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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Virtues

19 January 2024

5 min read

The corrosive effect of profuse profanity

The coarsening of speech prompts Yaroslav Walker to remember that what you say influences who you are.

Yaroslav Walker

Yaroslav is Vicar of Christ Church, Hampstead.

An irate man holds a mobile phone to his ear while gesticulating with his other hand.

Malcolm Tucker makes his point.

“You breathe a word of this to anyone, you mincing f*****g C**T, and I will tear your f*****g skin off, I will wear it to your mother’s birthday party and I will rub your nuts up and down her leg whilst whistling ‘Bohemian-f*****g-Rhapsody’…right!?”

This is my favourite Malcom Tucker line of all time. This is what Malcom might call, ‘top swearing’. The Thick of It exploded onto our screens in 2005, supposedly lifting the lid on the workings (or absolute lack of) of the twenty-first century British government. The show immortalised the sweary Scot Malcolm Tucker – supposedly partly based on real-life New Labour spin-doctor Alastair Campbell, and played to perfection by Peter Capaldi. The nation watched with a mix of horror and delight, enraptured by the best political comedy since Yes, Minister. However, unlike Yes, Minister, power in The Thick of It is not wielded through the obscurantist language of the elite Oxbridge-educated civil service, but through the terrifyingly unhinged and violent rantings of Tucker’s Svengali spin-doctor. I can only assume that most people on the outside of government took it all with a pinch of salt – I certainly did. Surely, SURELY, it couldn’t be as bad as ‘that’!?

Dipping in and out of the coverage of the UK’s COVID public inquiry showed me just how wrong I was. Civil servants and political appointees writing on WhatsApp were indistinguishable from eighteenth century press-ganged sailors in a tavern. The highlight was the testimony of Dominic Cummings, who was confronted with his use of the saltier elements of the English language: “Due in large part to your own WhatsApps, Mr Cummings, we’re going to have to coarsen our language somewhat…” the investigating KC chided. “I apologise”, was the rather phlegmatic response.

We were then given a tour-de-force of aggressive sweariness – ministers were called ‘useless f**kpigs’, ‘morons’, ‘c**ts’, and it was suggested that in the case of civil servant Helen MacNamara he would ‘handcuff her and escort her’ from Downing Street. Upon being asked whether this language might have contributed to a lack of effectiveness in the Downing Street COVID response, Mr Cummings denied the charge – he was just reflecting the prevailing mood…but of course such language did.

He is very clear in teaching people that the words that leave their mouths have the power to bless them or damn them.

We live in a culture where speech, especially public speech, has progressively been coarsened. The television ‘watershed’ excludes less and less offensive speech, performative profanity is now de rigueur for many celebrities and even some politicians, and there has emerged a real generational divide between those of my generation and the baby-boomers. We appear to have forgotten a basic rule that the ancients knew all too well: affect has effect. What you say influences who you are.

What we say, just as what we do, impacts the sort of person we become and the virtues (or lack of them) that we build up and possess. If we look to Aristotle, we are introduced the concept of habitus. It isn’t just a habit – not just an activity that we engage in on a regular basis – but is a repeated behaviour that builds up our character, for good or for ill. This idea was taken up in some form by Augustine, Averroes, Aquinas, and even people whose name doesn’t begin with the letter A. Our speech, if repeated over and over again, moulds our character. Kind speech, lovely speech, righteous speech – repeated ad nauseum – will have as their end product a kind, a lovely, a righteous person. Violent speech, aggressive speech, coarse speech, will have as their end product a violent, aggressive, and a coarse version of the same.

Going beyond Aristotelian categories to biblical ones, the use of language is often a favourite theme. The most famous Hebrew example is perhaps the commandment: “Thou shalt not take the name of the LORD thy God in vain…” Our speech is important to God, because it is a basic indicator of how we conduct ourselves – and so an indicator of who we are – and we ought to be conducting ourselves in the light of God’s will and God’s law: “Let the words of my mouth, and the meditation of my heart, be acceptable in thy sight, O Lord, my strength, and my redeemer.”

As we move from the Old Covenant to the New, we find St Paul continuing this idea and extending the principle – our words reflect our relationship with God, and so will impact our relationship with other people (who are made in His image). He asks the Colossians that they speak ‘always with grace’, tells the Ephesians to avoid ‘filthiness…foolish talking…jesting’, and commands the Romans to always have a word of blessing ready rather than a curse. The community of holy people, living a life for God and for each other, can easily be destroyed by a cruel slip of the tongue – a fight can break out over even a mild insult. Perhaps this is why Jesus is quite so strict about speech – “But I say unto you, That every idle word that men shall speak, they shall give account thereof in the day of judgment.” He is very clear in teaching people that the words that leave their mouths have the power to bless them or damn them.

Perhaps one of its recommendations could be that at the highest levels of national decision making, our leaders and officials always strive to behave with calm and considerate courtesy.

“Do you think your description of your colleagues, the way in which you described them, their functions, their abilities, their talents, added to that dysfunctionality?” the KC asked Cummings. “No, I think the opposite…” came the slightly bewildered reply. But how could it not? How could speech that has been revealed to be so chaotic, so hostile, so unpleasant, and so callous contribute anything positive to the working environment? More importantly, and I don’t know Mr Cummings and am not making a statement on what his inner character and virtue actually is - how can it contribute anything positive to the person who utters it?

The COVID inquiry has been set-up to teach us lessons on how to be better prepared to tackle the next pandemic. I pray that it succeeds in this aim. Perhaps one of its recommendations could be that at the highest levels of national decision making, our leaders and officials always strive to behave with calm and considerate courtesy, where speech is used to edify, support, and commend. I believe, and Scripture teaches, that if this is taken on as a vital lesson we will, not only be better prepared to steer the country through the crises of the future, but the entire tenor of our political and public life will be better – holier even. The good news is that it costs nothing to put this recommendation into practice...all it takes to get started is a kind word.