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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Nationalism

3 August 2023

5 min read

Beyond wealth and wellbeing: how nations flourish

As GDP data is increasingly scrutinised, Ryan Gilfeather asks how to measure the true health and wealth of a nation.

Ryan Gilfeather

Ryan Gilfeather explores social issues through the lens of philosophy, theology, and history. He is a Research Associate at the Joseph Centre for Dignified Work.

Two women sit behind a press conference desk against a backdrop, one listens as the other speaks and gestures.

A recent International Monetary Fund press conference on the world economic outlook.

IMF.

Discussions of GDP loom large in our current age. As we live under the shadow of the threat of a recession in the UK, ministers and commentators anxiously follow our country’s Gross Domestic Product, to see whether we are on the right track. Measuring the total value of goods and services produced in a country, this figure is a litmus test for the health of an economy. Crucially, many policymakers and leaders in government believe this figure reveals the health of a nation.

As we will see, not all agree. Opponents rightly highlight that an increase in GDP does not necessarily mean that ordinary citizens live better lives. There are good reasons to share this opposition from a Christian perspective. However, ultimately, the Christian tradition highlights a very different way to measure the health of a society.

In 2020 The Carnegie UK Trust, a think tank campaigning for greater welfare for all, published a new measure for social progress: GDWe (Gross Domestic Wellbeing). In brief, they gathered and processed ONS (Office for National Statistics) data on a variety of domains in life, giving them a single figure on a 10-point scale to rate well-being. These domains included personal well-being, relationships, health, vocational activities, living environments, personal finances, the economy, education and skills, governance, and the environment. When they plotted GDP against GDWe from 2013-9, they revealed that the two do not always line up. As GDP steadily increased from 2016, overall welfare in society dipped. From 2013-9 GDP increased by 10.34 per cent and GDWe only 5.19 per cent. Hence, measuring GDP does not necessarily reveal whether life is getting better for ordinary.

Economic resources are not useless... However, they are not sufficient unto themselves for us to live full and good lives.

This attempt to shift the conversation about social progress from predominantly centring GDP is commendable. The Bible does not legislate on whether to use GDP or GDWe. However, scriptures within it repeatedly decouple economic wealth from flourishing. For example, in the gospel of Matthew, Jesus says the following:

Do not store up for yourselves treasures on earth, where moth and rust consume and where thieves break in and steal, but store up for yourselves treasures in heaven, where neither moth nor rust consumes and where thieves do not break in and steal. For where your treasure is, there your heart will be also.

In life, we can either focus our efforts on attaining wealth or fostering our relationship with God. Only the latter will lead us to flourish. Economic resources are not useless; they are necessary for us to thrive in certain conditions. However, they are not sufficient unto themselves for us to live full and good lives. Furthermore, when wealth becomes the focus of our hearts and minds, our lives will be hollow and fractured. GDWe is a good measure, insofar as it acknowledges that economic flourishing is not the same as a good quality of life, and it attempts to shed light on the latter. However, the Christian tradition highlights a different framework altogether to grasp the health of a society.

Gregory of Nyssa, a fourth-century theologian and bishop, frames wellbeing as a human being reflecting the image of God to the greatest of their ability. The book of Genesis says that God made us all in His image. Gregory argues that this means that we can become like God in certain ways. God is the fullness of all good things, such as love, justice, peace, joy, and courage. Consequently, Gregory argues that when we act in good ways, we begin to share those characteristics, which in turn leads us to act well in the future. For example, if I defend someone who is under attack, I will become more courageous, and more likely to repeat the same action in the future. The more we reflect the image of God, by acting well and taking on His characteristics, the more we will flourish as individuals. In this vision of human flourishing, Gregory brings together an Aristotelian account of virtue, with a Christian understanding of people as the image of God.

This framework for the well-being of an individual also provides a good barometer for the health of a society. All of these actions and characteristics are building blocks for a healthy society. So long as we have a good sense of how to act appropriately with love, justice, peace, joy and courage, then our actions will build up our common life together. They benefit all, rather than one. They are not zero-sum actions. Accordingly, a society made up of individuals who are acting well and reflecting the image of God would be very healthy indeed.

As a measure of a society, we should ask whether it leads citizens away from virtuous actions and characteristics. For example, between 2019 and 2021, gun murders in the USA rose by 45%. Earlier this year, journalist John Burn-Murdoch argued this rise is partly due to decaying public trust in that country. This tells us that a culture marked by fear of others can lead some of its citizens to commit terrible actions and live lives full of violence. GDP may rise during this time, as may other markers of welfare. However, to see the whole picture we need also consider how societal forces are leading citizens away from flourishing in their reflection of the image of God. Then, we should go about addressing these malignant forces.

In times of adversity... individuals in societies marked by high levels of trust are more satisfied with their lives and act more benevolently.

At the same time, we should also consider how a society enables its citizens to reflect the image of God. Societies with high levels of social trust create space for a variety of positive actions and characteristics. The World Happiness Report studies people’s sense of life satisfaction worldwide. It routinely finds that in times of adversity, like the Great Recession in 2008 or the COVID pandemic, individuals in societies marked by high levels of trust are more satisfied with their lives and act more benevolently than others. Again, these social forces are not the same as GDP, yet they have a significant ability to shape the extent to which citizens can reflect the image of God, and thereby flourish.

In my work for the Joseph Centre for Dignified Work, I am particularly concerned with low-wage workers’ pay and conditions. As I have argued elsewhere, low pay leads to some workers needing to take on two or more jobs. They, consequently, have no time to see their children, nourish their faith, or participate in community institutions. It is clear, therefore, that the widespread pattern of paying below the Real Living Wage (£11.94 p/h in London, £10.90 elsewhere), hinders people in their expression of love for God, family and neighbour. Pay and conditions are but one further example, amongst many, of how societal forces can hinder or help our flourishing in the reflection of the image of God.

Needless to say, GDP and GDWe are still useful and necessary tools. However, they do not tell the full story. GDP only describes the progress of the economy as a whole, and GDWe can only describe the quality of an average person’s life. In contrast, when we set a goal that each citizen should reflect the image of God, we can begin to explore how societal forces enable or squeeze out this aim. With this greater knowledge in mind, we can strive for progress in our nation by fostering good structures and stamping out bad ones, so that all may reflect the image of God to the greatest of their ability.