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. 

Weekend essay
Comment
Ethics
Justice
8 min read

The Post Office scandal: why truth matters

Lawyer Alex Stewart analyses the Post Office scandal for the lessons it teaches on our missing morals.

Alex Stewart is a lawyer, trustee and photographer.  

A man, dressed in a suit and anarak, stands in front of a law court.
Toby Jones plays the eponymous Mr Bates in ITV Studios dramatisation.

The reaction to ITV's 4-part dramatisation of the The Post Office Horizon story has been profound. It managed to stir up huge public sympathy for the sub postmasters and has galvanised the Government into action. The story has also tapped into deep wells of moral outrage at a time when trust in our institutions and corporations is the lowest in living memory. It’s a tale of failure to take responsibility. It’s a tale that shows the truth matters. 

A failure to take responsibility 

What seems to have enraged us most is the collective moral failure over many years of those in positions of power. They either deliberately covered up the problems with the Post Office’s Horizon IT system, by withholding information about known faults, or simply ignored them.  The sense of disbelief has been compounded by the apparent inability, so far, to pin the blame on any one person or group of people. The Post Office’s ex CEO, Paula Vennells, has handed back her CBE but it seems she was only the tip of an iceberg of obfuscation and prevarication.   

What emerges is a pattern of behaviour that moral philosophers call moral diffusion. It is also called the ‘bystander effect’, so-called after a case in which a woman was attacked in New York in the presence of a large number of people who knew that she was being assaulted but failed to come to her rescue as they all saw it as someone else’s problem. 

I witnessed an example of this the other day in London at a busy pedestrian crossing. A man with an angle grinder was cutting through a bicycle lock.  As the sparks flew, pedestrians looked at each other for reassurance, as if to ask - is this ok?  Was he shamelessly stealing the bicycle, or had he been sent by the council to remove a long-abandoned bicycle?  No one knew and no one intervened. 

The instinct to shirk responsibility seems to be hardwired into us, part of our fallen nature.  It all started with Adam and Eve. Embarrassed and ashamed they hide, only to discover you cannot hide from God. And when they are discovered, both deny personal responsibility, saying in effect “it wasn’t me”.  

Later we have the story of Cain killing his brother Abel. Cain doesn't deny he has done something wrong, he simply denies he had any responsibility for his brother at all.  He asks why he should have any concern for anyone beyond himself. ‘Look after Number One’ Is the voice of Cain throughout the ages. 

Why is this failure of leadership such an effrontery to us? Because we instinctively recognise that leadership is not about lording it over others. 

The Government has promised to hold to account those responsible for the scandal.  Perhaps the roving searchlight of the inquiry will succeed in identifying the human culprits? In the meantime, executives and politicians are scrambling over themselves to deny responsibility, typified by the response of Sir Ed Davey who has taken the art of the non-apology to a new level. The honourable exception, among the political class, is Lord Arbuthnot who as an MP was both tireless and fearless in campaigning for justice for the sub-postmasters.     

Why is this failure of leadership such an effrontery to us? Because we instinctively recognise that leadership is not about lording it over others, hiding behind other people’s decisions or passing the buck, it is about taking responsibility.  In practice we do not live by the philosophy presented by Glaucon in Plato’s Republic, that justice is whatever is in the interest of the stronger party.  Nor are we willing to live in a Darwinian world where in the struggle for supremacy there is no need for the powerful to look out for the weak simply because they are powerful.    

There is a fascinating moment in the story of Moses in the book of Exodus when he notices an Egyptian official beating one of the Israelite slaves. He sees that no one else is willing to intervene and he gets involved, at some personal risk, and in so doing marks himself out as a leader.   

Leadership is born when we become active not passive, when we decide that something is wrong and we need to take steps to put it right. These are the people who make the world a better place because doing nothing, though it may not be illegal, is not morally neutral. Failing to act to prevent a wrong does not simply leave a vacuum, it gives permission for evil to flourish. Or as Burke put it “The only thing necessary for the triumph of evil is for good people to do nothing.”   

Alan Bates could have resigned himself to his fate, but instead has doggedly pursued justice for 20 years.  

We all long for leaders who will lead responsibly and not out of self-interest, who will not turn a blind eye to the suffering of the powerless or blame others when asked to explain why they did nothing.   

