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 These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who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
Gaza
Israel
Middle East
Old Testament
Trauma
War & peace
10 min read

Two years on: the tragedy and the trauma of Gaza

As the anniversary of 7th October comes round again, an ancient story helps shed a new light on this conflict

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

Split-screen on TC shows many different news channels in English, Arabic and Hebrew.
Split-screen reporting.
Al Jazeera.

It is now two years since Hamas' vicious attack on Israeli citizens at the Nova music festival. Two years later, much of Gaza lies in ruins, nearly 70,000 of its people have died, and Israel continues its campaign to rid itself once and for all of Hamas, a hostile neighbour. The spectre of antisemitism has raised its ugly head again on the streets of Manchester. Meanwhile, the world waits to see if the Trump peace plan has a chance of working. 

The world is also deeply divided on the question of who is to blame here. Is it, as the Israelis say, firmly Hamas’ fault, the result of a fanatical Islamist group, sponsored by Iran, determined to extend militant Muslim control over the Middle East in general and Israel in particular? Or, as the pro-Palestinian crowds chant, are we watching a genocide which is the inevitable outcome of Israel’s ongoing occupation of the West Bank and Gaza? Everyone is pushed to decide. As a child of a friend asked his mum the other day: “Which side are we on?” 

Yet what if we try to see this conflict in a different light - not so much in terms of blame but pain?

Echoes of the past

Of course, this is not the first time there has been war between the people of Israel and their enemies on the coastline of Gaza.

The book of Judges in the Bible recounts a series of confrontations around 3,400 years ago between the Israelites and the Philistines, who harassed and taunted the Hebrew tribes as they struggled to establish themselves in the land of Canaan (NB - the Philistines are not the ethnic ancestors of modern Palestinians, despite the similarity in name. The Romans. partly to annoy the Jews, simply decided to change the name of the region from Judaea to Palestina.)

One of those ancient stories tells of Samson, an immensely strong Israelite warrior, who kills numerous Philistines in a spree of violence lasting several years. Samson eventually marries a Philistine woman, Delilah, who betrays him into the hands of his enemies. He is captured, and his eyes are gouged out. In a final act of violence, he brings down the roof of the Philistine Temple at the height of a religious feast, killing both himself and more of his enemies than he killed in his lifetime.

The story is both a tragedy and a trauma. John Milton’s great verse drama Samson Agonistes, written around 1650, presents Samson as a tragic figure, gifted and heroic, a hero of Israel brought low into his Gazan prison by a fatal character flaw of pride and lust, betrayed by his cunning wife, and in his famous phrase, ‘eyeless in Gaza at the mill with slaves, Himself in bonds under Philistian yoke’. The tragedy ends in his final act of destruction of both himself and his enemies.

Yet besides a tragedy, this is also trauma. The roots of the trauma lie deeply hidden in the history between Israel and the various tribes that surround them. Samson is one of many dragged into a history of tit-for-tat violence which ends in this scene of death and devastation. In the story of the Bible, he is caught up in the long history of human wrongdoing – as both victim and perpetrator - that stretches right back to Adam and Eve in the garden. The result is Samson and his enemies all lying dead in the rubble of a demolished building in the heart of Gaza.

In this one small strip of land today we find two peoples living out the trauma of what has happened to them in the past. And without a new approach, the result will be the same – destruction and devastation.  

On many trips to Israel/Palestine over the past 35 years, as I listened to Palestinians and Israelis look at the same issue with such different eyes, this conflict often struck me as both a tragedy and a trauma. That sounds bleak. Yet this perspective can, despite its apparent gloom, bring a glimmer of hope.

Tragedy and trauma don’t avoid the question of blame, but they don’t start there. They start with a posture of empathy. Tragedy makes us pause before making moral judgments and instead, simply to notice and enter into the sadness, the grief of it all. When we watch the final scenes of Hamlet or Macbeth, or even the Samson story, we are simply left in silence. We don’t rush to judgment, but simply acknowledge the heart-breaking sorrow experienced by the ordinary people caught up in this. Tragedy sits with the grief and darkness, and does not reach immediately to blame, realising that real life is usually more complex and the causes of conflict more opaque.

At the same time, understanding this as trauma forces us to enter into the pain underlying the conflict. Samson is born into traumatic times with his people under attack, and ends up living out the trauma he has experienced by brutal revenge on his enemies. In a similar way, in this one small strip of land today we find two peoples living out the trauma of what has happened to them in the past. And without a new approach, the result will be the same – destruction and devastation. 

The Jewish people of today, especially in Israel, remain deeply traumatised by the history of anti-Semitism which climaxed in the Holocaust of the 1930s and 40s. A determined attempt by a sophisticated, modern European nation to systematically exterminate every single one of the Jewish race is not just a historical event but one whose ripples or perhaps better, stormy waves, reach us today. Alongside this there is the expulsion of Jews during the C20th from Muslim countries such as Syria, Iraq, Yemen, Algeria, Tunisia and Libya. For those of us who are not Jewish it is hard to imagine the impact of such a reality, not just as a fact of history but as a real danger in the future. After all, if it happened once, it could happen again. It explains why Israel has always paid scant attention to international opinion and resolutions of the UN for a ceasefire, such as the one recently called for. As the Jewish writer Daniel Finkelstein put it:

“The origin of the state of Israel is not religion or nationalism, it is the experience of oppression and murder, the fear of total annihilation and the bitter conclusion that world opinion could not be relied upon to protect the Jews. So, when Israel is urged to respect world opinion and put its faith in the international community the point is rather being missed. The very idea of Israel is a rejection of this option. Israel only exists because Jews do not feel safe as the wards of world opinion. Zionism, that word that is so abused, so reviled, is founded on a determination that, at the end of the day, somehow the Jews will defend themselves and their fellow Jews from destruction. If world opinion was enough, there would be no Israel.”

