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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Eating

General Election 24

12 June 2024

5 min read

Give us each day our daily bread

Why the political parties cannot understand farming.

James Cary

James is a writer of sit coms for BBC TV and Radio.

A man stands looking baleful next to a row of red tractors

Jeremy Clarkson re-considering the farming life.

Amazon Studios.

Go to the Labour Party’s ten election pledges. Search for the word ‘farm’. I’ll wait.

You’re not going to do that, are you? Fair enough. Let me tell you happens when you do. Nothing. You won’t find the word ‘farm’. That absence is revealing.

Or is it? Am I just being parochial? I’m not a farmer, but the son of a farmer and raised on a dairy farm in Somerset. It was a relief to my parents that I didn’t want to follow them – and every other Cary throughout history – into the family business, as the good years were clearly coming to an end. My parents sold their herd of cows a few years before Mad Cow Disease. They bought sheep for a variety of slightly perverse incentives. After a few years they discovered sheep are the worst, since they find all kinds of imaginative ways to die. The only bit of luck they had on the sheep was selling them before the Foot and Mouth epidemic hit.

Farmers in the UK have gotten used to being ignored by politicians, even though 70 per cent of the UK’s land is farmed. So what’s the plan for how over two-thirds of the country is going to be managed, given that Labour are certain to win? It’s hard to tell.

I found a more detailed manifesto on the Labour Party website, based around five Labour policies called ‘Let’s get Britain’s future back’. Idiotic nonsensical slogans notwithstanding, I did find one mention of the word ‘farm’. But only once. And it was part of the word ‘windfarm’. Labour is more interested in the farming of wind than the farming of wheat, cattle or vegetables. That managed air might explain where their slogan came from.

It is no wonder that the rural communities don’t trust Labour. According to FarmersGuide.co.uk, only 28 per cent said “they believe Labour understands and respects rural communities and the rural way of life”. But it’s not all bad news for Labour. The Tories are trusted even less, having dropped down to only 25 per cent. In short, the people in the countryside have no confidence in politicians.

The reason agricultural policy gets so complicated is because we have a great deal of knowledge but no wisdom.

You need only to watch Clarkson’s Farm to understand why this is the case. Farmers have been subject to an enraging mixture of overregulation and political indifference. Some of this has been Brexit. Some has been bureaucratic incompetence.

But there is another more fundamental problem. I discovered it when reading The National Food Strategy. This was a document courageously commissioned by the Conservatives in the hope that someone else would come up with some coherent policies for the countryside. It runs for hundreds of pages plus footnotes and sources and is an impressive piece of work. It pulls together issues around land use, food security, climate change, food inequality and obesity.

These issues are all interconnected. In fact, they are interdependent. How can they not be? You have to consider them all together. But once you open these cans of worms you end up with all kinds of other questions about pesticides, genetic modification, food waste and the identity of the maniac canning worms in the first place.

The reason agricultural policy gets so complicated is because we have a great deal of knowledge but no wisdom. We understand crops on a molecular level. We can design gigantic machinery to efficiently administer the correct dosage of pesticides to individual plants. We can theorise about animal bedding until the cows come home. But we can’t make decisions. That requires wisdom.

Wisdom is discernment, choosing between two good things – or making a decision based on the lesser of two evils. We can’t do that, because we can’t decide what is very good, what is good, what is okay and what is evil. Everything is practical pragmatic politics. You do what works. Except how do you define ‘what works’? For whom? Based on what?

Because we can’t make decisions, we end up having to balance entirely valid concerns about climate, obesity, food inequality, subsidies and the life cycles of bees. But we can’t do it. It’s too complicated. It produces anomalies and perverse incentives. The result is middle-aged men taking their own lives because TB-ridden badgers have ended up with more legal protections than tenant farmers.

We would do well to look to our ancestors. They lacked our granular knowledge but they had wisdom which, according to the Bible, begins with ‘the fear of the Lord’. They ploughed the fields and scattered the good seed on the land. They understood that our food doesn’t come from our brains, our labs, our factories or our highly integrated just-in-time delivery systems. Our food comes from God. As the Psalmist writes:

He makes grass grow for the cattle,
     and plants for people to cultivate—
     bringing forth food from the earth:
wine that gladdens human hearts,
     oil to make their faces shine,
     and bread that sustains their hearts.

Psalm 104

That’s why our predecessors ask for God’s blessing on their tools on Plough Monday in early January. It explains ‘Rogation days’ in the spring when the entire congregation would wander round the fields asking for God’s blessing. There was Lammastide when the harvest was beginning to ripen in early August. And every Sunday, the congregations prayed this central line of the Lord’s prayer: ‘Give us this day our daily bread’.

Jesus was good at bread. He was so good, he didn’t even need wheat to make it. He could feed five thousand families from a handful of loaves. It’s interesting that avowedly atheist regimes – like Stalin’s Soviet Union and Mao’s China – end up with mass starvation.

Our own society has turned its back on God. We have made ourselves gods. And after much consultation and two hundred pages of background and policy – plus foot notes - it turns out that food is a lot harder than we thought. Omniscience and omnipotence are really handy which it comes to a coherent plan for 70 per cent of the land in the UK. Rather than another National Food Strategy, let’s just have Psalm 104. Right now, our farmers are prepared to try anything.