Article
Assisted dying
Comment
Justice
5 min read

Will clinicians and carers objecting to assisted death be treated as nuisances?

The risk and mental cost of forcing someone to act against their conscience.
A tired-looking doctor sits at a desk dealing with paperwork.
Francisco Venâncio on Unsplash.

After a formal introduction to the House of Commons next Wednesday, MP’s will debate a draft Bill to change UK legislation on Assisted Dying. Previously, a draft Bill was introduced in the Scottish Parliament in March 2024, and is currently at committee stage. Meanwhile, in the House of Lords, a Private Member’s Bill was introduced by Lord Falconer in July and currently awaits its second reading. These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who wish to recuse themselves from carrying out a patient’s end of life wishes on grounds of Conscientious Objection.  

There are various reasons why someone might want to conscientiously object. The most commonly cited are faith or religious commitments. This is not to say that all people of faith are against a change in the law – there are some high-profile religious advocates for the legalisation of Assisted Dying, including both Rabbi Dr Jonathan Romain and Lord Carey, the former Archbishop of Canterbury. Even so, there will be many adherents to various faith traditions who find themselves unable to take part in hastening the end of someone’s life because they feel it conflicts with their views on God and what it means to be human. 

However, there are also Conscientious Objectors who are not religious, or not formally so. Some people, perhaps many, simply feel unsure of the rights and wrongs of the matter. The coming debates will no doubt feature discussion of how changing the law for those who are terminally ill in the Netherlands and Canada has to lead to subsequent changes in the law to include those who are not terminally, but instead chronically ill. The widening of the eligibility criteria has reached a point where, in the Netherlands, one in every 20 people now ends their life by euthanasia. This troubling statistic includes many who are neurodivergent, who suffer from depression or are disabled. It is reasonable that, even if a Conscientious Objector does not adhere to a particular religion, they can be allowed to object if they feel uneasy about the social message that Assisted Dying seems to send to vulnerable people.  

“You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances” 

Mehmet Ciftci

  Conscientious Objection clauses can themselves send a social message. A response to the Scottish Bill produced by the Law Society of Scotland notes concern over the wording of the Conscientious Objection clause, as it appears to be more prescriptive in the draft Bill than in previous Acts such as the Abortion Act of 1967. In the case of any legal proceedings that arise from a clinician’s refusal to cooperate, the current wording places the burden of proof onto the Conscientious Objector, stating (at 18.2):  

In any legal proceedings the burden of proof of conscientious objection is to rest on the person claiming to rely on it.  

The Bill provides no indication of what is admissible as ‘proof’. Evidence of membership of a Church, Synagogue, Mosque or similar might be the obvious starting point. But where does that leave those described above, who object on grounds of personal conscience alone? How does one meaningfully evidence an inner sense of unease?  

The wording of the Private Member’s Bill, currently awaiting its second reading in the House of Lords, provides even less clarity, stating only (at 5.0): 

A person is not under any duty (whether by contract or arising from any statutory or other legal requirement) to participate in anything authorised by  this Act to which that person has a conscientious objection. 

Whilst this indicates that there is no duty to participate in assisting someone to end their life, there remains a wider duty of care that healthcare professionals cannot ignore. Thus, a general feature in the interpretation of such conscience clauses in medicine is that that the conscientious objector is under an obligation to refer the case to a professional who does not share the same objection. This can be seen in practice looking at abortion law, where ideas around conscientious objection are more developed and have been tried in the courts. In the case of an abortion, a clinician can refuse to take part in the procedure, but they must still find an alternative clinician who is willing to perform their role, and they must still carry out ancillary care and related administrative tasks.  

Placing such obligations onto clinicians could be seen as diminishing rather than respecting their objection. Dr Mehmet Ciftci, a Researcher at the McDonald Centre for Theology, Ethics and Public Life at the University of Oxford comments:  

You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances who are just preventing the efficient delivery of services. They are forced to refer patients on to those who will perform whatever procedure they are objecting to, which involves a certain cooperation or facilitation with the act. 

This touches everyone, even those who (if the Bill becomes law) will still choose to conscientiously object. Therefore, it is important to consider that the human conscience is a very real phenomenon, which means that facilitating an act that feels morally wrong can give rise to feelings of guilt or shame, even if one has not been a direct participant.  

Psychologists observe that when feelings of guilt are not addressed, if they are treated dismissively or internalised, this can significantly erode self-confidence and increase the likelihood of depressive symptoms. But even before modern psychology could speak to the effects of guilt, biblical writers already had much to say on the painful consequences of living with a troubled conscience. In the Psalms, more than one ancient poet pours out their heart to God, saying that living with guilt has caused their bones to feel weak, or their heart to feel heavy, or their world to feel desolate and lonely.   

If the Conscientious Objection clauses of the new Bill being proposed on Wednesday are not significantly more robust than those in the draft Bills proposed thus far, then perhaps that is something to which we should all conscientiously object? There is much to discuss about the potential rights and wrongs of legalising Assisted Dying, but there is much to discuss about the rights and wrongs of forcing people to act against their consciences too.  

Article
Comment
Community
Sustainability
Wildness
5 min read

What my noisy, messy crow neighbours have taught me about how to live

We can’t control nature; we just need to become more porous to it

Joel Pierce is the administrator of Christ's College, University of Aberdeen. He has recently published his first book.

