my default is to want justice when I am wronged, but mercy when I am in the wrong. Who among us has not made a mistake or hurt someone else but then defended our actions by claiming mitigating circumstances or good motives? We want to be forgiven. Even when we know we have done wrong, we do not want to be punished.

I’m self-centred in my approach to mercy and justice. I am also way more lenient when those I love get things wrong than I am when someone hurts someone close to me. I assume that those dear to me had the best intentions, and those I don’t know or don’t like had the worst. My friends meant well; my enemies meant harm.

The Bible presents God as both merciful and just. It repeatedly affirms his concern for victims of injustice and reminds anyone who claims to know him that, if they really do, pleading the cause of the vulnerable and marginalised will be an inevitable (even required) outworking of that. It says that getting justice for the oppressed is more important to God than religious rituals such as fasting from food. In fact, it calls caring for the afflicted and distressed “true religion”.

But at the same time, Jesus told the religious people around him – the justice-warriors of his day who looked out for the slightest misdemeanour in others so they could call them out on it – that they needed to learn that God prefers mercy to sacrifice. Indeed, there is no example in the Bible of anyone pleading for mercy and God denying them. Even the most wicked and cruel abusers of power, if they humbled themselves and cried out to God for mercy, were shown it.

And it is not just God who exercises both justice and mercy. He says that he wants ordinary human beings to act justly and love mercy. In Christianity, justice and mercy are not pitted against each other; they are woven together as time and time again we are invited to live a better way by valuing and practicing both. Jesus criticised the religious leaders of his day for following all sorts of detailed and pedantic rules while neglecting what he called “the weightier matters of justice, mercy and faithfulness” and ultimately he died on the cross in the most astonishing act of faithfulness to bring perfect justice and limitless mercy.

But how do we mere mortals do both? We start by recognising that justice in its purest form, at its best, is inherently merciful because it wants repentance more than it wants retribution. Without repentance, there can be no reconciliation or restoration. A society that rules out redemption – that says no apology or atonement can ever be enough – will soon become a harsh and hopeless place. Biblical justice always leaves space for mercy. So must we.

‘Natalie Williams' Tis Mercy All: The Power of Mercy in a Polarised World is published by SPCK.