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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Education

15 May 2023

5 min read

Why the RE teacher recruitment crisis is a problem

In the week that over a quarter of a million young people sit their GCSE Religious Studies exam, Paul Smalley analyses the crisis in religious education -demand for which is rising.

Paul Smalley

Paul Smalley is a Senior Lecturer in Religious Education at Edge Hill University and a Local Missional Leader in the Diocese of Liverpool.

Credit: Get Teaching

I could have laughed at Nick Gibb, the Minister of State for Education recently – but unfortunately, I don’t think he was trying to be funny. What caused my outburst of hilarity was a written answer he had given to a parliamentary question. The question had been asked by Catherine West, a shadow minister, and was enquiring about what steps the government was taking to ensure that recruitment targets for religious education teachers are met. As the daughter of a headmaster and a practising Quaker, it seems reasonable that she might take an interest in such matters; she is clearly aware of the recruitment crisis that is threatening the teaching of the subject in schools up and down the country. This awareness seemed to be lacking in the Minister of State’s response.

The first part of his answer was to report that the number of teachers remains high. And of course, he is correct – the number of Full Time Equivalent Teachers in England has remained fairly steady at around half a million for the last few years. What he didn’t mention is that there are over a quarter of a million more pupils now than there were five years ago. The pupil to teacher ratios in secondary schools has risen each year since 2013. Every teacher needs to teach more pupils. Last year the recruitment target for teachers was missed by some way and will be only slightly better this year.

Gibb’s answer was designed to suggest that there was no problem, nothing to worry about – when in fact there is a crisis.

But the question was about RE teachers specifically. And again, Nick Gibb chose his answer carefully, choosing the one year (2020/21) in the last ten when the recruitment target for RE teachers was exceeded – the year that the target was substantially reduced. In 2022/23 the recruitment target was missed by 25 per cent. On average between 10 and 12 per cent of RE teachers who train leave the profession within five years of training. This is higher than the average across all subjects.

Gibb’s answer was designed to suggest that there was no problem, nothing to worry about – when in fact there is a crisis. Teacher recruitment for all subjects is down 22 per cent from last year. However, RE stands out, being down a third of applicants from the last recruitment cycle.

Students often describe it as the one time in school where they can think independently about the people, events and beliefs in the world around them.

Why does it matter if there aren’t enough RE teachers?

Religious Education is the only subject which every state school must provide for all of its pupils. It has been this way since 1944 – but the subject has changed beyond recognition in that time.

It is a popular and increasingly important subject for our young people to study. Over the last five years entries to the GCSE have stood at around an average of 250,000 with entries to the full course GCSE rising by 30 per cent over the last decade. It is a subject which helps young people navigate the complex and dynamic nature of our multi religious, multi secular world. It has never been more important, recognised by wider society as vital for preparing students for life in global Britain.

Students often describe it as the one time in school where they can think independently about the people, events and beliefs in the world around them. It is a space where ultimate questions are discussed. Big questions such as: ‘Why do people suffer?’, ‘Is death the end?’, and ‘How should we behave in the world?’. In an increasingly secular world, young people need a space where they can explore these questions, gain insight into how Christians, members of other faiths and non-religious people respond to these issues and develop their own understanding of their place in the universe.

I wouldn’t go as far as some in saying that RE is an opportunity to de-indoctrinate young people against a prevailing secularising agenda, but RE is a curricular space where pupils can come to realise, that whatever their own personal background, someone’s belief or worldview, shapes and influences how they engage with and interpret the world around them. For some people these beliefs are fundamental; there is no place of neutrality on such matters – nobody stands nowhere. Pete Greig reminds us (in the book How to Pray: A Simple Guide for Normal People) that even those who state that they are not religious will often pray: there is a spiritual side to life, even if people fail to explicitly recognise it. If children are growing up in non-religious households, school may be the only place where spiritual matters are discussed openly and objectively.

High school pupils are now three times more likely to be taught RE by someone with no qualification in the subject than, for example, in history.

Teaching young people is a demanding job, and as someone who has been training people to teach RE in high schools since 2006, I know that teaching RE demands a particular skill-set. RE is multi-disciplinary, so it requires a teacher who understands how to think like a theologian, and a historian, a philosopher and a social scientist. It requires academic skills such as ethnography and literary analysis, but also the people skills to act impartially, empathetically and sensitively when discussing important and controversial issues. And all that on top of the skills required of any teacher – to manage behaviour, plan lessons and monitor progress for example.

However, such is the level of crisis that all too often RE is being taught by non-specialists, simply because there are not enough trained RE teachers. High school pupils are now three times more likely to be taught RE by someone with no qualification in the subject than, for example, in history. Of those who teach RE in secondary schools over half spend most of their time teaching another subject (compared to only 13 per cent of those who teach English and 27 per cent of those who teach Geography). These same pressures contribute to many schools’ RE provision simply not being good enough.

What can be done?

The first step for the government to take is to acknowledge that there is a problem – with teacher recruitment across the board. The teaching profession as a whole needs a boost – to show that teaching is an attractive career. Significant workload reductions and pay increases will help this perception.

But there is a specific problem with RE recruitment. Postgraduate teacher training attracts a bursary to teach Geography of £25,000. RE trainees receive no bursary. I have heard of well qualified humanities or social science graduates who have chosen Geography over RE simply because of this. In years when there has been a bursary available to train as an RE teacher, then recruitment has risen significantly.

But what might really make a difference is a properly funded National Plan for RE to ensure it is properly resourced and taught by professionally trained teachers.

For more information about becoming an RE teacher or supporting the campaign, visit: Teacher Recruitment - Culham St Gabriel's (cstg.org.uk)