False steps in the assisted dying debate


As we approach the House of Lords’ debate on Lord Falconer’s Assisted Dying Bill, (writes Andrew Goddard) it is clear that there is a concerted attempt to undermine the church’s traditional opposition to laws enabling the killing of the suffering and dying. There have always been some Christians who have supported this, such as Hans Kung and Paul Badham and in recent times Canon Rosie Harper has been a prominent Anglican voice. They have now been joined by two senior retired Archbishops, George Carey and Desmond Tutu. What is astonishing, looking at their articles, is not only their lack of theological content but the number of serious flaws and confusions in their arguments. The debate is clearly entering a new phase and it would be a shame if these misleading claims were perpetuated and so prevented a proper reasoned discussion. What follows offers the briefest of sketches of some of the main false steps in recent Christian arguments.

First, letting go is not the same as assisted killing. Archbishop Tutu makes great play of the fact that “What was done to Madiba (Nelson Mandela) was disgraceful” and George Carey claims that “sophisticated medical science also offers people the chance to be kept alive far beyond anything that would have been possible only a few years ago”. These are valid arguments to consider the amount of intervention to prolong life. They are not arguments for ending life. Assisting people to approach death with dignity through the provision of appropriate medical care and support and the non-provision of useless or burdensome treatments must be distinguished as a separate category from assisting them to bring about their death, for example, by prescribing lethal drugs whose only purpose is to end their life.

Second, easing pain is not the same as assisted killing. George Carey notes that “church leaders already understand that the use of pain medication such as morphine may occasionally have the effect of hastening death” and then asks “Why not extend this understanding further, so that the dying have a choice over how and when they wish their lives to end?”. Leaving aside the fact that properly administered pain medication is very unlikely to hasten death and the seemingly uncritical acceptance of unfettered individual autonomy, this simply ignores the important distinction between intended and unintended outcomes of our actions. Pain relief intends to ease pain, lethal injections intend to kill and prescribing lethal drugs intends to enable killing. To facilitate or enact the last two actions does not “extend the understanding” that allows the first. It represents a totally different, perhaps consequentialist, ethic in which either the intention of the agent is irrelevant or the intention to kill or assist in self-killing is held, in this case, to be good.

Third, an appeal to compassion is not an argument and certainly not an argument for assisted killing. Rosie Harper in her speech to peers recently began with the claim, “I’m speaking from a Christian perspective – and this is about compassion” and stated “There is no condemnation in the bible for someone who is too compassionate”. George Carey asserts that the current law “risks undermining the efforts of families and doctors to care for and ease the pain and misery of people reaching the end of their lives” (a claim which is not substantiated and only holds if one assumes making assisted suicide a crime somehow undermines care and easing pain) and that as “such compassion and concern should be at the very heart of our society” there is a “growing gap between the existing law and the need for compassion”. He explains his rethink in terms of asking whether he had been “putting doctrine before compassion” and states it would be “more compassionate” to replace the current legal framework with Lord Falconer’s bill and that our attitude to difficult cases should be one “not of judgment, but of compassion”.

At no point is there any attempt to explain what is meant by compassion or why the proposed law is more compassionate. Compassion refers to a fellow-suffering with someone which leads one to act to relieve their suffering. It is, as Carey notes in one of his few theological points, a mark of Jesus’ ministry: “Jesus’s mission was underpinned with compassion for those suffering from the most dreadful conditions, such as leprosy. To those people, rejected by society and condemned to live apart, he brought comfort, healing and a new sense of dignity”. These actions are those which embody compassion – to claim that enabling the sufferer to end their life is the true expression of compassion is highly counter-intuitive (how is that a sharing in their suffering?) and finding an example of such an embodiment of “compassion” from Jesus’ pattern of ministry an interesting challenge.

The language of “compassion” is here being used emotively rather than rationally. This is a highly dangerous move as it portrays defenders of the current law and traditional Christian teaching as lacking in this central Christian virtue. Indeed, Rosie Harper concludes by stating that the “bottom line” is that to vote against the bill is “neither moral or Christian” while Carey is only slightly more temperate in implying the traditional teaching favours doctrine and dogma over compassion and human dignity and sanctions “anguish and pain, the very opposite of the Christian message”. This points to the real danger that, aided and abetted by such rhetoric and lack of reasoning by Christian leaders, secular society will soon dismiss traditional Christian teaching in relation to dying as immoral and cruel. Better to acknowledge that no perspective has a monopoly on compassion and to engage in serious discussion about the nature and limits of compassion and what actions best embody it.

