Article
Assisted dying
Care
Comment
Death & life
Suffering
5 min read

Why end of life agony is not a good reason to allow death on demand

Assisted dying and the unintended consequences of compassion.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A open hand hold a pill.
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
Comment
Community
Migration
Politics
5 min read

Starmer’s ‘island of strangers’ rhetoric is risky and wrong

The Prime Minister needs an English lesson.

Krish is a social entrepreneur partnering across civil society, faith communities, government and philanthropy. He founded The Sanctuary Foundation.

A prime minister stands next to an Albanian police officer in front of a ferry.
Border control. Starmer in Albania.
X.com/10DowningSt.

In a recent speech launching the UK government’s white paper on immigration, Prime Minister Keir Starmer expressed concern that the country risks becoming an “island of strangers.” It is a compelling phrase - yet, for many, a deeply worrying one. Some argue it echoes Enoch Powell’s notorious 1968 “Rivers of Blood” speech, in which the then Conservative MP for Wolverhampton claimed that people in the UK were being “made strangers in their own country”. Even if the reference was unintentional, the sentiment is divisive and dangerous. Here are five reasons why this narrative must be challenged.  

Geography: We are fundamentally connected  

First and foremost, the United Kingdom is not a single island. To describe it as such is not only geographically inaccurate but symbolically unhelpful and politically careless. This sort of language risks excluding all those UK citizens who live in the other 6,000 islands that make up our country - islands such as the Isle of Wight, Anglesey, the Hebrides, Orkney, Shetland and the Channel Islands, as well as the 2 million UK citizens who live in Northern Ireland. Many of our families, mine included, are testament to the fact that between the British Isles there are connections and marriages. We are islands, plural, united by a national bond of friendship and collaboration, and a shared story of connection across water.  

Sociology: We are intrinsically social  

The notion that the UK is becoming “an island of strangers” contradicts what we know about how human societies function. We are fundamentally relational - forming and building connections in our schools, workplaces, neighbourhoods, shops, and clubs on a daily basis. Even if we do not know the names of those who live across the street, we have a great deal in common. They are not strangers, but neighbours. In times of crisis, as shown during the Covid pandemic, neighbourliness is a critical front-line defence. To undermine that by calling our neighbours ‘strangers’ is a recipe for social breakdown. True social cohesion can never come through exclusion only by being deliberately nurtured through acts of welcome, the language of inclusion and recognition of shared purpose and identity.  

Language: What we say matters 

In his speech, the Prime Minister gave credence to the claim that migrants fail to integrate because they don’t speak English. He said: “when people come to our country, they should also commit to integration, to learning our language.” But English proficiency is not the main barrier to social cohesion. As a country that proudly recognises multiple languages: Welsh, Scottish Gaelic, Irish, Cornish, British Sign Language, we should understand this. And as a nation who fails miserably at learning other world languages we should appreciate the enormous effort it takes to learn any level of English. The vast majority of migrants put us to shame in how quickly and readily they learn to communicate effectively. Might I suggest that the Prime Minister - whose speech contained questionable language that was factually untrue, politically dangerous and socially offensive - might benefit from an English lesson himself? 

Honesty: We benefit from migration 

When the Prime Minister claimed he was launching a strategy to “close the book on a squalid chapter for our politics, our economy, and our country,” he implied that migration is to blame for many of the difficulties the UK is facing. This is not a new tactic — some of the world’s darkest moments have been preceded by politicians stoking fear and resentment against immigrants for political gain. We must resist this rhetoric. Perhaps we could start by asking exactly which migrants are being blamed for this so-called "squalid chapter"? Is it the 200,000 people from Hong Kong who have arrived under the British National Overseas scheme, bringing skills and making major contributions to our economy? Or the 250,000 Ukrainian refugees who have been welcomed with open arms and helped knit communities closer together? Is it the 30,000 Afghans who supported British forces, risking their lives to do so? Or the 750,000 international students contributing £35 billion a year to the UK economy, sustaining our universities and global reputation for outstanding education and research? What about the 265,000 non-British NHS staff who work tirelessly to care for our sick and elderly? Blaming migrants for the UK’s problems is dishonest and dangerously divisive, potentially alienating the very people who are often most invested in making the country stronger, safer, and more successful.  

Integrity: We need to fix the real problem  

The Prime Minister’s use of the phrase “island of strangers” strikes a chord, not because we are all strangers to one another - we are not - but because many of us increasingly feel isolated in our own communities. There is evidence to support this emotional response. According to the Office for National Statistics, around 27% of adults in the UK report feeling lonely always, often, or some of the time. A report titled A Divided Kingdom, published just a day after the government’s immigration white paper, highlights growing intergenerational divides with only 5.5 per cent of children in the UK living near someone aged 65 or older, and just seven per cent of care home residents regularly interacting with anyone under the age of 30. Young adults are increasingly working remotely, reducing opportunities for casual, everyday social contact. Rising numbers of people live alone, and digital technology — while connecting us in some ways — often replaces the richness of face-to-face relationships. 

These shifts are not caused by immigration, and blaming migrants for the disconnections and discontent we feel only distracts us from addressing the real causes of social fragmentation. We need to find ways to reconnect with one another in person, recognising in those around us the image of God, our common humanity and the opportunity for service. 

Starmer’s narrative must be challenged before it becomes a self-fulfilling prophecy. The great English poet and cleric John Donne famously wrote: 

 “No man is an island, entire of itself; every man is a piece of the continent, a part of the main.”  

It would be sad if, in our modern world, we lost sight of that truth and ended up becoming estranged islanders floating on a sea of fear and xenophobia. 

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