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
Climate
Comment
Sustainability
5 min read

What “drill baby drill” really means for the world’s poor

Climate jargon pales in comparison to hard, hot and harsh realities.

Jane Cacouris is a writer and consultant working in international development on environment, poverty and livelihood issues.

forest tree-tops break a mist.
Forest in Cameroon.
Edouard Tamba on Unsplash.

“Drill, baby, drill,” declared Donald Trump during his inauguration speech in January to roars of Republican approval, going on to sign executive orders to “unleash” the American oil and gas industry to do just that: drill. This, even though the United States is already the largest crude oil producer of any other nation, according to its own Energy Information Administration, and has been for the past six years in a row. 

Fossil fuel combustion is undeniably the largest source of greenhouse gas emissions worldwide says the IPCC, with oil accounting for about 34 per cent of global CO2 emissions from fossil fuels. And World Economic Forum statistics show that the lowest income countries produce only one-tenth of emissions but are the most heavily impacted by climate change.  

Something doesn’t seem very fair here.  

Many of us are aware of the statistics and policies and rhetoric around climate change. It is all buzzing around in the background of our lives, in the news, on social media and in opinion pieces like this one. But if we’re honest, it is all still theory for most of us living in the Global North.  

On a recent work assignment, involving research in remote communities in Southern Cameroon, I found the true extent of climate crisis is hard hitting and very real. According to the IMF, Cameroon is ranked 16th in the world in terms of countries most vulnerable to the impacts of climate change, partly due to its geographical location. 

High levels of rural poverty and the country’s economic dependence on agriculture, which employs over 70 per cent of the population adds to this climate vulnerability. But the government statistics and climate jargon, worrying as it is, paled as I discovered the reality of rural Cameroonians’ lives. Lives that depend almost solely on the productivity of the land, and therefore on the weather. Lives that have no Plan B when the climate is unpredictable.  

The communities we studied live in rural villages many kilometres from any urban centre, and rely entirely on natural resources for their livelihoods. They depend on traditional rain-fed agriculture, hunting for bush meat, and collecting non-timber forest products such as tropical fruits, insects, medicinal plants, herbs and honey from the dense forests near their dwellings to survive.  

The effects of the changing climate have been felt by them for some time. During periods of water scarcity, which is becoming more unpredictable and prolonged, local streams dry up, meaning crop yields fail, such as corn, groundnuts and cassava, and families go hungry. Fishing yields dwindle. The work burden for women rises, as they have to travel further to collect water for drinking, washing and cooking. Poor roads with inaccessible tracks during heavy rain events, or non-existent roads, prevent communities from accessing markets, health care and external support, making them isolated and more vulnerable to climate impacts. 

With the science predicting rising future temperatures and higher seasonal variability in their region, these communities will only become more vulnerable, mirroring the story of millions of other people around the world. They must adapt to survive. The alternative is not surviving. Devastatingly, this is a very possible future outcome.  

I’d say the UK is standing on the side lines in the playground, looking on.  

Why should wealthy, powerful nations mostly responsible for global carbon emissions, not only refuse to compensate those at the receiving end of resulting climate change, but actively seek to cause more damage? It echoes of a bully in a school playground, inflicting suffering on a smaller child, gaining in popularity, power and self-confidence as a few egg them on, others stand by, whilst the receiver of the abuse summons all their remaining strength simply to survive and make it through another day.  

So where does the United Kingdom stand in the playground?  

In terms of domestic climate policy, the UK must meet net zero by 2050, in line with the target set out in UK legislation, i.e. in twenty-five years from now, total greenhouse gas (GHG) territorial emissions must be equal to the emissions removed from the atmosphere. On paper, it seems the UK is on track to achieve this. GHG emissions have halved since 1990, driven by investing in renewable power and phasing out coal in the electricity sector. However, as WWF and others have pointed out, this figure has a glaring omission. Products including clothing, processed foods and electronics imported into the UK are counted as the “manufacturing country’s emissions,” not the UK’s. This is known as “offshoring.” And according to WWF, between 1990 and 2016, emissions within the UK’s borders reduced by 41 per cent, but the consumption-based carbon footprint only declined by 15 per cent, mainly due to goods and services coming from abroad.  

In terms of climate finance for the world’s poorest nations, the UK pledged to spend £11.6 billion between 2021 and 2026, and the government recently said it remains committed to meet this pledge. However, the pot from which this climate finance must come, the UK’s overseas aid budget, was slashed in recent months from 0.5 per cent to 0.3 per cent of national income to prioritise defence spending. Meanwhile, climate experts and charities are warning that what the world needs now is stronger global solidarity in the face of the climate crisis, rather than national self-interest. I’d say the UK is standing on the side lines in the playground, looking on.   

Trump professes to be a practicing Christian… I wonder what would Jesus have to say about the way America and other wealthy nations have dealt with the climate crisis? One of Jesus’ most well-known and powerful teachings was to love your neighbour. The parable of the Good Samaritan in the Bible demonstrates the way we should treat our neighbours; acting with love, compassion and mercy, not only towards those we know or who live in our friendship network, community or country, but towards every human being, regardless of nationality, background or social group. In the context of climate change, Christians are called to love our global neighbours. This includes supporting the world’s poorest communities to thrive, speaking up on their behalf, demonstrating love through political and social action. Jesus certainly doesn’t teach us to put ourselves “first.”  

Imagine a world where every nation signed up to Jesus’ teaching on how to treat our neighbours. Would climate change abruptly halt, human suffering stop and global peace prevail? In truth, probably not, because humanity is imperfect and we get things wrong even when we mean well. But if the intention was there, and if world leaders looked to Jesus’ lead on this, there is little doubt we would be many steps closer.  

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