Fourth, hard and difficult cases make bad law. Harper, Carey and Tutu all follow the standard pattern of recounting powerful examples of human suffering in the approach to death to support the view that the law must change. The reality is that every law, by its nature, creates hard and difficult cases where the strict application of the law may be open to question. That is not in itself an argument against the law. As Nigel Biggar, for example, has argued, there is a strong case for the current law in this area, and this is so even if one grants there may be extreme cases where the taking of human life in the approach to death could be morally justifiable. The legal process has various means for handling difficult cases in relation to whether to prosecute and sentencing following conviction. To change the law would represent a much more fundamental shift and the warning of Baroness Butler-Sloss needs to be heard:

Laws, like nation states, are more secure when their boundaries rest on natural frontiers. The law that we have rests on just such a frontier. It rests on the principle that we do not involve ourselves in deliberately bringing about the deaths of others. Once we start making exceptions based on arbitrary criteria like terminal illness, that frontier becomes just a line in the sand, easily crossed and hard to defend. The law is there to protect us all. We tinker with it at our peril.

Fifth, whose lives should the law allow us to assist in ending? One of the strangest features of the arguments of the two Archbishops is the hard and difficult cases they cite in support of changing the law. Lord Carey admits that “it was the case of Tony Nicklinson [a sufferer of locked-in syndrome] that exerted the deepest influence on me” and also appeals to the situation of Paul Lamb, paralysed in a car crash. Desmond Tutu appeals to the South African Craig Schonegevel who killed himself in tragic circumstances “after 28 years of struggling with neurofibromatosis” as he “decided his quality of life was too poor” and the law meant he could not “end his life legally assisted, listening to his favourite music and in the embrace of his beloved parents, Patsy and Neville”. It would appear that the proposed Bill would have done nothing for them or anyone else in similar circumstances as they were not terminally ill and expected to live for less than six months.

This highlights the lack of logic in the arguments but also the fundamental challenge to any change in the law. Unless the law allows an unrestricted “right to die”, it needs to define certain groups of people who would be eligible for assistance in ending their lives; in so doing it excludes other people whose situation of suffering would appear to require similar treatment. Despite Lord Carey’s protestations that “it would be outrageous” if the bill’s scope “were extended beyond the terminally ill to an ever-widening group of people, including the disabled and the depressed” his own argument shows that this is not a possible slippery-slope arising from human weakness. It is rather the inherent logic of the position he has adopted. Compassion as he defines it and the cases he cites must lead to a widening of the scope of those able to be legally assisted to kill themselves and, lest we discriminate against those physically incapable of ending their own lives even with assistance, will press hard on extending this to allowing others to kill them.

Sixth, what about the weak and vulnerable? By focussing on hard cases the bigger picture is easily lost. Once a category of people are legally classed as eligible for support to end their lives all those who find themselves in that class will face either spoken or unspoken cultural and perhaps familial pressure to exercise their legal right. The category currently proposed are in many ways the most vulnerable – “given I/you have only a few months left, why not take control, do what needs to be done, save lots of money being wasted, and end things sooner rather than later in a way I/you want?”. Much better if society, through the law, tells every living person, however old or near death or depressed or incapacitated, that their life is valued and anyone who takes it or assists them in taking it has done something for which wider society, through the law, will hold them to account.

Goddard andrew(3)In conclusion, as we consider the current proposed change to the law and doubtless others in the future, it is vital that the emotions that we rightly feel in the face of suffering and dying and the desire to do something to help do not prevent us engaging in serious, reasoned reflection. The points above highlight that even Christian leaders often fail to do this when they critique the current situation. They also often fail to promote the clear, indisputably Christian alternative. The obligation to show compassion which is at the heart of Lord Carey’s argument is one which – with Christians playing a leading role – has found expression in the medical and nursing professions (which risk becoming compromised if implicated in the deliberate ending of life, hence their widespread caution or antipathy to changing the law) and in particular in the provision of hospices and palliative care for the dying. As the Church of England calls for a Royal Commission in this area it needs not only to continue its reasoned defence of the law but also to consider afresh how, as we face the possibility of changes in the law and the need to be distinctively counter-cultural, it can support this alternative embodiment of faith, hope and love in the face of suffering and death as the true expression of Christ-like compassion.

