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.

Review

Comment

Culture

Death & life

14 August 2023

5 min read

'Do you guys ever think about dying...?' - Barbie

Pat Allerton reflects on the Barbie movie, the societal questions that it answers and the existential question that it doesn't.

Pat Allerton

Pat is vicar of St Peter’s Notting Hill and author of A Pocketful of Hope.

Margot Robbie as Barbie in Greta Gerwig's Box-Office smash hit movie

So I’ve just got home from watching the brand new and much acclaimed ‘Barbie’ at the cinema (don’t worry, I also watched ‘Oppenheimer’ last week). It’s 11pm, my wife and our 8.5 month old daughter are asleep upstairs and despite having church in the morning, I feel stirred to write some thoughts.

First and foremost, huge congratulations to Margot Robbie, Ryan Gosling, the whole cast, crew and team. It’s an absolute belter! Full of laughs from beginning to end. I thoroughly enjoyed myself and would encourage anyone else to go and see it.

But secondly, far from being the shallow, plastic cliché that you might expect, what you actually get is an intelligent, searing critique, albeit somehow gently done, of the world we live in and what’s predominantly wrong with it. Which is, you guessed it, men. Or more specifically, patriarchy.

The film begins in ‘Barbieland’ where everything is seemingly perfect, as encapsulated by Barbie when she describes the day we first meet her as, ‘the best day ever. So was yesterday, and so is tomorrow, and every day from now until forever.’ That is, until we meet Ken (played by the excellent Gosling). It is here that the first inkling of imperfection or wrinkle in their world is detected. As the narrator (voiced by Dame Helen Mirren) makes clear, ‘Barbie has a great day every day, but Ken only has a great day if Barbie looks at him.’ (We’ve all been there guys). His niggling insecurity and consequent competitiveness towards other Kens however, still aren’t enough to wake Barbie from her dream-like state and reveal that all is not well in paradise.

Issues of equality, respect, independence and identity are addressed in a way that left this 'pale, stale male' challenged but not condemned.

That moment arrives unexpectedly, during what appears to be a standard evening with ‘a giant blowout party with all the Barbies, and planned choreography and a bespoke song’ to which Ken is told he should ‘stop by’. The dance is breathtaking, the happiness palpable, and yet suddenly, as if from nowhere, Barbie blurts out the pivotal line in the film, the hinge on which the whole (Barbie) world turns, ‘do you guys ever think about dying?’ Cue the DJ’s vinyl record screeching to a halt, the choreography closing down, the dancers looking at her in disbelief, and the general sense of a serious buzz-kill. ‘Dying to dance’, she disingenuously adds, desperate to keep the party going, to shrieks of relieved delight and Dua-Lipa's return. Disaster averted, reality restored.

Except it’s not, it’s simply avoided. Avoided by everyone that is, bar Barbie. Something has changed for her, she knows it, and she must somehow find out why. That wrinkle in her world (along with the wrinkle on her thigh) turns out to be caused by a tear in the fabric separating her plastic world from the real one.

Long-story short, avoiding spoilers where I can, Barbie and Ken then embark on an eye-opening, perspective-shattering, journey from their world to the real world in order to find out where such unnerving questions (and cellulite) were coming from. Major issues with (or norms within) our world are encountered, from the objectification of women (Barbie receives immediate unwanted attention from all kinds of men), to the totally unmerited respect of any man (with someone even asking Ken if he had ‘the time’). They each go on an existential journey of discovery, with Ken delighted to learn that in the real world, men rule the roost (except for a brief time when he thought that horses did). Inspired with fresh vision, he quickly returns home in order to make some fundamental changes to and establish much of the best practice that he’s witnessed in patriarchal L.A.

I won’t say how things end up, but suffice it to say, issues of equality, respect, independence and identity are addressed in a way that left this ‘pale, stale male’ feeling both challenged but not condemned. Kudos to the team for getting that balance right! However, as big and important as these issues are, and as satisfying an ending as was reached from a social justice warrior’s point-of-view, it struck me that the biggest elephant of all was still left there in the room, or at least charging around on the beach. Because the very question that began her journey, the deepest one that woke her up, is the very one that’s just left hanging, unaddressed and ungrappled with.

The music stops and that is it. And yet don't our hearts long for more?

It’s almost as if that moment of existential angst on the dancefloor (and who hasn’t had one of them), realising the fragility of our own mortality, did nothing more than focus Barbie on the need to lay hold of everything she can in this life, rather than exploring the reality (or not) of the next. Our culture has a word for it. YOLO, if you didn’t know, standing for ‘you only live once’. Which of course is true, whether you’ve got faith or not. But the Christian worldview would go further, saying that whilst indeed you only live once, the Scriptures tell us that you also live forever (or YALF, to coin a phrase). Which sounds ridiculous on the face of it (the concept, not the phrase, although granted, YALF might not catch on). After all, as the creator of Barbie, Ruth Handler, tells us in the film, ‘ideas live forever, humans not so much.’

Unless, of course, they do, or can, which only our creator could possibly make possible. And so Ruth’s appearance raises another interesting question, if she made Barbie, who made Ruth? Only when we’re dealing with questions of this nature can we be positioned to take on the big mama (I was tempted to say ‘daddy’) question of, ‘do you guys ever think about dying?’ Which, of course, every one of us does. You can’t be human and avoid doing so. You’d have to be a doll in a made-up world.

But it’s a frightening thing to do, whether in Barbieland, in England’s green and pleasant land or anywhere for that matter. Because it all just looks so final. Like the music stops and that is it. And yet don’t our hearts long for there to be more? For one more song, for the beat to continue? Dare we hope for resurrection where life and light beat death and darkness? Because as beautiful as this life is, with all its opportunity for growth and freedom, be it in self-revelation and actualisation like Ken (the film ends with him wearing a hoodie that says, ‘I am Kenough’), or greater progress and equality on a socio-political level, experience tells us that until we have an answer for Barbie’s first and biggest question, then our own days here on earth, however good, happy and choreographed, will always be rudely interrupted by the reality of death and its long shadow. Find an answer for that... and let the DJ’s music play.