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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Trauma

9 May 2024

5 min read

Bitterness and weaponised words can’t soften scars

Finding peace for Daniel Anjorin, Salman Rushdie and Bishop Mar Mari.

Krish Kandiah

Krish is a social entrepreneur partnering across civil society, faith communities, government and philanthropy. He founded The Sanctuary Foundation.

A man sits being interviewed and holds a hand to the side of his face, one lens of his glasses is tinted black.

Salman Rushdie discusses his attack.

BBC.

Knife crime around the world is unacceptably high, and with around 50,000 offences expected this year in the UK, it is sadly no surprise when we hear tragic news stories involving knives and sharp instruments. Recently, it was the terrible circumstances of the death of Daniel Anjorin that made the headlines. The gentle, much-loved, 14-year-old boy was on his way to school in East London when he, along with several others, was randomly attacked by a man with a sword. He died from his wounds shortly after being taken to hospital.

I happened to be in the middle of listening to Knife, a memoir by Salman Rushdie, when the news broke of that tragedy. It is another heart-rending story. Rushdie describes how, in 2022, during a speech he was giving about the need to protect writers, a man ran onto the stage and frantically stabbed him 15 times. Rushdie was airlifted to a hospital and survived the attack but lost an eye. Then began his difficult physical and emotional journey towards recovery, documented in the book he never wanted to write.

It was not the first time Rushdie had been the victim of aggression. In 1988, following the publication of his novel The Satanic Verses, the Iranian government called for Rushdie’s death by issuing a fatwa against him. His book was perceived to be blasphemous to the Islamic faith, and despite ten years of round-the-clock police protection in London, he faced several serious assassination attempts.

The fatwa was lifted in 1998, but twenty-four years later, Rushdie was clearly still not safe. He recounts the moment when he saw the man running at him in the darkness as he gave his lecture.

“My first thought when I saw this murderous shape rushing towards me was: So it is you. Here you are…. It struck me as anachronistic. This was my second thought: Why now? Really? It’s been so long. Why now after all these years? Surely the world had moved on, and that subject was closed. Yet here, approaching fast, was a sort of time traveller, a murderous ghost from the past.”

I can’t imagine how I would cope in his shoes. I have not had to experience the daily fear of assassination for decades as Rushdie has. In all my years of delivering speeches and sermons on stages around the world, I have never had cause to even contemplate the possibility of an attempt on my life. Nevertheless, I was surprised to hear in Rushdie’s voice, the words he chose to say to his attacker:

“If I think of you at all in the future it will be with a dismissive shrug. I don't forgive you. I don't not forgive you. You are simply irrelevant to me, and from now on, for the rest of your days, you will be irrelevant to everyone else. I'm glad I have my life and not yours and my life will go on.”

Rushdie admits that his words are his weapons – and he certainly uses them to good effect. They are sharp. They are designed to eviscerate. They are calculated to cause pain. They express derision towards his attacker. Part of me cheers him on: a defenceless man in his seventies who walked into a lecture hall expecting to give a speech to rapturous applause but left barely alive as the victim of a brutal frenzied attack. Like the plot of every action movie I have ever seen, the story seems to have a happy ending – the hero is saved, the bad guy is locked up and justice is seen to be done.

But there is another part of me that knows these Hollywood endings can’t be trusted. Those 27 seconds of violence have clearly left Rushdie reduced to spitting insults at a young man in prison. He claims his life now is “filled with love”, but sadly there is little evidence of it in the way he addresses the radicalised 24-year-old. Bitterness and weaponised words, however eloquent, can’t soften the scars, nor do they make the world a safer place.

Indeed, I have found it difficult to forgive the comparatively trivial experience of being metaphorically stabbed in the back.

I can’t help but compare Rushdie’s reaction with that of Bishop Mar Mari Emanuel. The day before Knife was published, the Iraqi-born bishop was preaching at his church in Sydney, Australia, when he too was attacked by a young man with a knife, and, like Rushdie, ended up losing an eye. The attack was an overt terrorist act against Bishop Mar Mari, a controversial figure who has spoken dismissively about the Islamic, Jewish and LGBTQ+ communities.

Despite the striking similarities between the two men’s terrible ordeals, the contrast in their response couldn’t be starker. Speaking just two weeks later at a Palm Sunday service, Bishop Emanuel affirmed that he had forgiven his teenage assailant:

‘I say to you, my dear, you are my son, and you will always be my son. I will always pray for you. I’ll always wish you nothing but the best. I pray that my Lord and Saviour Jesus Christ of Nazareth, to enlighten your heart and enlighten your soul your entire being to realise, my dear, there is only one God who art in heaven…. the Lord knows it is coming from the bottom of my heart. I’ll always pray for you and for whoever was in this act. In the name of my Jesus, I forgive you. I love you, and I will always pray for you.”

Woven into the fabric of every form of Christianity is a commitment to love and forgiveness, clearly exemplified for us here by Bishop Mar Mari. His words resonated around the world this week as he returned to the pulpit where he was stabbed, bandage over one of his eyes, to speak out with kindness and compassion.

I am deeply challenged by the bishop’s response. I have never experienced the physical pain and emotional trauma of a knife attack. Indeed, I have found it difficult to forgive the comparatively trivial experience of being metaphorically stabbed in the back. I know how hard it is, to be gracious to those who deliberately cause pain to me or to my family members through their actions. Like Rushdie, I sometimes I would like nothing more than to see them locked up, living a loveless, meaningless, irrelevant life. But this is not the Christian way. I follow Jesus who forgave the soldiers driving nails through his hands and feet, so I must strive to be compassionate to those who do us much lesser harm, as well as seek, in his name, to tackle the underlying causes for the greater dis-ease in society.

The issues that lead to knife crime are many and complex. They include poverty, fear of victimisation, gang culture, radicalisation, distrust of authorities, lack of education, experience of violence in childhood, and much more. Whatever we can do to tackle these problems, we do for the sake of love and peace in our world. Perhaps as we seek to overcome these things together, we can work towards a day when what happened to Daniel Anjorin on 30th April can never happen again.