Crows caw and strut.
Meet the neighbours.
Townsend Walton on Unsplash.

Our neighbours hate our crows. I can’t blame them. The hundreds of crows that occupy the tops of the ancient pines which surround our rural manse are the noisiest and messiest residents I have ever lived near. They greet each sunrise with a din of caws and counter-caws, as if they are deeply concerned that anyone might miss this momentous daily event or the fact that it’s now happening before 5:30a.m. In nesting season, which lasts most of April and May, our car is easily identifiable in any carpark by the crusted grey spots with which the crows see fit to adorn it. Within a week of moving in, we gave up on the washing line so invitingly strung between two of the pines. Our pristine whites were too tempting a target for our crows. 

I do not attend the meetings of our local community council, but I hear whispers of what transpires there. Our crows, evidently, have been a regular topic of conversation. Multiple solutions have been proffered for driving them away. All have been tried and all have failed. Our crows cling fiercely to their homes and their determination is more than a match for any human efforts. If I have the vibe of my community right, at least some of its members feel that there’s something perverse, obscene even, about a flock of birds being allowed to upset our human right to create a serene, comfortable, and convenient habitation. Our clump of houses is surrounded by a visually stunning landscape; shouldn’t the aural landscape be equally beautiful?  

If my family does not mind our crows, it is because the treetop drama is just one more example of many natural encroachments on the house, some more welcome than others.  

Every year we celebrate the miraculous return to our eaves of house martins, home from their intercontinental peregrinations. We look forward to another summer spent watching their acrobatics and listening to their chicks in the nests an arm’s length from our windows.  

Clearing up the mess of our attic’s bats is an annual chore, one thankfully performed stoically by our church’s property convener, but there are compensations - such as the twilight shows they put on outside our living room window, performing impossible turns and reversals midair in their search for prey.  

Less welcome are the massive spiders, which are a perennial presence; the slugs, which seemed to apparate onto the hall carpet all through winter, the mice, two of whom sacrificed themselves to knock our dishwasher out of action by chewing through its hose; and the wasps who built a nest the size of a telephone box in the roof space above our back bathroom.  

Least fun of all has been what we call the Great Earwig Migrations, which have happened twice in our half-decade in the manse and which involve weeks of finding the little bugs under, seemingly, every object and on every surface.  

When we moved into the manse, we expected challenges, the high heating bills, the leaking roof, and the isolation of the countryside. What we did not expect was the experience of porousness; the shock of realising that we had so little control over what other forms of life saw fit to share our habitation with us.  

At first it felt to me perverse, obscene even, that a house, even a 120-year-old house, should be so vulnerable to incursions by animal creation. Shouldn’t our home, our space, be a haven where we can control who or what enters, who or what we feel comfortable with, and who or what we can exclude?  

If I had to give a name to this expectation, maybe it would be that of the buffered home, a play on philosopher Charles Taylor’s description of the modern self as buffered. Taylor contrasts the selves we aspire to be in modernity, ones able to control and order our bodies, our space, our lives, and our relationships so that they accord with our autonomous desires and actions, with those of our premodern ancestors. Medievals and ancients assumed porosity. Bodies were subject not just to biological infection, but spiritual infections too. Projects and plans were frustrated not just by mistakes or personal failings, but by the ever-fickle whims of the goddess Fortuna. Their lives, their bodies, their homes, existed in a perpetual state of vulnerability. The threat of everything falling apart was always on the horizon. 

We want nature to survive, flourish even, but not at the cost of our comforts or our sense of autonomy and security.

Modern technology has helped us tame the more unwelcome of these forces, but it has also given us an overly naive expectation that all that is inconvenient about nature can and should be gradually eliminated. This expectation frames the way we respond to worries about climate change and other creeping environmental crises. We want nature to survive, flourish even, but not at the cost of our comforts or our sense of autonomy and security. But as our ancestors might remind us, we are part of nature too, and, just as in any relationship, mutual vulnerability and sacrifice are needed if we are all going to survive. This is scary, but there are resources within Christianity - within other faiths too - to help us understand that there are benefits to affirming our vulnerability, our porosity. 

My daughters love our crows. They point in wonder as the crows flood into the sky at dusk, hundreds of them making a giant circle once, then twice round the garden, before settling down for the night. When, in late May, grounded fledgings appear, bundles of feathers shocked at the sudden inhospitality of the nest, too stunned to realise they can fly home, my daughters watch over them, anxious lest the local cats take advantage of their bewilderment.  

A few Sundays ago, my youngest, who struggles to stay quiet and well-behaved in Sunday School, pulled me out of church early. We sat on the church lawn staring up at the crows and soon were adapting the andante melodies of that Sunday’s hymns into imagined songs of praise that crows might sing. “No,” my youngest said, simpatico with the crows as she is, “I think they’d want something more upbeat.” And so we tried setting our own corvid-themed praise lyrics to Rosé and Bruno Mars’ song APT, while listening to the caw and counter-caw above. “Dad, how do you think God sees the world?” she asked me when we finished. I stumbled through my best theologically informed explanation of how God could be in every part of creation without being of it, before she stopped me. “I think it’s like a giant snow globe that he holds in his hands.” Watching the birds swirl around us, two stationary figures caught by the same currents of air that were sweeping them aloft, what could I do but agree? 

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