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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Justice

30 August 2023

5 min read

Facing up to justice

The crimes and sentencing of baby-murderer Lucy Letby is driving fresh conversations about justice. Edward Smyth examines the confusion and contradictions within them.

Edward Smyth

A writer and speaker in the field of criminal justice and faith, Edward Smyth is now pursuing doctoral research on the 'through-the-gate' experiences of individuals who have found faith while in prison.

Lucy Letby's Police file photograph.

Cheshire Constabulary.

‘Christians need to be ready for the inevitable moment when Lucy Letby declares that she’s found Jesus in prison.’

So read one of many tens of thousands of tweets posted on the day Letby was sentenced to spend the rest of her natural life behind bars. I probably saw several hundred of those tweets that day; yet this one has lingered, niggling away at me whenever my mind is drawn back to a consideration of the appalling facts of a case that surely takes its place amongst the worst ever to have been prosecuted in this country.

One of the things about the Letby trial which has caused the most consternation has been her refusal to appear in court for some of the verdicts, and for her sentencing hearing. The strength and volume of the response to what is being almost universally termed her ‘cowardice’ has some challenging things to say about what contemporary society means – or thinks it means – when it talks of ‘justice’. And, as I write, the Government’s response has been to force criminals to appear. An interrogation of these responses might just help us all begin to be able to think through where this leaves us, too.

The sense seems to be that in refusing to enter the dock at Manchester Crown Court for her sentencing, Letby has somehow evaded what we might term her ‘just deserts’; and that her victims and their families – and indeed society – have been cheated out of some of the justice to which they feel entitled. If the act of receiving the sentence is viewed as itself part of the punishment (not an assumption by which I am wholly persuaded, but one which sits at the heart of this argument) then the outrage caused by Letby’s avoidance of her sentencing speaks to a certain weighting of the importance of that one morning in court as against the next forty or even fifty years Letby will spend in prison. What this boils down to, then, is retribution pure and simple. We think offenders should be made to listen to the impact of their offending because we want them to feel all the things that we believe they deserve: guilt, shame and pain. We want this because of some innate, deep-rooted sense of balance and fairness which dictates that an appropriate response to the imposition of pain is, in turn, the imposition of pain.

Our legal system exists, in part, to ensure that this remains proportionate: the state censures offenders to avoid the inevitable disproportionate vigilante or retaliatory action which would otherwise ensue, exercising what some criminologists refer to as its ‘displacement function’. Prisons, of course, are out of sight and usually out of mind which perhaps explains the importance of the sentencing hearing in cases like this: it is the only opportunity we have to see the convicted person suffer – and we need to see it with our own eyes to make sure that, even if we think ‘prison is too good’ (i.e. insufficiently painful), we have at least seen the convicted person suffer some pain.

Letby may have avoided being deluged by the waters of justice rolling down upon her ... in the dock, but we should be in no doubt that those waters are rising from the floor of her prison cell as we speak.

For Christians, though, the elephant in the room is that Letby has been sentenced to a ‘whole life order’. In passing that sentence the state is saying ‘we have no interest in your rehabilitation’; and that is something which should give all pause for thought especially Christians. I do not think there is a ‘correct Christian response’ to this issue, as it happens: personally, I would rather we didn’t have whole life orders, but equally I have no objection to someone spending the rest of their life in prison if that is the only safe course of action. If we were designing a Christian system of criminal justice, then whole life orders would be indefensible on the grounds that we have no right to make impossible redemption; but we’re not designing – or operating under – a Christian system of criminal justice; and redemption in the theological sense is still possible in prison. I struggle – particularly in light of cases like this one – to get too worked up about it.

But perhaps that’s the point. Perhaps the fact that my own theology opposes whole life orders but, when exposed to the facts of a case like Letby’s, I find it difficult to care very much is exactly the kind of confusion and contradiction of which I spoke at the outset of this article. And in that confusion and contradiction perhaps we find what it is to be a Christian, our instinctive and culturally conditioned human responses coming up against the teaching of the ultimate countercultural being and, so often, overwhelming it in our hearts.

Those hearts ache for the victims of Lucy Letby and their families. Have they received justice? She will spend the rest of her life in prison: I think they have. Is that justice compromised because she did not appear for her sentencing? I think it is not, on both secular and Christian grounds. Secularly speaking the state has performed its ‘displacement function’ and the punishment is being carried out whether she was there to hear it or not. The victims have – for better or worse – been removed from the conversation, which is why criminal cases are listed as ‘The King v. ...’ rather than ‘[Victims’ names] v … .’ Theologically speaking Letby may have avoided being deluged by the waters of justice rolling down upon her (as Justice is described in the Bible) in the dock, but we should be in no doubt that those waters are rising from the floor of her prison cell as we speak, and she will be soaked through soon enough.

The case of Lucy Letby – as with any case of great evil – is a violent challenge. For the Christian, it is one which can only be met with prayer, thought, and introspection. In short: they must pray their way to their own response. But whilst they are doing that as Christians in an increasingly secular world; a world where the responses that they know their faith obliges them to make are so quickly and easily monstered – I can only hope that they and we find in our Church an institution willing to preach that countercultural, unpopular Gospel.

'Modern man often anxiously wonders about the solution to the terrible tensions which have built up in the world and which entangle humanity. And if at times he lacks the courage to utter the word “mercy”, or if in his conscience empty of religious content he does not find the equivalent, so much greater is the need for the Church to utter this word, not only in her own name but also in the name of all the men and women of our time.'
Pope John Paul II