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.

Article

Care

Change

Mental Health

6 June 2023

4 min read

Social prescribing for whole person care

Responding to an anxiety epidemic, there’s a growth in social prescribing with a spiritual wellbeing element. Esther Platt explores how it's working out locally.

Esther Platt

Esther works as a Senior Consultant for the Good Faith Partnership. She sits in the secretariat for the ChurchWorks Commission.

Two people sit at a table with their hands resting on top of it. One speaks to the other

Photo by Christina @ wocintechchat.com on Unsplash

Since 2001, Mental Health Awareness Week has been marked once a year in May. This year, the theme was anxiety - an increasingly relevant topic in a country that has endured three years of world-changing crises and the soaring cost of living. Research from the Mental Health Foundation has found that 1 in 10 UK adults feel hopeless about financial circumstances and more than one-third feel anxious.

For centuries, it has been recognised that spiritual well-being is closely tied to mental well-being. By spiritual wellbeing, I don’t mean organised religion. I mean our sense of relationship to a higher-power or reality beyond our own, and our sense of purpose and meaning in life, as Craig Ellison outlines it as in his paper Spiritual Well-Being: Conceptualization and Measurement.

In Man’s Search for Meaning holocaust survivor Victor Frankl compellingly makes the case that in a world of suffering, our survival depends on our sense of purpose, meaning and hope. Frankl coined the term ‘the self-transcendence of human existence’ by which he explained that human beings look for meaning beyond themselves, either in a cause, a person to love, or a higher power.

With an increased understanding of the holistic nature of wellbeing, and the value of spirituality, a new way of looking at health is emerging.

While modern psychologists are still building a clinical-grade evidence base on the value of spirituality, there is clear agreement that spiritual wellbeing is crucial for a good quality of life, especially for those who are facing adverse life events, as you can read on the US National Library of Medicine web site. Traditionally, health provision in the UK has focused exclusively on the physical, and more recently the mental. However, with an increased understanding of the holistic nature of wellbeing, and the value of spirituality, a new way of looking at health is emerging.

Social prescribing is one way in which this is being done, and across the country.

In social prescribing, local agencies such as charities, social care and health services refer people to a social prescribing link worker. Social prescribing link workers give people time, focusing on ‘what matters to me?’ to coproduce a simple personalised care and support plan. This involves ‘prescribing’ individuals to local community groups such as walking clubs, art classes, gardening groups and many other activities.

Churches are playing a crucial role making social prescribing happen. St Mary’s Church in Andover, offer a wellbeing course to members of the community who have been directed to them through the local GP surgery.

Members of Revival Fires Church in Dudley have been trained to offer Listening and Guidance support to those who are referred by a GP.

Beyond social prescribing, St John’s Hoxton in London offer the Sanctuary Mental Health course to their community which gives people an opportunity to share their experiences and find solidarity in their struggles.

Church provides a space where the breadth of our wellbeing, our desire for purpose, community and hope can be supported in a way that the NHS does not have capacity or experience to deliver. As the Archbishop of Canterbury, Justin Welby, writes

"The issue of mental health is one that requires a holistic approach on an individual basis, incorporating as appropriate psychiatric, medical and religious support’.

Olivia Amartey, Executive Director for Elim, an international movement of Pentecostal churches adds,

‘I am convinced that there is no other organisation on earth that cares for the whole person, as well as the church. Its engagement with the statutory authorities, focussed on individuals’ well-being, provides an invaluable opportunity for a synchronised partnership to the benefit of all our communities.’

Jesus told his followers, ‘I have come so that you can have life and have it to the full’. This is the hope that animates churches. Christians find meaning and purpose in the hope of life, peace and justice that Jesus gives. Church can be a space where the complexity of hurt and suffering is acknowledged, and where we can find solidarity and support in the presence of those who can help us find purpose and meaning.

At ChurchWorks, a commission of leaders from the 15 biggest church denominations in the UK, we are excited by the prospect of more churches providing this space. On 18th May we held ChurchWorks for Wellbeing, in which we gathered over 300 church leaders to explore how the church can bring hope to our communities in this time. We shared stories of small and simple conversations, where offering a listening service, an art class or a food pantry enabled churches to give people in their community space to be, to grieve, to process and to grow. From the conference, it is our hope that we will see hundreds more churches start to engage in social prescribing and welcome their communities to access holistic wellbeing support.

At a time when anxiety is rife, and it is so easy to feel despair and hopelessness, the church offers a vital resource to us: a place where our spiritual wellbeing can be nurtured, where we can find purpose, where we can find community, where we can find hope.