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

America

Comment

24 November 2023

6 min read

The significance of legacy and what it can really stir

Concluding an American journey in the footsteps of his hero, Ian Hamlin ponders how legacy arises.

Ian Hamlin

Ian Hamlin has been the minister of a Baptist church since 1994. He previously worked in financial services.

Martin Luther King reaches from the pulpit of a church while he preaches.

MLK preaching at Riverside Church, New York.

The Gotham Center for New York History.

Travelling around recently, considering the impact of the US Civil Rights Movement as part of my sabbatical trip across four States, I’ve been struck by the immediacy of it. It really doesn’t seem very far away, or long ago. Part of that, of course, is its ongoing resonance, but there are also some personal factors. Martin Luther King was just four days younger than my mother, who’s still alive, and I was born in the week leading up to ‘Bloody Sunday’, and the Selma – Montgomery march. Although not strictly true, this feels like a history of my own time.

That sense has, I think, been amplified by some other recent significant dates. Earlier this summer was the sixtieth anniversary of the ‘I Have a Dream’ speech in Washington, the subway in Atlanta is still awash with anniversary posters. Beyond that, of course, just days later, we remembered a similar six decades since the Klu Klux Klan’s bombing of the 16th Street Baptist Church in Birmingham, Alabama, which killed; Addie Mae Collins, Denise McNair, Carole Robertson and Cynthia Wesley, three 14-year-olds, and one 11-year-old girl. A commemorative service was held in the church, just weeks ago.

History had changed, its arc had indeed bent towards justice. Yet such gestures, profound though they may be, rarely tell the whole story.

Less dramatically, yet still poignantly, 2nd November saw the 40th anniversary of Ronald Reagan signing the bill into law, which created Martin Luther King Day as a national holiday in America, on the 3rd Monday of January each year.

Now very much part of the fabric of national life, the holiday represents, as much as anything, the formal adoption of Dr King as a fully-fledged American hero, part of the great story of the Republic, and the ultimate acceptance of this black man by his country.

Symbols like that matter, such a legacy is significant indeed. It was on Martin Luther King Day 2013, that Barak Obama was inaugurated as President of the United States, for the second time, a black man, who spoke, that day, of a dream fulfilled, as he made his oath of office on King’s bible. History had changed, its arc had indeed bent towards justice. Yet such gestures, profound though they may be, rarely tell the whole story.

Should we be satisfied with the unity that comes from an altogether flatter story, even if it tends towards ‘Disneyfication’, or ought we insist upon messy truth... ?

The holiday wasn’t celebrated until January 1986, Reagan himself wasn’t particularly keen on it, it passed only after something of a battle in Congress where, famously, Senator Jesse Helms led a 16-day filibuster, where he claimed King was a subversive radical, dangerous traitor and communist agitator, And, it wasn’t until 2000 that it was acknowledged in all 50 states.

Such details, if known and remembered, serve to confuse the notion of legacy, to muddy the waters and call into question its real heart. Because the easiest histories are the most straightforward, travelling in a straight line from A to B, from problem to solution, tragedy to victory, despair to hope. They mould into the very fabric of the Nation that the key idea, that the good guys won in the end, like they always do, and the Republic sails inexorably on towards even brighter lights to come.

The question of legacy, when it comes to Dr King, as with many others, is vital for sure, but far more complex than that, and contested too. Should we be satisfied with the unity that comes from an altogether flatter story, even if it tends towards ‘Disneyfication’, or ought we insist upon messy truth, with its inherent conflict and challenge, recalled back then, and still present now?

Martin Luther King was far from a hero at the time of his death, quite the contrary, he was well on his way to becoming a pariah. No longer welcome in the Whitehouse, he had fallen foul of Lyndon Johnson over Vietnam, and his consistent enemies in the FBI now seemed to hold sway there. His relative ‘successes’ with the civil rights act of 1964 and the voting rights act of 1965, genuine and monumental as they were, had only served to demonstrate that a lot of the true causes of segregation, north and south, were less amenable to easy legislative removal, and were actually rooted in economics. As he turned his eye increasingly towards housing in particular and poverty in general, as well as what he called ‘the war question’, he largely lost his platform.

On 4th April 1967, at Riverside Church, New York, he gave what many consider to be his greatest and most eloquent speech ever, but few recall it. Distilling his Christian calling, his civil rights history and sense of present-day necessity, ‘the fierce urgency of now’ as he described it, he began by noting, “surely this is the first time in our nation's history that a significant number of its religious leaders have chosen to move beyond the prophesying of smooth patriotism to the high grounds of a firm dissent …” He went on, after giving a detailed dissection of American history and policy in Asia, to declare that “The war in Vietnam is but a symptom of a far deeper malady within the American spirit.” Before continuing to list out what he called ‘a true revolution of values.’ None of this was designed to win him an appreciative audience in an increasingly materialistic America, and it didn’t. King’s approval ratings, according to polls, were firmly in the negative, and falling. The idea then, that someday soon, the whole nation would come together annually to honour him, was laughable.

Just occasionally though, even in the killing, something is stirred that brings out a legacy more powerful than could ever have been imagined, even more so than national commemorative days.

Of course, death changes things, particularly, premature, violent death. It shocks and inevitably provokes both sympathy, and reassessment. It has us wonder, whether we should’ve listened more carefully, when we had the chance. On this site a few days ago, speaking of the current situation in the Middle East, Graham Tomlin longed for leaders of old who were prepared to break the cycle of violence in the name of peace. My mind turned, inevitably, to Martin Luther King, saying that ‘We will meet your physical force with soul force’. Adding, ‘Do what you will, threaten our children, and we will still love you …we will wear you down by our capacity to suffer, in winning the victory we will not only win our freedom, we will so appeal to your heart and your conscience, that we will win you in the process.”

Such talk rarely, gets you national holidays, named in your honour. It more often gets you killed. Just occasionally though, even in the killing, something is stirred that brings out a legacy more powerful than could ever have been imagined, even more so than national commemorative days.

Legacy speaks of the power of passing on, in the words of Jay Z, turned into a popular pin badge, ‘Rosa sat, so Martin could walk, so Barak could run, so we might fly …’ These cascading consequences of commitment, truthfully sketched out here, and which could’ve gone back further, at least to Maisie Till’s courage in sharing the death of her son, which was said to have inspired Rosa Parks. And, certainly they could also be projected forward. To a multitude of actions, large and small, destined to add to that ongoing legacy of justice. These are, in many instances', the continually ‘rolling waters’ of prophetic imagination that King loved to picture.

In his mind, there is no doubt they find their ultimate source and inspiration in a day set aside to remember, not his though, but Easter Day, when resurrection hope forever shook the world. If, on the 3rd Monday of January each year, some thought might be given to that truth, he could be forgiven a quiet, knowing smile.