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 These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who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
Books
Comment
Film & TV
Morality
6 min read

Murder we wrote: how cosy crime and psycho-thrillers carve our minds

Our reactions have changed from heart-wringing cries to merely puzzle-solving

Theodore is author of the historical fiction series The Wanderer Chronicles.

Elderly amateur sleuth stand by their pinboard.
The Thursday Murder Club convenes.
Netflix.

We love murder. 

That seems to be the only reasonable conclusion when you look at the sales figures of Richard Osman’s record-busting murder mystery series, which opened with The Thursday Murder Club back in 2020. In UK sales alone, it sold over a million copies within the same year as its release, something no other book has ever done.  

This was more than a bestselling debut novel, this was a cultural event in UK publishing. And no doubt Netflix are hoping for something equally seismic when their film adaptation of The Thursday Murder Club goes live. 

The combination of light humour, a clutch of charismatic octogenarians, tea and cake, and the odd violent death or two to keep them entertained, seems to have struck the motherlode of British cultural appeal. I can only imagine the stellar cast they have assembled for the film adaptation, led by Helen Mirren and Pierce Brosnan, will take the series’ success to new heights. 

As an author currently puzzling my way through my own contemporary murder mystery, I can only look on at the phenomenon in wonder and sigh for what may yet be.  

But murder has always been a tricky one for me as a) an author, and b) a Christian. Do those two facts mean I have to be a “Christian author”? And if so, what kind of limits does that put around what I should be writing about? It may not sound like much of a conundrum to you, but honestly I have wrestled with this question for a long time. There is darkness in the world: how much darkness should I explore in my books? (So far, if you ever read any of my historical novels, you’ll see the answer is: quite a lot.) 

Maybe I’m taking it all too seriously and murder is mere light entertainment now. Death is to be enjoyed with a nice cup of tea; evil, with slice of Victoria sponge cake. 

But somehow, I don’t think so. 

Recently, I was helped in my moral quandary by another crime author, Andrew Klavan. In his book, The Kingdom of Cain, published last month, Klavan explores the question of evil and specifically murder in what he terms a ‘literature of darkness’. It is a fascinating, if unusual, book. His approach is to take three murders that actually happened, and demonstrate how each has influenced a long succession of murder novels (and movies) up to the present day.  

Through this exposition, we witness the changing attitudes to murder over the last century and a half and in particular how those changes seem strongly linked to the ebbing tide of Christian faith in the West. 

For example, Dostoyevsky’s great novel, Crime and Punishment, was published in 1866. The double-murder, central to the plot, is carried out by a young student named Raskolnikov. He is an intellectual who is seeking to prove that the moral boundary beyond which murder lies is nothing more than a mere concoction, a social construct (or worse, a religious one) which he, being of superior intelligence, can transcend and therefore ignore. The entire novel is the story of how his conscience will not allow him to get away with this. Near the end, he confesses his crime to the young prostitute, Sonya, who responds to his confession in fearful horror: 

“What have you done? What have you done to yourself?” 

The second question is key. 

Dostoyevsky based the plot of his novel on a real axe-murderer, a Frenchman called Pierre François Lacenaire, who went to the guillotine in 1836. Lacenaire became an international sensation when, in court, he aired many of his own pseudo-intellectual justifications for his actions – that the murders he committed were a strike against the injustice of the elites and the iniquitous power structures of the day. Rather than what they appeared to be: a grubby little double murder for the sake of a few francs. Lacenaire set the tune which many still whistle today, I’m sorry to say. 

But Dostoyevsky was prophetic. He foresaw long before Nietzsche and others who would follow, that the tide of Christian faith was going out in Western civilization. And so it continued to do through the back end of the twentieth century and into this one. 

Before that, the notion that murder is wrong because every human being is made in the image of God was a long-held axiom, going back arguably to the first chapters of Genesis. And in killing the image of God, any image of God, this may therefore be the closest we can come to killing God himself. Seen in that light, murder is sacrilege on an appalling scale.  

But there’s the rub. That light has dimmed. The secular philosophies of the nineteenth and twentieth centuries have turned down the dimmer-switch, so that it is no longer axiomatic that humans possess an inherent sacred value. Instead, in varying guises and to varying degrees, the conclusion has been that humans are nothing but self-conscious lumps of meat. We (the state, the law) may ascribe them some value. “We are all equal,” yes - but as George Orwell anticipated, “some are more equal than others.” (Is intersectionality, for example, anything but the manifestation of that prediction?) 

Maybe this explains how the horror of murder has diminished from Sonya’s heart-wringing cry, into something more akin to a crossword puzzle. Don’t get me wrong, I love a good Agatha Christie. But her murder mysteries don’t waste much time on the philosophical implications of, say, the local doctor bumping off the parish priest. 

And from there, the genre of the murder mystery has split into two strains. On the one hand, we get the psycho-thriller, in which the horror of the act of murder is of less interest than the dark psychological state of mind of the killer themselves. But if that’s too dark, don’t worry. We can do light, too! And so on to cosy crime blockbusters, in which, if a murder was committed, it was because the victim had it coming – so let’s all calm down and have another slice of cake. 

There is no space here in which to explore how, as a culture, our collective historical experience may have helped to steer us in this direction, as well as our changing philosophy. But there is no doubt where we have ended up. We see death cults all around us. We see legislation being passed in our Parliament which would have been unthinkable until very recently. We see social justice where before we saw crimes.  

Think about how often the arch-crimes of history have been perpetrated on the ground of viewing the “other” as less than human, and certainly less than sacred. Then ask yourself, why should we see any human as more than a lump of meat? At what point does the rubber hit the road? - as surely it will. 

What have we done? What have we done to ourselves? 

I do wonder where all this goes. And yet, if the spiritual bellwethers are to be believed, perhaps we have reached low tide at long last – certainly it has revealed some pretty ugly creatures lurking at the bottom of the rock pool. Many, myself included, must hope that the tide of faith is truly on the turn. Let’s see. Certainly, if this proves to be the case, it seems to follow that our attitude to murder will change with that on-rushing tide. And so with it, the literature of darkness. 

Beyond The Thursday Murder Club, there may yet be other great stories told of murder; they, like Crime & Punishment, will be far truer, and in a paradoxical sense, far more beautiful. After all, at the heart of the gospel, there lies a murder. If God himself can take such a dark event and turn it into light, then, at a far inferior level perhaps, as His image-bearers, so might we. 

Which reminds me… back to my draft.

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