Assisted Dying

In this year’s Richard Dimbleby lecture, novelist Terry Pratchett has called for a change in the law on assisted suicide proposing that tribunals should be created to adjudicate whether or not it is appropriate for someone to be given help by the medical profession to end his or her life:

It seems sensible to me that we should look to the medical profession, that over the centuries has helped us to live longer and healthier lives, to help us die peacefully among our loved ones in our own home without a long stay in God's waiting room

A poll for the Panorama programme has revealed that 73% of those interviewed believed that in the case of terminal illness it was right to end another’s life if they themselves wished it and were in "sound mind". (Less than half believed that this option should be available to those who were not terminally ill). Then there have been two high profile and tragic court cases in which mothers have ended their childrens' lives because they were requested to do so by their children. In one case the conviction was for murder and in the other there was an acquittal. So this is an issue that is very much on the public agenda.

I am no expert on medical ethics ( I am no expert in anything!) and so my observations may be a little sketchy but I want to take our reading from Genesis as a starting point for some reflections on this issue. I need to start by saying that in this area, as in so many similar areas, we must proceed with great sensitivity. This matter is for many no abstract argument. The question of what happens at end of life takes us into deep waters, those of human suffering, pain, anguish, guilt and lost dignity. Perhaps you have faced or will face these questions yourself and they can be deeply painful matters to work through. For this reason, I want to make it clear that I believe those who take an opposite view to my own some of whom will themselves be Christians, hold it with full integrity and with the best of intentions; they are not driven by any sinister attempt to undermine the fabric of society. Nonetheless, I will argue that, from a Christian perspective, I do not believe we can judge assisted dying to be right but in so doing we need to acknowledge that those who do believe there is such a case have very similar motives to those who don’t. We are all concerned with human dignity and flourishing. Ironically, the basis on which those who argue for assisted dying do so, I believe, from the perspective that is rooted in the Christian virtues of love and compassion. They do not want people to suffer unnecessarily. But it is an incomplete perspective that threatens to return us to a pre-Christian world of fear and uncertainty. What is missing perhaps is an understanding of our dependence as human beings on God and one another and I will come to that in a moment.

But just a quick definition of terms which in the debate can be slippery. By assisted suicide I mean the active engaging of another person (be it family member or doctor) to intervene bring to end the life of another person before it has reached its natural end. This is different to switching off the life support machine or withdrawing medical help when it is clear that it is simply prolonging a life beyond its natural bounds and further treatment will not restore health. It has to admitted that there would be cases where there is a fine line between actively killing another person and simply allowing them to die but I think this is a distinction worth making. Medical science has enabled us to keep people alive when in previous generations they would have succumbed to death much earlier. We are learning that this a doubtful gift to have.

So why might allowing assisted dying be something we should resist?

I start at a place that many of those who advocate assisted dying would wish to rule off limits and I can understand why. In Genesis 1 (which, need I say, is not a scientific text book but a deeply theological reflection on human life in relation to God and the world) we learn that human beings are part of God’s creation but that they have special place within it:

So God created man
in his own image,
in the image of God
he created him;
male and female
he created them.

So we are God-made and so made in his own image. If you don’t believe there is a God then this argument is somewhat irritating. Mentioning God in this context seems to some to be an attempt to impose a set of religious beliefs on a secular society (as though these very same beliefs have not decisive in creating that society in the first place). But for those of us who do believe in God there is no other place to start. Those who don’t believe in God will have to derive their notion of human dignity and uniqueness from elsewhere but for the Christian (drawing, of course, on our Jewish heritage) the claim is that each and every human being is precious and bears in him or herself the indelible mark of God’s own image. It is this conviction that makes human life distinct and sacred. There is, in all people, however broken, obscured, damaged, something of God. The prohibition of the Ten Commandments is "Thou shall not kill" and, yes, we can think of exceptions, in war or self defence, for example, but the presumption is always towards the protection of human life because human life is a gift of God and contains within something of God, and to take it, even with the very best of intentions or in exceptional cases, always involves a defacing of the image of God in us. Because this life is a gift given by God it is not for us to take from another nor indeed take ourselves and a readiness to do so, for whatever reason, weakens the sense of the giftedness of human life and its preciousness.

