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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Politics

26 February 2024

3 min read

When tradition deserves a break

Upsetting a convention caused uproar, so is it right to break with tradition?

Yaroslav Walker

Yaroslav is Vicar of Christ Church, Hampstead.

A robed and seated man, in a speaker's chair talks and gesticulates.

The House of Common's Speaker.

Parliament TV.

“Nearly a quarter of a century has passed since a speaker of the Commons stood down from its high chair with dignity and to applause.” Thus wrote Andrew Rawnsley in the Guardian this Sunday. Last week the House of Commons erupted. An unedifying lava-spew of recrimination and anger flowed through the corridors of power as the Speaker of the House, The Right Honourable Sir Lindsay Hoyle, broke parliamentary convention to the seeming benefit of the Labour Party. Memories of his predecessors’ playing fast-and-loose with Parliamentary procedure pushed buttons. The SNP’s Gaelic fury founded a flurry of calls for the Speaker to step-down, and it was not until he gave a near-tearful apology that some calm seemed to be restored. Opponents cried foul - ‘how dare he upend the conventions of the House!?’ - while supporters jumped to his aid - ‘he was just trying to protect MPs from further harassment over the Israel-Gaza debate!’ - and everyone was unhappy…

The technicalities of this convention (that multiple amendments are not called upon for voting during an Opposition Day Debate) are less interesting to me than the fact that the convention exists. ‘Convention’ is another word for ‘tradition’. Traditions are important. Our famously ‘unwritten’ Constitution relies heavily on tradition, especially for the smooth running of Parliament. Rather than having the process of legislating and governing micro-managed with procedural minutiae, the Commons operate on the basis of nurturing and conforming to its traditions. In essence, the House of Commons operates on the basis of respect - by respecting the traditions of the House, Parliamentarians grow to respect each other as fellow followers of tradition. Exterior action builds-up interior disposition. Practice influences sentiment.

At least, that’s my romantic take on it. Traditions give some coherence to a society - from the society of elected MPs right through the society of a nation - and allow it to flourish. Traditions bind people together. Traditions unite. You may come from a different part of the country than your neighbour, have different family values, have a different religion or skin-colour or education-level, etc…but you can be united in the traditions you follow. Whether it’s having a roast on a Sunday, going to a Carol Service in December, singing Three Lions in a World Cup year, the traditions you share despite all other differences give you a common cause with those around you.

This is not to say that traditions can’t have a dark side. Some traditions can alienate guests. Some traditions can stifle creativity and innovation. Some traditions can be maintained purely to bamboozle the uninitiated for the benefit of those in the know. In extremis, some traditions can lead to groupthink, to the othering of those who don’t share them, to jingoism and hatred; St Paul wrote that it was the zeal for the traditions of his fathers than led him to persecute the first Christians. Traditions should never be taken for granted or left unexamined. Traditions are roses - beautiful and sweet-smelling, but always in need of pruning. But let the gardener prune carefully - you want some roses left for the garden.

When the scribes and Pharisees try to trick and trap Jesus with impossible thought experiments, they often quote their traditions. Jesus always wins the debate. He wins in the face of their traditionalism. He wins by being a radical. RADICAL! His radicalism is not marked by the abandonment of the concept of tradition, but by deep respect for it. The Sermon on the Mount is probably the most famous speech about the importance of tradition - “You have heard that it was said to those of ancient times…But I say to you…” - keeping the traditions of God in the face of the self-serving traditions of men. The scribes and the Pharisees are the White Witch to Jesus’ Aslan: ‘“It means,” said Aslan, “that though the Witch knew the Deep Magic, there is a magic deeper still which she did not know. Her knowledge goes back only to the dawn of time.”’

Not every critic last week will have genuinely cared about the traditions of the House of Commons. Many will have mouthed the words but would have happily stood by if the breaking of convention benefited them. Nevertheless, we must take tradition, and it’s breaking, seriously. Traditions nurtures the relationships of MPs. Traditions nurture the relationships of neighbours and fellow citizens. Traditions nurture relationship with God, as the traditional rhythms of religious practice and Church seasons help order prayer and worship. Perhaps we’ll look back on the upturning of this particular Commons tradition and recognise it as the right rejection of an outdated convention…but let's be cautious. Traditions are important. Break them with care.