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.

Article

Comment

Race

30 November 2023

5 min read

How reconciliation underpins acts of reparation

The case for reparations is criticised for looking too much to the past. Anthony Reddie argues that the ancient roots of reconciliation are vital for today’s debate.

Anthony Reddie

Anthony Reddie is Professor of Black Theology at the University of Oxford, and Director of the Oxford Centre for Religion and Culture.

A diagram plan of a slave ship showing hundreds of body outlines.

Diagram of the ship ‘Brookes’ from Regulated slave trade: reprinted from the evidence of Robert Stokes. (London, 1849)

Lambeth Palace Library.

Reconciliation is the key theological motif that runs through the scriptures and across Christian Tradition - Reconciliation between God and humankind, reconciliation between human beings across the cultural, social, political, ethnic and economic divide, reconciliation between our warring selves within us.

Paul’s writings form the earliest documented texts in the New Testament canon. His writings are full of references to God’s reconciling work in Christ on the cross. This theme, however, needs to be read in terms of Jewish thought. This will correct the over-spiritualising of this in Christian practice.

To make sense of the notion of reconciliation one also must understand the Jewish antecedents that inform Paul’s writing, given Paul himself was a Jewish man. In the Hebrew scriptures and in Jewish thought, atonement and salvation are collective and corporate concepts. This is very different to much of what constitutes post-Reformation Evangelical Protestantism where the emphasis is on individual salvation in Christ, by grace, through faith.

The Hebrew Bible traditions of the Sabbath and Jubilee were moments for system re-set and dismantling inequalities which had accrued.

Essentially, being in right-standing with God necessitated that one should be in right relationships with others. In fact, one could argue that it appears to be the case that one cannot be in a right relationship with God unless you were doing right by the other. The above can be seen in the Old Testament book of Leviticus. The early verses of its sixth chapter clearly state the notion of restorative justice for that which was wrongly taken and used, which is described as a “sin against God”.

One can also see this concept or formula evident within the book of Deuteronomy 15:12–18. The key is verse 12 which states:

“If any of you buy Israelites as slaves, you must set free after six years. And don’t just tell them they are free to leave – give them sheep and goats and a supply of grain and wine.”

As Peter Cruchley’s work on the Zacchaeus Tax campaign has shown, the Hebrew Bible traditions of the Sabbath and Jubilee were moments for system re-set and dismantling inequalities which had accrued. They were moments of breaking the cycling, ongoing basis of debt and economic enslavement. It’s worth reminding ourselves that not one penny has been given to any of the descendants of enslaved Africans for the wrong done to them and yet Christian communities in the West still want to talk about redemption that is affirmed by their Judeo-Christian roots!

Understanding the scriptures in their historical context enables Christians to discern a theological pattern for using money and other resources for enacting restorative justice. Modern interpretive theories on how we read biblical texts take full account of the fact that the New Testament was written within the context of the Roman Empire, where the Emperor claimed divine honours which faithful Jews could not affirm. Today’s reader must recognise that the context in which ALL of the New Testament canon was composed was one that echoed to the restrictive strains of colonialism and cries for justice against oppression. Judea, in which Jesus’ ministry was largely located, was an occupied colony of the Roman Empire.

Contemporary scholars have shown that in the Jewish tradition, issues of reconciliation, redemption and salvation have a corporate ad a collective dimension to them as well as an individualistic one.

Scholars such William R. Hertzog II have shown the extent to which wealth in the Roman Province of Palestine was always connected with economic exploitation. So, when Jesus challenges the ‘Rich Young Ruler’ to follow him, he says this in knowledge that the young man’s accumulation of wealth was not amassed in a neutral context. The reason why this encounter is so compact is because both the Rich Young Ruler and those first hearers knew the expectation of how he should behave.

The Three Cs (commerce, civilisation and Christianity) were the underlying rationale on which the British Empire was based. The Three Cs were coined by David Livingstone (a London Missionary Society ‘Old Boy’) in Oxford in 1857. The exporting of Christianity via the European missionary agencies in the eighteen and nineteenth centuries was largely undertaken under the aegis of empire and colonialism. Christian mission, therefore, has had a difficult relationship with non-White bodies or the ‘subaltern’ for centuries as they are the ‘other’ and have been exploited for economic gain. There was no ethic of equality between missionaries and the ‘natives’.

One can see that Jesus’ teachings around wealth and its relationship to discipleship and living the “Jesus way” has political and economic implications. Scholars such as Musa W. Dube, Catherine Keller, Michael Nausner and Mayra Rivera, have all shown the similarities between first-century Palestine, the slave epoch of the sixteenth to eighteenthcenturies, the eras of colonialism and our present globalized, postcolonial context. Each context is based upon imperialistic/colonial expansion, capital accumulation, forced labour and exploitation of the poor by the rich.

Pharaohs on Both Sides of the Blood-Red Waters is the title of a 2017 book by the famed anti-apartheid activist and scholar Allan Boesak, who reflects on the contemporary ‘Black Lives Matter Movement’ largely in the US and post-Apartheid South Africa. In this context he speaks of the corporate reality of ‘Cheap Grace’ as outlined by the famous German theologian Dietrich Bonhoeffer. The West has attempted transformation WITHOUT sacrifice or restorative justice. Bonhoeffer chided Western Christians for wanting to have discipleship without radical commitment to God’s word, and forgiveness and redemption without struggle and sacrifice. Boesak reminds us that there is no redemption without the cross. Reconciliation must cost us something!

Due to the influence of post-Reformation Evangelicalism, we have largely interpreted Jesus’ words in a purely individualistic way. Contemporary scholars have shown that in the Jewish tradition, issues of reconciliation, redemption and salvation have a corporate and a collective dimension to them as well as an individualistic one.

I believe that institutions like the Church of England can set a prophetic lead to other Christian institutions, and beyond it, to other civic bodies and indeed governments. ‘Cheap Grace’ NEVER leads to redemption and reconciliation. Without restorative justice there is no reconciliation, and the mission of Christ is diminished.