And this brings me to my second point and it is one I think can be widely shared whether or not you believe in God: our lives are not ours alone. The Christian would say our lives are first of all God’s (we know how irritating this is to some!) but for all of us there is a sense in which we are also belong by others – we belong to families, nations, friendship groups. When God made humankind, "male and female he created them" and later, in Genesis 2, we learn that God decrees "It is not good for the man to be alone". That is we are who we are only in our relationships with others. We have rights as individuals but these rights are also matched with responsibilities as people who are who we are because we are inextricably bound up in the lives of other people, people who have claims upon us.

This runs against much modern thinking which tends to emphasise the freedom of the individual over against every other commitment. This has some good sides to it: personal freedom counts for a lot and, indeed, it can strengthen the sense that, as I have just said, every human being is unique before God. We are not part of a "mass" to be herded this way or that by the will of others. But we need also to recognise that our lives are a constant negotiation between my needs and those of others. In fact, we are not simply free floating individuals with infinite possibilities to choose from. We are finite human beings in a finite world. Every action I take, every choice I make, has an impact on other people. If I choose to send my child to that popular school, it is one less place for someone else’s child to take because there only so many places available. My free choice limits the free choice of another person. We live in a world where our actions shapes the lives of others. The individual, exercising a free choice, always affects or limits the choices of others and, if is the case, we need to take notice of the impact our actions have on others.

One of the arguments for assisted suicide is: "It’s my body, I can do what I like with it. Whose death is it anyway?" as though my death and the manner of my dying has nothing to do with anyone else but me. The problem however is that assisted suicide itself, by its very nature, bears witness to the way in which we are dependent on others. Assisted suicide requires us to ask someone else to take our life and in so doing that person is implicated in our decision. For me, this is one of the most compelling arguments against assisted suicide. Put aside for a moment the question of whether I should seek to end my own life, for an assisted suicide to take place someone has to cross that boundary that for 2000 years we have been loath to overstep and kill another person, not in self-defence, but because they no longer wish to live. To do so is felt to be an act of mercy but for me it is asking too much – to lay upon another the burden of having killed another human being. My right to die (if there can be such a thing) has severe implications for those who are asked to "assist", whether it is a compassionate family member or a doctor. It may simply be the case that I shift my misery onto someone else. The emotional, psychological and spiritual implications of all this makes one shudder.

So the "right to die" has repercussions that go a long way beyond the individual who makes that decision – it implicates us all in potentially damaging ways. And, yes, I do believe that not only does it ask something of others that should not be asked – to take another’s life – it also begins to create a new kind of "mood music" in society in which it is agreed that some lives are not worth living and, no matter how many tribunals you set up, this new atmosphere will be damaging to the vulnerable, the easily manipulated, the depressed and those with low self-esteem. My choices never affect me alone. In affirming my right to die it might be that others, less confident, hear this a duty to die to relieve others of the burden a life no longer worth living. It introduces a degree of uncertainty, at least, that was never there before.

For someone tortured by terminal illness, all this will have a rather academic quality to it. It is hard to have to endure agony in order to satisfy some principle of the "greater good". We need always to speak carefully of these things in tones of compassion and certainly those who find themselves caught up in these dreadful circumstances must be treated with deep sympathy and mercy. And yet … when we try to come to a view about matters such as assisted suicide we are obliged to take into account this wider perspective. And this wider perspective must allow us to ask how individual choices affect the common good. What kind of world might we bring into being? Given humanity’s dubious track record do we believe that we can keep this matter under the careful supervision of jolly nice people sitting on tribunals? I myself would rather hold fast to the giftedness of life given to us by God in his love and grace, a gift that is ours to treasure but not to dispose of even when a painful death draws near. In so saying, God grant me the courage to live up to my own lofty words when the time comes.

Matthew Parker

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