So, with such a trauma behind them, it is not surprising that when a Muslim kills Jews in a British synagogue, when rockets rain down on Israeli towns, or Hamas militants swagger through kibbutzim, shooting people just because they are Jews, it triggers exactly the memory of the trauma that they have been through as a people. What Palestinians think of as resistance to an occupation of their land, is experienced by Israelis as an echo of the desire to exterminate the entire Jewish people, in a way that sends a shiver down the spine for anyone who has lived this story.

Just like Samson and his enemies. An eye for an eye leads both to end up eyeless in Gaza.

Yet the Palestinian people also have a trauma of their own. In 1948, at the time of the creation of the State of Israel, hundreds of thousands of Palestinians were made homeless and stateless, deprived of their homes and their land, often at gunpoint, and many killed by Zionist fighters. The Arab nations did little to help, only interested in their own interests. The European nations stood by. America continue to fund Israel so that their army vastly outweighs any other army in the region, and certainly enough to crush the stones, knives and bombs of various intifadas. Their deep sense of injustice also leaves a scar, one that can continue to be used by groups like Hamas for their own purposes.

And so today when Gazans watch their cities pummelled to dust, when Palestinians are made to queue at checkpoints simply to travel from one place to another,  when land is taken through the building of a security wall, and Israeli settlements continue to get permits to build on Arab land, while it is much harder for Palestinians to get planning permission to build a new home, all this triggers the memory of what Palestinians call the Nakhba or the disaster. What Israelis see as legitimate self-defence, security measures to keep terrorists at bay and to keep their people safe, is experienced by Palestinians as an echo of their own past trauma of dispossession.

The result is that both sides end up caught yet again in a cycle of violence, just like Samson and his enemies. An eye for an eye leads both to end up eyeless in Gaza.

Yet this approach perhaps places upon us who look on, the responsibility to try to enter into the pain of the other side.

Now of course, we can argue about which trauma is the greater. We can debate the merits of each moral case, or where real blame lies. But trauma doesn't work like that. Trauma sits within the mind and the body, and spreads, overwhelming any ability to cope normally and react with a sense of proportion and balance. The effects of trauma are not deliberate or logical but involuntary. Reactions to trauma are notoriously complex and differ according to individuals. Trauma stays with individuals for years and with communities for generations.

Understanding this conflict not so much as through the lens of blame but of pain may help us understand this conflict differently. Of course, it doesn't avoid the question of blame, because terrible things have been done here. It also doesn’t deny Israel’s right to defend itself against Hamas’s attack with legitimate force. Most of us tend to lean towards one side or the other of the conflict. Yet this approach perhaps places upon us who look on, the responsibility to try to enter into the pain of the other side. And when the dust of battle settles, it perhaps promises a better way to cut the cycle of violence in the future.

Understanding this conflict as both tragedy and trauma helps us see it in a new light. And perhaps it gives us the glimmer of a hope of a way forward. The memory never goes away, but trauma victims can find ways to approach the memory of what happened to them in different ways.

The story of Samson ends with destruction and his burial in the family tomb. It ends in death. Within the long story of the Bible, however, the chaotic period of the Judges is superseded by the monarchy – the kings of Israel, the best of whom is King David – a ruler with flaws, but described as ‘a man after God’s own heart’. Beyond that, the story of David points to a later ruler also born in Bethlehem, whose rule meant not hating and killing his enemies, but loving them to the point of dying for them, thus, finally, bringing peace. It is that kind of Jesus-shaped, self-sacrificial, radical, counterintuitive leadership on both sides that can show a way out of the cycle of violence and hatred that was there in the period of Samson, and is there today.

Only leaders who are not concerned with doing whatever it takes to stay in power, nor willing to sacrifice others for their own purposes, who don’t care about personal reputation, but are willing to take the risky path of reconciliation, as I have argued elsewhere on Seen and Unseen - only this kind of leadership can lead us beyond the tragedy and trauma of the past into a more hopeful future.

The last word might come from Audeh Rantisi, a Palestinian evicted from his home in Lydda in 1948. He went on to become an Anglican priest and an activist for reconciliation between Jews and Arabs and the need for both to recognise the scars and humanity of the other:

I still bear the emotional scars of the Zionist invasion. Yet, as an adult, I see what I did not fully understand then: that the Jews are also human beings, themselves driven by fear, victims of history's worst outrages, rabidly, sometimes almost mindlessly searching for security.

Four years after our flight from Lydda I dedicated my life to the service of Jesus Christ. Like me and my fellow refugees, Jesus had lived in adverse circumstances, often with only a stone for a pillow. As with his fellow Jews two thousand years ago and the Palestinians today, an outside power controlled his homeland - my homeland. They tortured and killed him in Jerusalem, only ten miles from Ramallah, and my new home. He was the victim of terrible indignities. Nevertheless, Jesus prayed on behalf of those who engineered his death, "Father, forgive them..."

Can I do less?

 

This article is an updated version of one first published on 7 November 2023