This is especially so in the church which holds itself to a higher standard and should know better. The ITV series quite deliberately dwells on the fact that Paula Vennells was, as well as being CEO of the Post Office, ordained in the Church of England.  

The truth matters 

Key to the success of the sub-postmasters case was the ability to get to the truth, a task made very difficult by the fact that the Post Office held all the records needed to prove that it was the Horizon system, not the sub-postmasters, that was at fault.   

Being able to determine the truth of a matter is essential to how we lead our lives, and especially in matters of justice.  The version of events presented by the Post Office turned out to be false, but once this false version was on record, the reputations of otherwise upstanding pillars of local communities were destroyed overnight.  The public shame and the human cost of being cruelly and wrongly labelled a liar and thief is powerfully brought home by the TV series, as is the relief of vindication. 

We do not in reality live our lives in a postmodern universe where truth is seen as relative (Oprah’s infamous “What is your truth?” moment), or nothing more than a claim to power.  We know on a daily basis the power of the truth to set us free, from false accusations or a guilty conscience, and how much it stinks when we are deceived - especially when it is by the powerful.  

A lack of integrity 

During the Cold War, there was a running joke that the best indicator of whether a country operated as a one-party state was whether it had the word “Democratic” in its name.    

We have become used to the same kind of dissonance between image and reality, whether it is the smiley telegenic people in a company’s glossy videos (actors? library footage?) or an impossibly worthy values statement.

I was once part of group of employees invited to revamp our employer’s declared values. We were presented with a set of aspirational statements that described a culture that was akin to the Garden of Eden and a working environment that bore no relation to the reality.  When I pointed this out, I was not invited back.   

In public Paula Vennells was insistent that the Post Office cared about its people while out of the spotlight those people were being horribly mistreated.   

It isn’t always so, but how can so many organisations live with such glaring contradictions?  Or is it that boards become so disconnected, by geography or otherwise, from the organisations they run and the cultures they preside over that they actually believe the image over the reality?  

"Computer says no"

One of the more terrifying issues raised by the Post Office scandal is how the principle of the presumption of innocence was abandoned.  How come the testimony of hundreds of innocent people was rejected in favour of a faulty computer system’s data?  

Part of the problem is that the English courts regard computer records as reliable unless the defendant can show otherwise. Since 1999, the burden of proof - and with it the presumption of innocence – has effectively been reversed: the defendant is guilty unless he can show that the computer records implicating him are wrong.   

The notion that we cannot challenge a computer that “Says No” is a real problem. As the Post Office scandal shows, computer software is often riddled with bugs. After all, it is written by fallible human programmers. It also became clear that the Horizon system’s data could be manipulated remotely - and without the knowledge of the sub postmasters.  

To assume that computer generated evidence is infallible is a very dangerous assumption in a world increasingly dominated by machines and, more recently, artificial intelligence.   

A very human story 

The sub-postmasters in the Post Office case were not machines or assets.  The ITV drama succeeded in doing what no legal or investigative process can adequately do, it humanised the victims. Despite all the PR talk about caring for its people, the Post Office only cared about its own reputation, and in the process of trying to save itself lost its humanity and its reputation.   

The drama successfully stripped away all the lifeless procedural, technical and legal terminology to reveal a very simple, devastatingly human story that needed to be told. In Alan Bates’ words: “the Post Office stole my livelihood, my shop, my job, my home, my life savings and my good name”.   

This Post Office story has struck a chord because it reminds us of is what is increasingly missing in public life - leadership, accountability, respect for the truth, integrity and humanity. 

Watching the ITV drama, I was frequently moved to tears and cheered at the end. We root for the victims out of solidarity, as if we ourselves had been wronged.  

The Christian understanding of sin identifies it as a public not a private matter, as it infects the whole body politic.  This is why the case name given to a crime is “R (that is, the state) v X”. There are certain wrongs which are so serious they are considered to be offences against the whole community, not just the individual victim.  

The Post Office saga is a parable of our times.  It tells a story of a society whose elites have become dangerously detached from principle and deaf to the concerns of ordinary people. It will not go away any time soon. The moment of true catharsis, if it comes, will be when our institutions and leaders have earned back our trust. 

The last word goes to the book of Proverbs: 

When good people run things, everyone is glad, but when the ruler is bad, everyone groans.