Article
Assisted dying
Care
Comment
Death & life
Suffering
5 min read

Why end of life agony is not a good reason to allow death on demand

Assisted dying and the unintended consequences of compassion.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A open hand hold a pill.
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. 

Essay
Character
Comment
Language
6 min read

Our language use is leading to a cultural abyss

We are witnessing a profound loss of commitment and discernment in the use of language, writes Oliver Wright.

After 15 years as a lawyer in London, Oliver is currently doing a DPhil at the University of Oxford.

Four rugby players stand and watch beside a referee gesturing with his arm.
Rugby players wait upon Wayne Barnes' word.
RFU.

The 2023 Rugby Union World Cup Final was one of the most iconic international matches in living memory, involving two of the most iconic teams – the All Blacks and the Springboks. It’s not surprising that after reaching such a pinnacle of a sporting career, there should be retirements that followed. But two retirements caught my eye. Not from players, but from referees: Wayne Barnes, the most experienced international referee in the world, the main match official, and Tom Foley, also highly experienced, the Television Match Official. Why? Wayne Barnes’s statement is particularly gracious and thoughtful. But the reason given in common with Tom Foley, and indeed many others in similar situations and similar high-pressure roles in the public eye, is worrying: online abuse. After the cup final, death threats were even sent to the school of Foley’s children.   

Online abuse has become an endemic, worldwide problem. There are real people issuing these threats and abuse; and there are real people receiving them, and responding in some way. Of course, there is also the problem of online ‘bots’. But they only succeed in their abuse because of their imitation of real abusers.  

It’s worth asking why, because we can go beyond the helpless handwringing of ‘the perils of being online’. There are philosophical and indeed theological reasons, and philosophical and theological ways, I suggest, of climbing out of the abyss.   

In fact, all words ‘act’ in some way. Even plain truth-describers assert something, such that an interlocuter can learn or discern for themselves. 

Let’s go back to the 1950s, when two important advances in the philosophy of language and in religious language occurred. The first came from Oxford, and the White’s Professor of Philosophy, J.L. Austin. The second came from Durham, and its then Bishop, Ian Ramsey.  

Austin, whose remarkable life and work has now been brilliantly documented for the first time in the biography by Mark Rowe (published by OUP, 2023) was a decorated Second World War veteran in the intelligence corps who was widely recognised as being one of the masterminds of the success of the D-Day Landings. On his return to Oxford in the late 1940s he perceived with great dissatisfaction a certain philosophical move which accorded the greatest importance in language to words and phrases which described things, which indicated some form of empirical truth about the world. For sure there were other kinds of use of language, religious language, emotional language, and so on, this argument continued. But that was fairly worthless. Describing cold hard scientific truth was the true utility for language.  

Austin’s most famous response was in his book How To Do Things With Words. The function of language goes way beyond the scientific description of the world. Language acts, it does things. We promise, we name, we cajole, we threaten, we apologise, we bet. There is no real ‘truth’ as such conveyed in such ‘speech-acts’. Their importance lies, rather, in what is thereby done, the act initiated by the words themselves. Or, in the Austin-ian jargon, the ‘illocution’ within the ‘locution’.   

But Austin realised something even more important as he investigated this form of language – these performative utterances. In fact, all words ‘act’ in some way. Even plain truth-describers assert something, such that an interlocuter can learn or discern for themselves. What matters is how ‘forceful’ the relevant act of speech is in each case. Sometimes the speech-act is very simple and limited. In other cases, such as threats, the performative aspect of the utterance is most forceful indeed.   

Austin’s student John Searle took the idea of performative language to America, and developed it considerably. Most notable for our purposes, however, over against Austin’s idea, was the separation of speech from act. By analysing the conventions and circumstances which surround the performance of a speech act – a baptism service for instance – we can observe how and why the act occurs, and how and why such an act might go wrong. But the debate was then divorced from the context of speakers themselves performing such actions, an integrity of speaker and action. The philosophical problem we then hit, therefore, is that a spoken word and the associated act (‘locution’ and ‘illocution’) are two entirely separate ‘acts’.  

Let’s move now from Oxford to the great Cathedral city of Durham. At the same time as Austin was teaching in Oxford, the Bishop of Durham Ian Ramsey – apparently unaware of Austin’s new theory of performatives – investigated religious language to try and get to grips with both how religious language does things, and what it says of its speakers and writers. Ramsey developed a two-fold typology for religious language – that of commitment and discernment. First, religious language implies two forms of commitment: there is the speaker/writer’s commitment of communicability, a desire to communicate, to be comprehensible, to ‘commune through language’; and the speaker/writer of religious language also  entertains prior commitments for the language adopted – language is rarely neutral when it comes to religion. Second, religious language implies a form of discernment about the words that are being invoked and for what purpose. They are not universals, but carry special meanings according to the particular conventions involved. Commitment and discernment.  

But this new innovation in the philosophy of religious language too was taken up and developed away from Ramsey’s idea – particularly in the much more famous work of John MacQuarrie, a Scottish philosophical theologian who spent much time teaching both in the States, and in Oxford. In MacQuarrie, writing at the height of the influence of thinkers such as Heidegger and Bultmann, Ramsey’s ‘commitment’ and ‘discernment’ got subsumed into existentialism and myth. The religious speech act became merely an event or an act for the self, a personal matter which might involve transformation, but might not.  

 These two strands, of the philosophy of language as it got taken up by Searle and his American counterparts, and of the philosophy of religious language as it got taken up by MacQuarrie, have for some time now predominated. And it is only recently that scholars on both sides have begun to perform a ressourcement, both on Austin, and on the nature of religious language in the wake of Bultmann.  

 The Twitter-sphere seems irrevocably to have divorced the bonds that tie speaker to their acts. In these fertile conditions, abuse flourishes. 

We can now return to the cases of Wayne Barnes and Tom Foley, and many others in many different walks of life just like them. Undoubtedly, the emotional, existential, and physical distance secured by interacting online has created the conditions for online abuse to flourish. But at a deeper level, what we are witnessing is a profound loss of commitment and discernment in the use of language, in society as a whole and also in the Church. Real people feel free to use language oblivious to any inherent act contained within it. The Twitter-sphere seems irrevocably to have divorced the bonds that tie speaker to their acts. In these fertile conditions, abuse flourishes. Similarly, in the Church, the commitment and discernment which has lain behind millennia of liturgical and doctrinal language has become a private spiritual matter; or indeed has been neglected in public when religious witness has not been matched between word and deed.  

How do we walk back from this cultural abyss? There is an ethical, and, potentially, a religious choice to make. The ethical choice is to think about what our language does to those who read (or hear) it, and to change the way we speak or write, accordingly. Ramsey's modes of ‘commitment’ and ‘discernment’. The religious dimension is to recognise that our words bind us to a system of belief, whether we like it or not. Saying one thing and doing another in a religious context implies a diminution in value of language for all concerned, not just the private life of the individual believer.  

Actions speak louder with words.