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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Community

Culture

Football

Idolatry

Sport

19 June 2024

5 min read

The decade that defined sport

What the sports stars of today owe to the eighties.

Simon Burton-Jones

Simon is Bishop of Tonbridge in the Diocese of Rochester. He writes regularly round social, cultural and political issues.

Maradona runs in celebration, holding a hand aloft as an England player sits dejected on the ground.

Maradona celebrates, 1986 World Cup.

Dani Yako via Wikimedia Commons

If the 1980s were your formative years as a sports fan, you will carry many images with you even today. Dennis Taylor potting the last black after midnight to beat Steve Davis. Barry McGuigan defeating Eusebio Pedrosa in the ring at Loftus Road. The races between Coe and Ovett at the Moscow Olympics. The tie break between Borg and McEnroe. Botham’s Ashes. Diego Maradona versus England at the Mexico World Cup.

You will undoubtedly have other memories, though these will have been controlled by a limited number of broadcast editors. I clearly recall watching Viv Richards’ astonishing century in one cricket World Cup final against hosts England being regularly interrupted on BBC1’s Grandstand with coverage of a routine horse race meeting. The introduction of the less fusty World of Sport on ITV was a route in for some sports that faced an implicit class bias, but it was all still far removed from the 24/7 reverencing of sport today.

The eighties was an era of transition as sport began to gain a place in our cultural consciousness. It was also a decade in which the relationship between sport and politics became cemented on paths we still walk. In Everybody Wants To Rule The World, academic and journalist Roger Domeneghetti has written an entertaining and informative book subtitled ‘Britain, Sport and the 1980s’.

In our branding of the twenties as the decade of polarisation, we forget how deeply divided Britain was in the eighties. Recent commentary on the fortieth anniversary of the miners’ strike has been a reminder of this and how violent public life proved. Football hooliganism was pervasive and after a riot at a Luton Town – Millwall game in 1985, Margaret Thatcher asked of football officials: ‘what are you going to do about it?’. In a pithy and telling response, the FA secretary Ted Croker said: ‘Not our hooligans, Prime Minister, but yours. The product of your society’. Perhaps more than any other exchange, it symbolised the braiding of sport and politics, threads that endure to this day.

The sports stars of today have become surrogate saints, held up as an inspiration for what can be achieved and frequently employed as motivational speakers.

The argument that sport and politics don’t mix has a familiar ring for people who live with the tired old trope that religion and politics don’t either, as if our experience of culture and values are sealed off from each other. Sporting boycotts in the 1980s - from Olympics to apartheid South Africa – placed athletes in the unavoidable position of having to make decisions about participation that would reflect on their values and could affect their careers; positioning that other people were spared. These were an early taste of the moral standing afforded to sportsmen and women today; a status that somehow asks more of them, perhaps because other professions have become so tarnished and mistrusted.

Domeneghetti’s book is also a sobering reminder of how ugly and careless much of our shared life was in the eighties. The Bradford City fire and Hillsborough disaster were awful losses that showed the low priority of health and safety and the culture of institutional cover up that continues to blight the nation. The author locates these failings in the wider context of disasters like Kings Cross, Piper Alpha and the Marchioness boat as part of his bid to write a social history of sport.

Yet in a sense, Domeneghetti chose arbitrary parameters. Football in particular was on the cusp of a revolution with the introduction of the Premier League in 1992. Cultural sympathy for the game was about to change with the writings of Nick Hornby in Fever Pitch and Pete Davies in All Played Out. The nasty face of football was to be transformed into a highly marketable model.

The ugliness of the era is laid bare in the prolific and casual racism, sexism and homophobia that coursed through every sport. The Windrush’s second generation broke through in the 1980s, notably in football, but was met with staggering levels of prejudice. Anyone tempted to think this has now been eradicated hasn’t spent any real time at a football ground or on social media. Women’s sport had virtually no profile in the eighties outside of tennis and athletics and as recently as 1978, Lord Denning had ruled that an eleven-year-old girl should not be allowed to play competitive football against boys the same age even though she merited a place in her team. Meanwhile, stars like Justin Fashanu, Martina Navratilova and John Curry were targeted for their sexual orientation. It remains hard for present day athletes to identify as gay, despite the rhetoric of acceptance. Sport then, as now, held up an unerring mirror to our faces.

The sports stars of today have become surrogate saints, held up as an inspiration for what can be achieved and frequently employed as motivational speakers. But there is the gloss of a hyper-individualistic, neo-liberal culture. Sports stars succeed because of a combination of innate gifting (which cannot simply be replicated) and material advantage (too many Olympic medals are still awarded to wealthy and advantaged Britons). I won because I wanted it more is a dishonest assessment of sporting success in the UK and in this way also holds up a mirror to other walks of life.

The powerful personal branding of today’s athletes in many ways have their origin in the 1980s and the way the likes of Ian Botham, Carl Lewis and John McEnroe transcended their sports. The cult of the conquering superstar is a smart diversion from the reality that money usually wins. Just look at the Premier League table.