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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25 September 2023

4 min read

The challenge of filling your blank page or keeping it empty

The start of a sabbatical sets Ian Hamlin thinking through the tension between contemplation and action.

Ian Hamlin

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

A notebook is open at two blank pages. a pen rests across the page.s.

Photo by Mike Tinnion on Unsplash

The famed anxiety inducing nemesis of any writer or creative, the ever-daunting blank page. Well, I’ve bought myself a new notebook, so I have a literal open page in front of me, but also something more.

I’m starting a three-month sabbatical from my role as a Baptist minister. Stepping down from my day-to-day responsibilities of work, but also, to a degree, away from the basic structures that define my life; the people, purpose and rhythm of, not only what I do, but who I am. It’s a weird sort of job like that.

What would you do with three months off? From work, family commitments, whatever it is that defines your day to day ordinarily? Well, buy a notebook, obviously, but after that?

I’m conscious, of course, that this is a rare privilege, a consequence, I guess, of the strange link between a professionalised clergy and academia from days past, but also, a recognition of the all-encompassing nature of the role. Maybe, because of that, it’s also a real challenge, a true ‘blank page’.

The first instinct, I guess, is to take a break, to stop, to breathe. That’s undeniably good, but how long for? Is that it? At what point does stopping and breathing become lazy indulgence? I’ve been reading quite a lot lately, perhaps subconsciously preparing for these months, about taking time out, resting, slowing down. Often, these thoughts have been expressed as an exploration of the notion of ‘Sabbath’ that Judeo-Christian notion of keeping a period of time, a day a week, special, sacred even. This, of course, is the route from which ‘sabbaticals’ have grown, not so much the ivory towers and quadrangles after all, but more the Hebrew prophets and itinerant Jewish preachers of ancient days, seeking to find the rhythms of a fulfilled life There’s John Mark Comer’s ubiquitous The Ruthless Elimination of Hurry, which seems to have touched a cultural nerve, but also Ruth Haley Barton’s Invitation to Solitude and Silence. Then, out of the blue, I was invited to reflect again on Walter Brueggemann’s sense of Sabbath as:

‘the refusal to let one’s life be defined by production and consumption, and the endless pursuit of private well-being’.

He also observed that, recognizing just how we, like multiple generations before us, each in their own way, are utterly enmeshed in systems and structures designed, not so much for our well-being but rather the benefit of others,

‘the departure into restfulness is both urgent and difficult, for our motors are set to run at brick-making speed.’

(A reference to one of those earliest structures, highlighted in the Bible, where Egypt’s Pharaoh had Hebrew slaves building ever larger structures, to assuage their growing thoughts of freedom.)

Most recently of all, I’ve been struck, by following Pete Grieg’s pilgrimage walk from Iona to Lindisfarne, and the passing comment that the original Celtic monks, in making the same journey, eschewed the offer of horses to ride, preferring to walk, fearing that the increased pace of travel might cause them to miss something.

I’m sure I’ve missed lots, I’m convinced I’m caught up in a whole range of hectic, consumerist structures, and I’m often tired, so rest, gets a big tick from me. At least I think it does, but barely do I sit down, and I’m feeling restless again. How long can/should I keep this up? There are so many things to do, opportunities to explore, people to please. I need to justify this privilege of time and space.

His speaking, his marching, his campaigning and protesting, even his sitting, was driven with a passion and an urgency that was infectious, and effective.

And then there’s that ever-present sense within me, my natural instinct if you will, true, I’m sure, of many. That I like the idea of contemplation, the need for it even, but, actually, I’m more driven by activism, by getting stuff done. The focal point of my whole break, planned for quite a while now, is a trip to the USA to follow the life of one of my spiritual heroes, Rev. Dr. Martin Luther King. Now, there’s an activist if ever there was one. His speaking, his marching, his campaigning and protesting, even his sitting, was driven with a passion and an urgency that was infectious, and effective. His consistent rage against injustice has been a call to arms, both to his immediate contemporaries, and generations subsequently, to get up, go out and do. Ultimately, of course, he poured out his whole life in the cause. It’s taking me an age to read a few preparatory biographies of him, stimulated as I am from every page, challenged to act, to never let injustice rule while I have voice and agency.

So, there we have it, another paradox, in the complicated business of being the person I’m meant to be, realizing the best of God’s investment in me. The conflict between rest and exploration, being and doing, contemplation and activism. I imagine we are all drawn to a certain place on that spectrum.

Blank pages, freed up days and diaries, only serve to underline what we already are. But, I suspect, we can all also hear the call to either end of the range; to be stirred to action by the things that break the heart of God, and to lay down our burdens, take upon ourselves the easier yoke, and live increasingly in ‘the unforced rhythms of grace’. Maybe, to start with at least, listening to that call, recognizing the tension, while not allowing it to create pressure in us, is enough. Hearing, praying, scribbling my first, semi coherent, thoughts on that vast empty page, making myself another coffee, and wondering what I might do next.