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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Ambition

Comment

General Election 24

Politics

18 June 2024

5 min read

Is it really time to “go for the jugular”?

How to handle political enemies.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A screen grab of a news paper report with a headline and picture. The headline reads: 'Go for Keir Starmer’s jugular to rescue campaign, Rishi Sunak urged'.

The Times' 16 June headline.

The Times.

As the election campaigns trundle down the hill to election day, poll trackers have shown little meaningful change for weeks. Amongst my friends and acquaintances, I can find barely anyone who is bothering to read the campaign coverage. No doubt, news editors are just as bored as we are with the same-old, same-old. Perhaps it is they who are leaning on commentators to spice up their language, saying things like it is time to “go for the jugular”. Are they straining for headlines by provoking candidates to stop waving manifestos and start lobbing personal attacks? (And did anyone stop to consider the irresponsibility of such language, following the awful, violent murders of MPs Jo Cox and David Amess?)

It is very uncomfortable to have enemies, which only makes it all the more astonishing that anyone ever goes into politics – professional enemy-making, if you will. And there is an incredible subtlety to the business. As a politician, one needs to be a convincing enemy to one’s enemy, but at the same time, a convincing friend to one’s enemy’s friends (in the hope that they might switch their allegiance). Then, if elected, one must serve a whole constituency, including many ‘enemies’ who didn’t actually vote for you, and probably never will. In such a complicated game of gregarious gymnastics, and with the ever worrying rise of violence and threats against MP’s, how on earth does a politician maintain any reasonable sense of safety and of self?

An enemy who has lost his temper is one of the few people that you can trust to tell you the truth about yourself.

Reflecting on this, I wonder whether the game of politics gives a fresh insight into those very famous words that Jesus once said: “Love your enemies.” This instruction has long baffled and inspired the great thinkers of this world. Why would Jesus say such a thing? Some focus on the way in which loving one’s enemies benefits the lover. Desmond Tutu, for example, said, “Love your enemy: it will ruin his reputation.” Or Mark Twain, somewhat more cynically, said, “Love your enemy: it will scare the hell out of them.” There are many others I could quote here, but the general theme is one of power. Loving empowers the lover to keep going in the face of hate, and it is surely the only way an MP can get through the day, serving so many people who didn’t actually vote for them.

But looking at those who speak of enemies, there is another general theme that can be identified, one which pre-dates Jesus’ command to love enemies, and one that is to do with the way in which they help to define us. The Greek Philosopher Antisthenes is reported to have said that an enemy who has lost his temper is one of the few people that you can trust to tell you the truth about yourself. As a thinker, Antisthenes was famously cynical, one who very much subscribed to a “what doesn’t kill you makes you stronger” kind of vibe, even welcoming ill-repute because it could help one to grow in virtue.

Given the popularity of Greek Philosophy in the first century, it is possible that many of Jesus’ listeners had Antisthenes pithy advice, or something like it, in the back of their minds when Jesus uttered his famous words. Of the many ways to understand “love your enemies”, some may have heard it as a reminder that enemies do us a kind of service. They help us to define ourselves, giving a profound (if somewhat uncomfortable) reflection of how we appear to others. Of course, enemies are biased. Like a distorted mirror, they over emphasise our bad propensities and overlook the good. But taken in the right spirit, this serves as a foil to our friends and acquaintances who may well distort the uncomfortable truth about ourselves in the opposite direction.

Perhaps it is no bad thing for our politicians to admit their mutual enmity – not in the sense of tearing each other down but in the sense of sharpening each other up...

As a young adult, I was given the advice not to fear enemies, but to divide them up into two categories: enemies in residence and enemies in exile. The exiled ones are the ones who are simply dangerous or nasty – the bullies, the gossips and those who may tend towards violence. To love these people is to pity them and to pray for them, but also to keep them far enough away so that they cannot do you harm. Enemies in residence, however, are the useful ones. These are the enemies that you keep just close enough so that you can hear what they have to say. They will scrutinise your words and your actions, they will cast doubt on your motivations, and they will scoff at your ambitions. All of this is both miserably uncomfortable and highly valuable, sowing just enough seeds of self-doubt that you check yourself, analyse yourself and strive to be the best that you can be.

Perhaps Antisthenes was on to something: when it comes to harsh critique from enemies, what doesn’t kill you does indeed make you stronger. And perhaps this is one of the ways to interpret Jesus’ words, “love your enemies” – in the sense of loving what they do for you in terms of personal growth. If this is the case, then perhaps it is no bad thing for our politicians to admit their mutual enmity – not in the sense of tearing each other down but in the sense of sharpening each other up, of spurring each other on to be the best, most clearly defined versions of themselves that they can be.

So, it is fine with me if there are enemies in politics: a person with enemies is a person who knows who they are and what they stand for. Enemies should, as Jesus advised, love each other enough to do the job properly and fairly – (this is no inlet for cowardly keyboard warriors). But even so, I didn’t care for the cheap, headline-grabbing phrase “go for the jugular” – it all sounds unnecessarily violent. As much as we and our politicians should love one another enough to be enemies, let us not love one other to death.