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

7 February 2024

6 min read

Northern Ireland’s imminent danger is distraction

Distraction damages much more than your concentration. Its consequences could cost Northern Ireland its future.

Andy Flannagan

Andy Flannagan is an author, organiser and musician.

Smartly dressed politicians sit or mill around a round table.

Rishi Sunak with the leaders of the Northern Ireland Government.

Prime Minister's Office.

Should you be reading this article right now? Are you meant to be working? Perhaps you’re working from home with the glorious ‘freedom’ that brings? Forgive me for judging, but it’s just that I know myself all too well. Dear reader, I must confess to you that in the course of writing this article I have already ‘cut away’ to cricket scores or my fascinating chess match with covidchessfun34 more than a few times. We are an increasingly distractable people. But you’re here now, so whether you landed here through word of mouth or social media, welcome. Much as you would (I am sure) love me to deconstruct yours and my individual psychology and boundaries, my hopefully more important point here is that distraction also operates at a political level.

It’s been a frustrating few years for the people of Northern Ireland. Which when placed on top of the devastating history of the last 50 years seems a tad cruel. Just when the Good Friday Agreement seemed to have pulled off a miraculous balancing act on the high wire of a divided island with contested history, Brexit came along to throw off NI’s centre of gravity. It was in fact thrown off to such an extent that NI was left just trying to cling on, balance and survive, rendering no forward progress possible. Sadly, the circus metaphor seems appropriate in more ways than one.

Given that context, you can appreciate how the people of Northern Ireland felt this week when Prime Minister Rishi Sunak flew into Belfast and attempted to educate them. He urged the newly formed Northern Ireland executive to focus on ‘things that matter’ rather than constitutional change. With hospital waiting lists that rival Sierra Leone and some roads that rival, well, Sierra Leone, I think that folks in Northern Ireland get that ‘things that matter’ are the things that matter. Of course, what the Prime Minister is talking about is Northern Ireland’s obsession with the elephant in the room - the border, or the desired removal of it. We don’t just talk about the elephant in the room. We study her in minute detail. We build brand new scientific devices just to study her. So, to be fair to the Prime Minister, ‘Don’t get distracted by the border’ is at a surface level an important thing to hear. Especially as Northern Ireland’s new First Minister Michelle O’Neill has not been shy about putting a United Ireland firmly on the agenda in her first days in office.

Condescension from someone that knows more than you is challenging, but condescension from someone who knows less than you do really grates.

But what has grated the good people of Northern Ireland is that this sermon to not be distracted by constitutional change was delivered by one of the chief exponents of Brexit – the biggest constitutional upheaval for Northern Ireland in a generation. The time spent and the regulatory gymnastics involved in trying to do a job of Brexit damage limitation for Northern Ireland has sucked the political energy and life out of these last seven years in Belfast and beyond.

None of us enjoy condescension. It is that annoying thing that happens when people know more about a subject than we do and lord it over us. But what the people of Northern Ireland have had to endure in this last decade is being lectured by the Jacob Rees-Moggs of this world about the wonders of Brexit, when it became patently clear to most Northern Irish folks that not only had the particular challenges of NI not been fully considered but that even senior Brexit-supporting politicians didn’t actually understand the logistics how NI currently operated within the EU. Condescension from someone that knows more than you is challenging, but condescension from someone who knows less than you do really grates. And that’s only the nuts and bolts we’re talking about. Probably more detrimental was the ignorant blind spot around identity and psychology that was exposed. A palpable lack of knowledge was exposed regarding how the Good Friday Agreement combined with EU membership had created a remarkable ‘safe space’ in Northern Ireland where people who wanted to feel Irish could feel Irish and people who wanted to feel British could feel British. Condescension feels even worse when it seems that people don’t understand your circumstances or care about you.

The force(s) of darkness are not idiots. They don’t waste time for most of us tempting us with the big stuff. In short, they try to distract us.

So, I put it to you that the consequences of distraction can be large. Those of us with Irish DNA need to hear the challenge that our obsession with the border has led to us not loving our neighbour as ourselves and stolen decades of healthy existence from our island. But might it be wise to at least consider that the distraction of Brexit has stolen and may continue to steal decades of focus on climate change, strengthening family life, healthcare, immigration, economic justice, international peacebuilding, and maintaining local service provision from local councils. In short, ‘things that matter’.

The temptation is to see distractions as whimsical, temporary things. We think, “ah that quick scroll through Facebook or Instagram may make me less efficient, but it won’t kill me”. But that is exactly how temptation works. If you believe in an invisible battle between good and evil (and I do), then there are some dynamics that are worth considering. If there is a person or an impersonal force tempting me, then it is unlikely to tempt me to do things that are socially and culturally inappropriate in my world. I am not likely to be tempted to murder someone this morning. That would be an inefficient tempting strategy. But it would appear from the state of the world that whoever is in charge of tempting is actually quite good at it.

That’s why I believe we are more usually tempted not to swing dramatically one way or the other but by a small shift of the needle. Just a little bit more than the day before. Not tempted to kill someone but tempted to score that point in a social media discussion. Not tempted to rob a bank, but tempted to ‘creatively’ adjust small increments in our tax reporting. Not tempted to commit adultery, but tempted to linger too long in a conversation or on a website.

The force(s) of darkness are not idiots. They don’t waste time for most of us tempting us with the big stuff. In short, they try to distract us. Just a little wander off the main path. Won’t hurt anyone. Won’t take up much time. Except that habits form and unhealthy practices and opinions start to solidify, and ever-so-subtly the wheels may start to come off. Multiply that by a few million people and a whole country can end up hacking through gorse and bushes rather than driving on the track.

Sure, a marriage can be patched up after innocent distraction becomes a porn addiction, but there will be wounds and scars. We need to acknowledge and repent to allow healing. The people of Northern Ireland know all too well that real reconciliation needs the hard yards of repentance and forgiveness.

My prayer for the new Northern Ireland executive is that they can avoid further distractions and keep the main thing the main thing. At present only seven per cent of young people in Northern Ireland attend an integrated school. That means that the vast majority of people are growing up not getting to know kids from the other side of the religious divide. In that vacuum the fear, ignorance and prejudice can fester. Our own secret apartheid. That would be one place to start.

Speaking of which. Get back to work.