This article can also be found on the Fulcrum website

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13 thoughts on “False steps in the assisted dying debate”

  1. Thank you for setting out the flaws in the arguments for assisted suicide so logically and clearly.

    Back in the 1980s and 90s euthanasia advocates were making similarly flawed arguments but in those days the hard cases presented were all of the, “90 years old and in a coma,” variety. Now the Dutch are euthanising children with spina bifida and a large and growing percentage of euthanasia deaths there are involuntary.

    I would like to point out a false step you haven’t mentioned. That is the assumption that doctors are the proper people to be performing euthanasia. People want doctors to do it because they don’t want to do it themselves and having a doctor do it has all those connotations of caring and niceness so that what is actually happening can be obfuscated; they can pretend it’s not murder so much as it is treatment.

    But those who don’t want to bear the burden of knowing that they are responsible for a person’s death fail in compassion when they expect someone else to bear what they won’t. The fact is that people involved in judicial executions – from the executioners and prison wardens right down to the jurors – are known to suffer adverse psychological consequences. Doctors who perform euthanasia also suffer adverse psychological consequences. See http://www.pccef.org/articles/art44.htm

    Killing is not so technically difficult that it takes someone with a double degree and years of further training to do it. Those in favour of assisted suicide should stop being so selfish and choose someone to do the killing who is unlikely to be harmed by it and who might even enjoy it; a convicted serial killer, perhaps. If that suggestion is too creepy for them they should do the job themselves, live with the consequences themselves and stop trying, in the name of compassion, to force other people to do their dirty work.

  2. Who’s been involuntarily euthanized in the Netherlands? They don’t drag people kicking and screaming to their executions.

    If a Dutch patient is comatose or otherwise incapacitated and they have expressed their wish for their life to be maintained no matter what the circumstances then maintained it will be. Only in cases where no such will has been expressed will the next of kin be able to authorize euthanasia.

    It’s clearly important that each person’s will in this matter should be expressed freely and confidentially to avoid cases of undue influence, but as far as I know Dutch law takes account of this and the ultimate decision rests with each individual.

    Of course the Christian Right doesn’t want to acknowledge this. They want to paint a picture of enforced euthanasia so that people will be scared they’ll be knocked off if they so much as sneeze. Just like during the equal marriage debate, conservatives are resorting to a mixture of scare tactics, distortions of the truth and outright lies in order to keep imposing their beliefs and will upon us all.

    It won’t work this time either. The age when personal autonomy could be sacrificed on the altar of someone else’s Christian conscience is over.

  3. It is interesting to read the account of the Dutchman, Professor Theo Boer. He was spearheading the assisted dying programme in Holland when it first became law. As a result of what he has seen of assisted dying over recent years in the Netherlands, he now warns against it very strongly. I quote “Once the genie is out of the bottle. there is no going back – don’t go there.”

    As a doctor, I thoroughly agree with the comments about the ill effects on those carrying out the process of killing (for that is what it is). No doctor enters medical school to train to kill people, and this is totally in opposition to the Hippocratic oath. The current ‘lax’ use of the Abortion Law is far from the 1967 bill – the same thing will happen if Lord Falconer’s Bill goes through this week.

  4. The slippery slope is a common Christian scare tactic, but one that has lost its power to influence the debate through misuse in the past.

    For example, equal marriage was supposed to lead to the breakdown of society, rampant polygamy, industrial scale child abuse and even floods and earthquakes. It didn’t.

    In the same vein, it’s highly unlikely that any of the dire consequences of euthanasia as preached by the Christian Right will come to pass.

    The worst that could happen would be, as the Dutch statistics seem to indicate, that increasing numbers of people will opt to take charge of their own deaths. But surely this is no surprising outcome of a change in the law that by its very nature will apply to the situations of more and more of us as we age.

    Diseases of aging that were relatively unknown just a few decades ago are becoming more and more common as the population grows older and older. Advances in medical treatments may have increased the length of our lives, but they do little to ensure quality of life. As more of us become dependant on invasive and often painful treatments to push the boundaries of our lives beyond any natural limit, it’s hardly surprising that some will weigh the quality of their lives against sheer quantity and come to the conclusion that 5 or 10 more years just aren’t worth it if they mean being confined to a wheelchair or being forced to live with debilitating and constant pain.

