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. 

Article
Comment
Community
Middle East
Migration
6 min read

Letter from Istanbul: how many neighbours is it possible to love?

It’s easy to feel overwhelmed by the sheer mass of humanity in Turkey

Becky is a a writer living in Istanbul.

An Istanbul street curves and the sun illuminates one side
An Istanbul street.
Drew McKechnie on Unsplash.

 

Living in the megalopolis that is Istanbul in Türkiye, as the country is now calls itself*, is both wonderful and utterly overstimulating. As the sun dawns earlier in the summer months, I often ponder on what woke me up as I sip my morning coffee. Was it the Call to Prayer from our neighbourhood mosque; the caterwauling cats; fighting crows; howling dogs or squawking seagulls?

Istanbul (formerly known as Constantinople) is where East meets West, and home to up to 20 million people. It's the only city in the world to straddle both Asia and Europe, separated by the narrow Bosphorus sea, which you can cross by ferry in 20 minutes. 

Known in the Bible as 'Asia Minor,' Türkiye boasts a wealth of Christian history and numerous religious sites, including the breathtakingly preserved ancient city of Ephesus.

Once the largest Christian cathedral in the world, the Hagia Sophia in Istanbul’s historic quarter Sultanahmet attracts millions of tourists to its grand Byzantine architecture every year, as both a mosque and a museum. 

Istanbul's gastronomy is among the best in the world. The food, paired with the melting pot of history, faith, and culture, also makes for the warmest sense of hospitality in the world to visitors and newcomers that you could ever imagine. It is a stark contrast to what I was used to in the UK. 

Turkish hospitality is about way more than tulip-shaped glasses of tea and aubergine köfte kebabs; in Turkish culture, a guest is honoured, making them feel as if they belong. From the drawn out etiquette of home visits to literal fights breaking out when it's time to pay the bill, in Türkiye, a guest is seen as a 'gift from God.'

Speaking of hospitality, Türkiye's official population is indeed an estimate due to the constant stream of refugees that pour into the country and settle in Istanbul, hoping to build new, better lives for themselves.

It is a hugely built-up city, with each skyscraper competing for height and a Bosphorus sea view; here and there, you can spy small little houses called gecekondus (which means 'put up at night'). These are the (illegal) homes of newcomers. 

Türkiye is, on the whole, proud of its migration history (and its 2016 agreement with the UN). Of course, it's a country in a prime position to grant refuge to displaced people in neighbouring nations and as a transit country for people trying to emigrate west, and is home to the world's largest refugee population (3.2 million Syrians and up to 222,000 other nationalities). The latest refugees to seek sanctuary in the four thousand year old city are more Iranians. I enjoy friendships with Turkish, Persian, and Syrian friends in my faith community. 

Of course, attitudes vary regarding the many 'neighbours' who make their home in Istanbul. There are complaints that 'enough is enough.' There is a 'Türkiye first' rhetoric that permeates the Caffe Nero I sometimes work in.  (Eye-rolling and body language speak louder than words when the barista is short with a burka-wearing, stroller-pushing mum speaking Arabic. 

And I do get it. 'Istanbul is overcrowded' is a massive understatement. You can't even begin to compare it to the UK immigration rhetoric. 

Behind most discrimination is fear, and secular locals worry that so many refugees in Türkiye could lead to a different religious landscape one day.

I, too, am a guest here in Türkiye, and I am grateful I've been able to make it my home. I'm reminded that every person is worthy of love and respect no matter where they are from. 

Of course world events significantly impact attitudes towards refugees in Istanbul. Sadly, it's a fact that events around the world can shape people's discourse regarding certain people groups. I find it hard to switch off from what's going on around the world, and since Israel bombed Iran last two weeks ago, I've been glued to the news. 

My hairdresser is an Iranian girl who has a residence permit due to her husband's job in hospitality. I asked her how she was doing. She said she's scared for her mum and sister, who are in a city that's being bombed, and she wants to bring them to Türkiye. She said the scariest thing about it all is that all flights are grounded right now, and the internet is inconsistent; they feel utterly helpless. All I can do is hug her and tell her all life is precious to God, and that I am praying for peace.

A week later, I woke up to the news that the USA had struck Iran, with the intention of destroying three of its nuclear facilities. The world waits and watches with bated breath to see what will happen next.

I don’t have the answers for overcrowding or immigration policies, but when I reflect on 'who is my neighbour' I know it is whoever I find standing in front me.

 

Many in Istanbul do ask 'who is my neighbour? It is a question that has been asked for millenia, most famously by Jesus.

Jesus replied with a powerful story that would have pushed the buttons of all those gathered around on issues of race, religion, and hospitality, which became one of his most famous parables. In 'The Good Samaritan,' a traveller and a Jew are brutally attacked and robbed when he's walking from Jerusalem to Jericho. Beaten, bloody, and left for dead on the side of the road, a priest passes by, but instead of helping, he ignores the man and continues his journey.

Next, a Levite who also worked in the Jewish temple comes along the road, crosses to the other side, and walks away.

Finally, a man from Samaria (sworn enemies of the Jews) passes along the road, sees the injured man, and stops. He stops, tends to his wounds, puts the man on his donkey, and takes him to an inn to recover, covering all the expenses from his pocket.

You can imagine the sound of a pin dropping when Jesus asks which of these three was a neighbor to the man attacked by robbers: 'The expert in the law replied, 'The one who had mercy on him.' Jesus told him, ‘Go and do likewise.’

The message is simple- our 'neighbours' are all the people we come across. It's those different from us and even those with whom our ethnicity and national history demand we make enemies. 

As a white woman with a British passport, I am privileged. I can return to the UK when I choose. People don’t wince if they hear me speak English in Caffe Nero. As a resident in Istanbul, I navigate the attitudes and ever-shifting narratives towards immigration in Türkiye by prayer. 

I want to hold space for my Turkish friends who feel scared and frustrated.

I want to be a voice of peace to my friend who sends me a video of missiles heading for Iran over the border from Hatay, Türkiye. 

Living in Türkiye as a woman of faith has changed me, and I can't help but think that if we all adopted the Turkish philosophy of hospitality, which views all guests as gifts from God, deserving to feel like they belong, the world could be a different place.

I don’t have the answers for overcrowding or immigration policies, but when I reflect on 'who is my neighbour' I know it is whoever I find standing in front me, no matter where they come from. I ask for the strength to 'love my neighbor as myself' no matter the country on their ID card (or despite their lack of one). And when I feel overwhelmed by the sheer number of precious human lives arriving in Türkiye every day, I remember that each of them is also a neighbour - and my job is to care for the one in front of me.


* Türkiye is the new spelling of the country’s name. Find out more