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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Film & TV

18 May 2024

5 min read

Théoden and breaking the spell

Bernard Hill’s most famous role sheds light on where humanity needs to be.

Theodore Brun

Theodore is author of the historical fiction series The Wanderer Chronicles.

A movie scene of a king and prince walking confidently.

Bernard Hill, middle, in The Lord of the Rings.

New Line Cinema.

Recently we saw the sad passing of Bernard Hill, one of the great British actors of his generation, whose career enjoyed many high points. Hill came to prominence, in Britain at least, in the 1980s with his role as an unemployed tarmac-layer in the BBC series Boys From the Blackstuff. Through the 1990s, he went on to star in a number of big budget Hollywood feature films, such as The Ghost and The Darkness, Titanic, and The Scorpion King. But his best-known role, the one which won him global recognition, was as King Théoden in Peter Jackson’s Lord of the Rings trilogy.

In both Tolkien’s book and Jackson’s adaptation, the character of King Théoden plays a pivotal role in making a stand against the forces of evil advancing under the banners of first the wizard Saruman the White in The Two Towers, and then the Dark Lord Sauron himself in The Return of the King, the trilogy’s climax.

Théoden’s character arc is as heroic as any in Tolkien’s epic. But perhaps the most memorable moment within it comes when he is first introduced. Gandalf comes to Théoden’s hall of Edoras to rally support against Saruman’s rampaging armies of orcs. But instead of a redoubtable king and ally in the fight against their common enemy, he finds a weak man buckled under the weight of old age and infirmity, cowed by fear and indecision, and enthralled to the counsel of Grima Wormtongue - whom Gandalf reveals to be an agent of Saruman.

In Jackson’s version, Gandalf ‘delivers’ Théoden from his enthrallment, in effect breaking the spell of inertia and inaction which Saruman, through his minion Wormtongue, has cast over him. Théoden awakes from his bondage, is physically rejuvenated, and is now able to rise and take his proper place in the battleline against Sauron’s evil power. In Tolkien’s version, Théoden has more agency. He chooses, at last, to throw off the counsel of Wormtongue and cling to the slim thread of hope which Gandalf represents, however desperate it may seem.

It is a powerful image, and one from which we can and must learn today.

Our ears are open to so many voices through both mainstream and social media that it becomes a matter of extreme importance to be able to discern who is Gandalf and who is Grima Wormtongue?

Few would deny that recent times have revealed new and determined manifestations of evil in our culture and our world. And yet, both inside and outside the church, these latter years have also been characterised by a feeling of helplessness and inaction in the face of such evil. It’s common to hear both men and women complain that they feel unable to speak up in opposition to what they perceive as wrong. They have been silenced. Either those who dare to speak up find themselves cancelled. Or else those who don't self-censor, keeping their mouths shut and their heads well below the parapet. Like Théoden, they lock themselves away in their hall. In this latter case, the battle is ceded without ever having drawn a sword.

As the famous Edmund Burke quote goes: ‘The only thing necessary for the triumph of evil is for good men to do nothing.’ Much of the church, some might dare to say most of it, resides in this place of cowed inaction. Enthralled and confused by the Wormtongue whisperings of the media as mouthpieces for agendas diametrically opposed to the good, we have willingly subjected ourselves to this spell. And the consequence? Like the Westfold of Rohan, the land is burning.

It is not controversial to say anyone who cares about our culture and its future needs to awaken from their slumber. Needs to cast off - or else have cast out - the gag of silence. But what is more troubling perhaps is that, even having done that, we cannot agree on what is evil and what is good.

In the Bible, the devil is portrayed as often masquerading as an angel of light. And it warns against the descent of some cultures into a state of such moral confusion that God’s ordinances are inverted: good is called evil, and evil is called good.

So how are we to navigate our way through this mire of uncertainty? Warnings against misinformation and disinformation abound. And yet, those in positions of power who proclaim them may equally be charged with propagating untruths and dissembling realities, all for the sake of shoring up their own power structures.

All this is to say - our ears are open to so many voices through both mainstream and social media that it becomes a matter of extreme importance to be able to discern who is Gandalf and who is Grima Wormtongue?

Tolkien’s choice of the name Grima Wormtongue is significant. ‘Grima’ derives from the Old Norse word, grímr which means ‘mask’. ‘Worm’ similarly derives from another Old Norse word: ormr which means ‘snake’ or ‘serpent’.

As such, it throws us right back into the Garden of Eden and the honeyed words of the serpent which led humanity into such disaster, offering some purported good up front, while concealing the calamity (and shame) which comes hard on its heels. If we are to stand up and contest the modern manifestations of evil, we must be able to recognise the side of the field of battle on which to take our stand.

Who is Gandalf? In Tolkien’s world, though he hated the idea of his work being interpreted as allegory, Gandalf does represent the Christ figure. And Sauron in turn suggests the Anti-Christ - a nebulous figure arising from scripture, poorly understood at the best of times. But somehow the fountainhead from which, humanity is told, all evil must flow.

But if humanity thinks of Christ on the side of good, and Christ as the most human of us all, perhaps this provides a yardstick by which we can discern the lines of battle.

Is it human or anti-human to stand up for life at its most vulnerable? Is it human or anti-human to stand up for the family unit? Is it human or anti-human to honour and celebrate each and every Imago Dei as they were created to be? Is it human or anti-human to safeguard a parent’s right to speak good into their children’s life? Is it human or anti-human to preserve the innocence of our young? Is it human or anti-human to challenge systems of power which enable all kinds of exploitation and other self-evident evils?

First we must awaken. Then we must choose our side. And finally, like Théoden, we must ride to the fight.

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