    This situation can only get worse as medical science pushes the boundaries further and further and keeps people alive who really shouldn’t be. So yes, the numbers opting for euthanasia probably will grow year on year, keeping apace with the latest excesses in “acharnement thérapeutique” (don’t know how to say that in English) as doctors compete to see how much longer they can extend a cancer patient or burns victim’s suffering.

    I don’t see this as a problem, rather as a logical consequence of an aging population and a medical profession hell-bent on extending life in all circumstances, no matter what the consequences. In fact I would argue that advancing medical knowledge positively requires a right to die. If a patient can’t call time, what’s to stop a modern Mengele inflicting unbearable suffering on him in pursuit of bigger research grants and professional recognition as a “life saver”?

    I’ve seen far more psychological pressure applied to the terminally ill by doctors who view their patients as guinea pigs to be kept alive at all costs than I’ve seen from greedy families eager to inherit. Indeed Christians and doctors sometimes seem to be in league. One wants to further his own career while the other is determined to see the patient suffer as he believes God intended. Together they form a powerful alliance responsible for much misery and pain that could otherwise be avoided. I hope this new law stops them wielding unquestioned power over the lives of others.

    • Etienne, I am curious that you think there is no problem with the Dutch system if you have read Theo Boer’s comments. They are cited and linked to on the next post.

      Is it an issue if thousands of people are, in effect, coerced into an early death?

      • Is their specific evidence that thousands of people in the Netherlands are being coerced into euthanasia, which is as illegal there as anywhere else? If so, has it been forwarded to the Dutch authorities? How did they respond?

  5. I don’t believe anyone has been coerced into dying.

    Numbers alone are no evidence of coercion. Just because one solitary Dutchman claims that thousands have been coerced into ending their lives doesn’t mean that’s what actually happened. What proof does he offer beyond a growth curve that could have many other explanations?

    This sounds to me like a guilty Christian conscience trying to absolve itself of responsibility. It appears he was an enthusiastic supporter of euthanasia in the past, until he realized that other people might not share his Christian morality and might want to end their lives for what he considers to be insufficient reasons. Apparently it would have been OK for the deaths of the people he thought should die to be hastened. But it isn’t OK if his judgment on who deserves control over their death isn’t followed to the letter.

    Yet another Christian control freak wanting to impose his faith and his morality on us all, and when he can’t, inventing shock and horror stories to try and scare the rest of us into accepting his moral authority.

    Let’s see some proof of his fantastic claims before we modify our own trajectory towards the legalization of euthanasia. If there are thousands of evil Dutch families wheeling their aged relatives into execution centers so they can get their hands on an early inheritance, it must also be happening in other jurisdictions where euthanasia is legal. Unless of course the Dutch are uniquely depraved and amoral. Do Belgians and Oregonians knock their elders on the head for the promise of a fast buck? Not that I’m aware. So are we to take one statement from a dubious Dutchman as incontrovertible proof that euthanasia laws lead to summary executions of unwanted family members?

    I don’t think so. Let’s hear some more balanced accounts from a range of sources before we make up our minds.

    • I agree, Etienne, in the article he explicitly says that people are *choosing* to die for reasons he disagrees with.

      Coercion should be prosecuted. Problem is, we’ve seen no evidence of coercion, just insinuation and guesswork. What charges have been laid before Dutch prosecutors? Were they upheld? Has there been a single guilty verdict?

      If the answers are no, unless there’s compelling evidence that the rest of the Dutch criminal justice system has, somehow, been corrupted by the euthanasia law, this is scaremongering.

  6. Oh and BTW I just had my 15 year old labrador euthanized this very afternoon. She was suffering – and I do mean suffering – from cancer and liver failure and could no longer walk. It was horrible but I’m glad I did it. Or should I have watched her waste away in terrible pain in her basket until a “natural” death took her?

    Of course a Christian will say that a dog’s life isn’t worth as much as a human’s and that dogs don’t have immortal souls so we can kill them as we please. I do not share that opinion. Any sentient creature can suffer and a dog suffers no less than a human. The only difference is that a dog can’t sign a consent form, so the final decision about ending its life has to rest with its human master.

    If a human being expresses a wish to end its life because of unbearable suffering, I think it’s beholden on us to respect its wishes.

    • Comparing a person at the end of his or her life to an animal is, I think, as sign of the need for proper ethical reflection on the nature of choice, will, power and coercion.


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