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 These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who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

The BBC and the Church of England: two giants, one crisis of trust

Will honourable resignations save the BBC—or anyone?
TIm Davie, sits in an interview in front of screens showing facts about the BBC
Tim Davie, former BBC boss.
BBC.

Sometimes it seems like the BBC is never out of its own headlines. Just as one crisis is finally overcome, another erupts. This year alone we’ve seen outcry over a documentary on Gaza and the Glastonbury fiasco. Now, the broadcaster’s director general Tim Davie and head of news Deborah Turness have resigned over the latest scandal. A leaked internal dossier concluded a Panorama documentary on Donald Trump had misleadingly edited a speech he made on 6 January (it also raised questions over the BBC’s LGBT coverage and its Arabic language service).  

Both Davie and Turness have insisted that the corporation is not biased in its coverage, even if mistakes had been made by its journalists and editors. But both found the pressure too much to bear. Speaking outside the BBC’s London HQ, Turness said:  

“I stepped down over the weekend because the buck stops with me. But I'd like to make one thing very clear, BBC News is not institutionally biased. That's why it's the world's most trusted news provider." 

She was right to identify trust as key. Can we trust the BBC to tell us what is going on in the world fairly and accurately, if it makes mistakes like these? Can we trust the individuals within the broadcaster to report the news impartially, regardless of their personal views? Indeed, can we trust those currently condemning the BBC to be acting in good faith, and not motivated by political hostility or commercial rivalry?  

According to research by the Reuters Institute for the Study of Journalism, the BBC is the most trusted news brand in Britain, with 60 per cent of people saying they have faith in its output. Some of its newspaper antagonists can muster barely a third of that trust score. An Ofcom survey from 2019 found an impressive 83 per cent of viewers of the BBC’s TV news output trusted it to be accurate. 

But trust in the media overall is slipping away in Britain. A decade ago, 51 per cent of people told the Reuters Institute they trusted the news in general; a Brexit referendum, Covid pandemic and ten years of political turmoil later, that figure is just 35 per cent.  

Trust in the BBC is one of its most precious commodities, part of what helps it stand out both in Britain and globally. This is why Davie and Turness decided to fall on their swords, despite nobody suggesting they had personally done much wrong. It has to preserve the trust of its audience at all costs and the price to pay has historically been that when someone messes up, the people at the top resign. We saw the same back in 2012 when the then director general George Entwhistle quit after just 54 days in the role after the BBC got sucked into the Jimmy Savile abuse scandal. In 2004, both the director general and chair of the BBC’s board had to resign in the wake of the suicide of Iraq War whistleblower David Kelly. 

This – the regular spectacle of the ‘honourable’ resignation – is an increasing rarity in other parts of public life. In our post-truth post-shame political environment, it is more common for politicians to brazen out scandal and disgrace, and rarer for their party institutions to insist leaders fall on their swords. We lost count of how many scandals Boris Johnson survived as prime minister before he was finally felled by Partygate in 2022. Across the pond, Donald Trump has effectively rendered himself uncancellable by capturing the Republican Party and much of the US media ecosystem, despite corruption and growing authoritarianism. As the Guardian columnist Marina Hyde put it, “The BBC is the last place anyone still resigns from.”  

And yet. There is an interesting counter-example from another storied British public institution battling to maintain relevance in the 21st century and wracked by scandal and division: the Church of England. Just a year ago it too suffered the ignominy of seeing its leader resign in disgrace. Justin Welby was forced to quit as Archbishop of Canterbury after he was criticised in an official review over John Smyth, one of the most prolific abusers in the church’s history.  

Welby painted his resignation in similar terms: an honourable act of falling on his sword to take responsibility for the institution’s broader failings. In his cloth-eared valedictory speech in the House of Lords, the outgoing Archbishop told his fellow peers that “there comes a time, if you are technically leading a particular institution, when the shame of what has gone wrong, whether one is personally responsible or not, must require a head to roll.” And in this particular case, there was only “one head that rolls well enough”, Welby added; his own.  

But did this supposedly principled act of resignation rebuild trust? Not really. In fact, it may have done the opposite and further damaged the public’s trust in its national church. Welby initially hesitated and refused to resign after the damning Smyth report was first published, only agreeing to go after a weekend of simmering outrage. The vibe was less 'honourable man falling on his sword' and more 'leader convinced they’d done little wrong reluctantly forced out against their will'.  

And yet with the passing of time, his resignation has become mired in regret. Growing numbers of both bishops and others in the church have questioned just how liable he really was for the failure to stop Smyth’s abuse, and how robust the Makin report’s conclusions are. There is an increasing sense Welby was forced out in a rush to find a scapegoat, any scapegoat, to stem the bleeding and show that the church was taking it seriously.  

His successful defenestration has radicalised the more hardline elements of the abuse survivor movement, encouraging them to try to topple their other despised enemies within the church hierarchy. Bishops now fear they will be next on the chopping block, regardless of their culpability; unsurprisingly this does not engender greater trust. In fact, many observers would suggest trust between the bishops and those in the pulpits and pews has never been lower in modern times. The tortured attempt to introduce blessings for gay couples has poisoned the well further, contributing to the system for appointing new bishops to begin to break down. Somehow, both the liberal and the conservative wings of the Church feel equally betrayed by the bishops’ actions during the gay blessings saga.  

Trust is slowly earned, and quick to drain away. Even doing the honourable thing and resigning is no longer a surefire route to restore trust in our public institutions. Just as with Welby, it is likely these BBC resignations will not rebuild confidence in our national broadcaster. Instead, they may well further encourage the right-wing press and demagogues like Trump to scream “fake news” and hector impartial news outlets further. The resignations also tell the ordinary viewer and listener the accusations of bias must be true – otherwise why would these bigwigs have to stand down? 

There are no easy lessons to read across from the Church of England’s battle to regain trust to the BBC. For years now bishops have been urging clergy and lay people to try to trust them once more, to put aside defensiveness and hostility and work together in vulnerable collaboration. And things have mostly only got worse. Trust cannot be willed back into existence, nor will it return through the bloodletting of high-profile ‘honourable’ resignations.  

In fact, there’s a deeper problem which goes much further than the BBC or the Church of England. A deeper crisis of trust in society at large. For 25 years the Edelman Trust Barometer has been measuring societies around the world, and of 28 nations polled last year the UK’s average trust score was rock bottom: just 39 per cent of people on average said they trusted businesses, the government, or the media. In fact, almost everywhere people are running low on trust. Fears that government leaders and media elites purposely lie to us are at an all-time high. Until we can find ways to rebuild the ties that bind us, as individuals and communities, it is hard to see how the large institutions that used to shape British civic life – whether that is the BBC, the Church or parliament – can regain the public’s trust, resignations or no resignations.

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