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 These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who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
Ethics
Politics
War & peace
5 min read

We must invest in defence, fast - it’s the only moral thing to do

The responsible use of force today precludes pacifism

Emerson Csorba works in deep tech, following experience in geopolitics and energy.

Amid a bombed alley, a victim is helped to walk by a rescue worker
Aftermath of a Russian drone attack, Odesa, Ukraine.
Dsns.gov.ua, CC BY 4.0, via Wikimedia Commons.

In May 2016, I was hiking the Southwest Coast Path in a group, trudging through dense forest between Lyme Regis and Weymouth, when a distinctly unsettling event occurred. As we moved along a narrow trail, a buzzing sound began—we assumed we had disturbed a bee’s nest. We quickened my pace, but the buzzing continued. Eventually, we emerged from the woods and looked up. The sound had not come from bees, but from a drone that had been following us.

I will never forget that sound; the eerie sense of something pursuing you, but unseen. In a recent BBC special on the war in Ukraine, a journalist documents the now-pervasive use of drones, the journalist and Ukrainian soldiers hiding under the cover of forest as a Russian drone scans the area, before escaping to their car in which an AI voice says ‘Detection: multiple drones, multiple pilots, high signal strength’ as they journey overground. This is the new era of covert warfare, where the enemy strikes without being easily identified. You hear the hum, but the source is elusive.

In the coming years, this kind of psychological warfare will make its way into Western cities. Terrorist attacks will shift from in-person confrontations—like the Novichok poisonings in Salisbury—towards remote, anonymous assaults: drones drifting from overseas into coastal cities to target civilians, or swarms carrying out mass attacks in dense downtown cores. The aim will be psychological trauma at scale. Civilians will grow hesitant to leave home, hyper-sensitive to the buzz of anonymous drones in their own areas. Iran recently declared that no US, British, or French base is safe from retaliation in the emerging Israel–Iran war. It is not difficult to imagine Western cities soon being viewed as legitimate targets.

We are entering a time of intensified conflict, with national security becoming the dominant framework for policymaking. The watchword of UK government policy is ‘security,’ and—writing now from Montréal—the recent Canadian election was framed around which party and leader could best protect Canadians from external threat. In this context, even domains once governed by cooperation are transformed into zero-sum contests, because national security framing by its nature shifts focus from reciprocity to limitation of the other. 

Free trade, for example - fundamentally the mutually beneficial exchange of goods and services as part of the creation of value - becomes, in a security-focused world, a question of containment. Trade, in a security-focused world, is turned on its head, free trade becoming trade wars. Fairness (in which the pie is grown and shared across multiple people) is replaced by interest, whether the interest of countries or communities and individuals within them seeking to protect themselves. As US–China competition escalates, we can expect human relations—among both states and citizens—to become even more zero-sum. 

In such an environment, do morals still matter? When the enemy grows more ruthless and more innovative in an era of national security, must we match them in kind? Or is it still possible to uphold principles while defending ourselves?

Restraint and humility are still critical virtues—but must not be mistaken for weakness.

In a recent Times column, Juliet Samuel suggested that gestures of non-aggression—such as Finland’s 2015 destruction of its one million landmine stockpile—now appear dangerously naïve. Ukraine, for its part, has rightly disregarded the Ottawa and Oslo (banning cluster munitions) conventions. Its survival depends on ingenuity, rapid technological development (for instance through the work of funds such as D3), and collaboration with its allies to prototype and deploy advanced systems.

Reinhold Niebuhr, in Moral Man and Immoral Society, contends that to be moral, one must possess the capacity for force—‘power must be challenged by power.’ That power, however, must be exercised with responsibility, humility, and moral purpose. Nigel Biggar, my former doctoral supervisor and a key figure in the Niebuhr tradition of Christian realism, argues in In Defence of War that war can be justified on balance when it meets the criteria of jus ad bellum: just cause, legitimate authority, right intention, proportionality, and reasonable prospect of success. 

War, in this reading, can express a ‘kind harshness’—a form of judgment exercised in defence of victims. Like Niebuhr, Biggar grounds his argument in Augustinian realism: the world is fundamentally good, yet broken. Because evil persists, the moral use of force becomes necessary to uphold what is right. I believe this to be true, and directly applicable to the national security-focused world in which we find ourselves. 

What does this mean then for Western countries as national security reasserts itself as the central organising principle of governance?

It means significant and urgent investment in defence and deep technology, including for instance emerging capabilities like cognitive warfare and neuroadaptive systems (wearables that enhance soldiers’ performance in live combat), counter-drone systems for urban, rural, and maritime environments, and next-generation electronic warfare and geospatial intelligence.

If drone attacks intensify at sea—such as those carried out by the Houthis to disrupt global shipping routes—counter-drone systems will be vital to ensure safe passage. In a world of manipulated narratives and disinformation, geospatial intelligence will serve as a source of truth, helping establish what is actually happening on the ground. And as agentic AI grows increasingly capable of manipulating users—through sycophancy, persuasion, and other techniques—oversight technologies like Yoshua Bengio’s new LawZero project will be essential for maintaining objectivity and integrity.

The responsible use of force today precludes pacifism, averting violence altogether. It means maintaining—and advancing—the capability for overwhelming force, so it is ready if needed. Morality in an era of national security demands investment in defence technologies at speed, to stay several steps ahead of adversaries. A ‘whole-of-society’ approach, as recommended in the recent UK Strategic Defence Review, means preparing citizens with such a mindset. Restraint and humility are still critical virtues—but must not be mistaken for weakness. Western nations must be prepared to act swiftly, decisively, and with the deterrent power that peace requires.

This is the world we are entering: one in which governments and civilians alike must be ready for unexpected threats. The hum of a drone overhead is more than a sound—it is instead a warning, reminding not only Ukrainians but those currently in peaceful situations, to prepare ourselves for potential conflicts to come. The appropriate response is not retreat, but the responsible and moral exercise of power: a necessary duty if we are to preserve peace, freedom, and justice in a world increasingly intent on contesting them.

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