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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Digital

19 June 2024

3 min read

When standards fail, what next?

Media’s fragmentation reflects our own shattered attention.

Jamie Mulvaney

Jamie is Vicar of St Michael's Chester Square, London.

Seat on an underground train carraige, a passenger holds and reads a newspaper.

Evening Standard headline 2013.

Derek Key, CC BY-SA 2.0, Wikimedia Commons.

News about newspapers is never good news. So, the not wholly unsurprising announcement that London's daily Evening Standard will only be printed weekly comes with sadness. There are fewer commuters and those who are on the tube or overground are making use of the Wi-Fi. Even the paper's editor, Dylan Jones, recently admitted he never reads a print newspaper. These shifts are hardly breaking news anymore, but they do need us to take out our earphones and pay attention.

Earlier this year, as if predicting the newspaper’s daily demise, Lord Hague wrote, 'Even a few years ago you would see, on the London Tube, a high proportion of people reading the Evening Standard, cheek by jowl sharing the commentary on the fortunes of the capital. Today, they sit with headphones on in their fragmented worlds.'

Most of us haven't noticed, because our heads are down staring at our screens, but he's right. Hague argues that we should fight against the plight of local newspapers, but even a recent ‘editorial pivot’ to local London news couldn’t save its daily edition. It's a newspaper known for pivoting a lot over the decades, but this is a step change.

Losing the daily printing of a two-century-old institution is more than the end of an era. Even for someone like me who has lived in London recently, the change in our reading habits that Hague describes is one that is unmistakable. I'm sure I will look wistfully at the empty trays of newspapers, without the obstacle of a newspaper in my face as I descend the steps to the tube.

The people are what makes these institutions: whether it’s the bellowing by the tube at rush hour, or those who write the articles. Journalist Tom Leonard's sepia-toned reflection is that the Standard was 'the closest you could get in the real world to a newspaper in a classic Hollywood film, with reporters and photographers actually rushing out together on stories… and editors actually occasionally saying dramatic things like “hold the front page”.’ But we're losing more than nostalgia, and even more than the life-altering job losses.

At the heart of that liberation wasn't agony-aunt good advice, but the heralding of good news for all people.

We are going through the largest shift in information dissemination since the arrival of the printing press five hundred years ago. They called that the Reformation. What will they call this? The Fragmentation? Or the Liberation? Information is not always illumination, and the new world we are creating is indeed an increasingly fragmented one. There's the threat to democracy, as Hague soberly warns. Never before have we felt the need to hold power to account, yet without the focused resources to do so.

And it's focus itself we're also losing. My scattered senses fling me to the urgent, rather than the important. They take me to ephemera rather than what really matters. Our attention spans drive us to snippets rather than stories, bitesize over background. It could be argued that rather than the power residing in the newspaper editor, the power is now in the hands of the person holding their phone, but let's not be naive about the quality and the neutrality of what we consume, and the echo chambers we're locking ourselves in. The power of the daily habit of reading what we will and won't agree with is the power of the printed press. Holding the Bible in your hands, in your own language for the first time was challenging, confronting, but also liberating. At the heart of that liberation wasn't agony-aunt good advice, but the heralding of good news for all people. This good news included repairing of the fragments that broke people apart from each other. It became the must-read.

As we adapt to a new standard in news, perhaps some old news might reveal a new standard.