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.

Conviction politics is changing morality

Political dialogue gives way to animal-like culture war.

Barnabas Aspray

Barnabas Aspray is Assistant Professor of Systematic Theology at St Mary’s Seminary and University.

A severed doll head, resembling Donald Trump, lies on dirty ground.

Max Letek on Unsplash.

“We're gathering 100 MILLION signatures to OVERTURN Trump's wrongful conviction!”

I received this SMS message, along with a link, on Monday 10th June. It was the fourth message of its kind I’d received since the verdict convicting former US President Donald Trump of felony. This time, out of curiosity I followed the link. I found a lot of words in capital letters conveying a sense of extreme urgency, but I did not find any evidence or argument for the injustice of the verdict.

Trump’s conviction has been met with a torrent of reactions from people across the political spectrum. Everyone sees the event as an episode in the upcoming US election in which Trump plans to run for president. For those on the left, it’s final and conclusive proof that he is unfit for office; the evidence is clear, the courts have decided, end of story. For those on the right, it’s a further sign of the depraved depths to which the Democrats will go to discredit him; the jury was rigged, and the whole thing was a political stunt to win the election. The legitimacy of the court ruling is something nobody on the left questions and nobody on the right admits.

To me, these responses are another sign of the ever-widening gap between left and right that eats up all common ground, even the rule of law. Political victory now takes priority over truth or justice – or perhaps more accurately: victory for my side is identical with truth and justice. To concede anything to the opposing side is seen, not as praiseworthy, but as betrayal.

My comments in what follows are nonpartisan: I want to point to what is true of both sides equally: the failure of dialogue and its replacement by a warfare mentality. This change affects even what we consider moral and admirable behaviour. It is not only a problem in the US. Ever since Brexit, things have become increasingly polarised in the UK as well.

That is what “culture war” means. War and dialogue are opposites; war is what happens when dialogue has failed.

Formerly in Western nations, rival political parties offered different means to achieve the same end: a flourishing society of justice, peace, prosperity, and freedom. Politicians disagreed but they respected each other. They had faith in the political process in which they all participated. Consider as an example the letter George Bush Senior left Bill Clinton after losing the 1992 US election.

“Your success now is our country’s success,” he wrote. “I am rooting hard for you. Good luck.”

The fact that he was now president was more important than which political party he belonged to.

In such a cohesive society, the legal system was a trusted arbitrator whose decisions would be accepted by victor and loser alike. This does not mean the system was perfect. Everyone knew that justice could sometimes miscarry. But the public did not see themselves as qualified to judge that either way. How could they expect to know more than the jury?

What we are witnessing now is a return to a more animal-like state in which the goal is that my team wins no matter what. If the arbitrator rules in favour of my tribe, they are seen as executing justice. If they rule against my tribe, their ruling must by definition be unjust.

That is what “culture war” means. War and dialogue are opposites; war is what happens when dialogue has failed because both sides have been unable even to “agree to disagree.”

Reasoned debate is seen as no longer effective in light of the vile underhanded tactics of the other side (but not, of course, of my side).

In dialogue, both sides aim to uncover the truth even if the truth turns out not to be what I wanted or thought. Prioritizing the truth means that I might realise I was wrong and concede the point, even at some material cost. For example, in a property dispute, I might become persuaded of the truth of my opponent’s case and give up my claim. That may be painful, but winning was less important than justice being done. In dialogue, both ‘sides’ are really on the same side because they both ultimately want the same thing.

In war, on the other hand, the goal is to defeat the enemy and it makes no difference whether they are right or wrong – or rather, it is assumed without question that they are wrong. If words are used in war, they are weapons in disguise, not meaningful communications.

This transformation from dialogue to war changes morality itself. You are now judged, not by the sincerity of your pursuit of truth, but by how loyal you are to your tribe. Even to take seriously the opposing position is viewed like reading a propaganda flyer dropped from a Nazi airplane: don’t even read it, it will only twist your mind!

Even seven years ago, fans of Jordan Peterson were fond of the phrase “all I want is to have a reasoned debate.” Regardless of your opinion of Peterson or of whether he exemplified this, those who used this phrase revealed a desire for dialogue rather than war. But today, many of those same followers no longer say that. Now they say, “the left is out to get us and must be stopped” and their counterparts say, “the right is out to get us and must be stopped.” Reasoned debate is seen as no longer effective in light of the vile underhanded tactics of the other side (but not, of course, of my side).

What do we want from our political opponents? We want them to listen to us and to take our arguments seriously.

What role can Christianity have in this polarised society? Sadly Christians are often seen as part of the problem rather than the solution: sold out to one political party. But we should be clear that Christianity does not sit neatly on either side of the divide. That does not mean Christians should be moderate or “centrist,” as if none of the issues matter much. Christianity comes down strongly on many things, but those are spread across the political spectrum. The way Christians vote depends on which issues they judge to be the most important or pressing in the current circumstances.

Second, Christians are called to make peace in time of war. “Blessed are the peacemakers,” Jesus said, “for they will be called children of God.” Christians are called build bridges rather than burn them, to seek common ground rather than trying to obliterate their opponents. This can start with showing love and respect for the person behind the argument; by celebrating our common humanity before trying to argue a point.

Third, it means exemplifying the kind of attitude we want to see in our opponents. “In everything do to others as you would have them do to you,” Jesus told his disciples. What do we want from our political opponents? We want them to listen to us and to take our arguments seriously. We want them to stop making cheap caricatures of us and represent us at our best. We want them to break out of their echo chambers and read news from a variety of political leanings. We want them to open themselves to persuasion and be prepared to change their minds. Jesus suggests leading by example and doing those things first.

Fourth and finally, the Christian’s allegiance is to truth and justice above any tribe, any agenda. The real political situation is almost certainly complex, with much to be said for and against both sides. There are awkward facts that don’t fit our own political position; let’s admit them. The Christian commitment to truth means being ready to acknowledge the weaknesses, failings, and faults on our own side before we point the finger. It’s hard, I know. I am not perfect at it myself. But it’s a more Christlike moral standard to aim for than that of the culture warrior who excels at demolishing the enemy.

Restoring dialogue won’t be easy and may come at a high personal cost. But the cost is greater if we don’t try. My own desire is to see Christians taking the lead in the restoration process and showing the world what Christlike peacemaking can accomplish.