Assisted Suicide: A Clash of Absolutes?

On Friday, November 29, a majority of Westminster MPs voted in favour of a bill titled “Terminally Ill Adults (End of Life) Bill”, proposed by Labour MP Kim Leadbeater. If passed into law, it will allow terminally ill people in England and Wales with six months or less to live to be supplied with lethal drugs to kill themselves under medical supervision. The bill stipulates that the person must be of sound mind and free from coercion, and have the approval of two doctors and a judge. Leadbeater claims that it has the most stringent criteria in the world, but it’s a woolly document with many vague areas. Some opponents pointed out that, wherever assisted dying has been legalised, the criteria have been liberalised, sometimes far beyond what was originally envisaged. This is particularly true of Canada and the Netherlands.

The arguments used by the bill’s supporters and opponents revealed fundamental differences in the ethical principles being applied. Those in favour tended to emphasise liberal values of autonomy and choice as if these were ethical absolutes. The idea of dependence and helplessness at the end of life motivated many to argue that they would not want to inflict such indignity and humiliation on themselves or their loved ones. Whether intended or not, this risks suggesting to disabled and dependent people, as well as to those who refuse assisted dying, that they lack dignity and are unworthy of respect.

Opponents tended to have a more communal and social ethos, emphasising not autonomy and choice but care and responsibility for the ill, the disabled, and the dying. This included those whose arguments were informed by their religious faith, as well as many from ethnic minorities and disabled people. The disabled actor and rights activist Liz Carr made a BBC documentary, “Better Off Dead?”, which expresses the worry shared by many disabled people that their lives will come to be seen as worthless and disposable if the new legislation passes.

Perspective

Religious leaders from different faiths signed an open letter appealing to MPs to reject the bill, and Catholic bishops urged parishioners to write to their MPs. The debate did not, however, divide along clear religious/secular lines. Opinion was divided among doctors and other medical practitioners. Many working in palliative care were opposed, as were disability organisations.

The ethical justification derives from the intention of the act”

From a Catholic perspective, assisted suicide finds no justification in church teaching. From its natural beginning to its natural end, every individual life is sacred and endowed with intrinsic dignity, and must be respected as such. However, while there are doctrinal arguments about the sanctity of human life, the Catholic tradition teaches that principles about law, morality and social justice should be defended by way of reason, without relying on faith-based claims. Many non-believers agree that killing a person in order to alleviate suffering crosses an ethical red line that should never be crossed.

Another relevant church teaching that does not rely on confessionalism is the doctrine of double effect, which concerns the intention of an act. Nobody is obliged to accept treatment that prolongs the process of dying when death is imminent. It is ethically acceptable to administer sufficient pain relief to a dying person, even if that might shorten his or her life, if the intention is to relieve pain. However, if the intention is to kill the person, as it is in assisted suicide, then the dosage must be sufficient to ensure death. The ethical justification derives from the intention of the act. Pain relief is justifiable, but killing is not.

Implications

We might also bear in mind that church teaching distinguishes between morality and legality. The law should only prohibit behaviour that threatens the common good. It should not be used to police people’s individual morality. Given that assisted suicide has profound social significance, including its impact on medical ethics and law, it cannot be reduced to a personal moral decision. We must consider the wider social implications.

Health Secretary Wes Streeting opposed the bill because, he argued, the NHS is in a parlous state, and access to palliative care is woefully inadequate. It is dangerous to introduce assisted dying at a time when many people are suffering unnecessarily because of a lack of good end-of-life care. The resources should be put into improving palliative care.

When fundamental principles of life and death are at stake, we need not anecdotes but robust philosophical debate, rooted in the most basic values of western society”

The question of coercion also raises concerns. It can be difficult to prove that a person is not being coerced. The option of assisted suicide might put undue pressure on suffering people who feel that they are a burden to their loved ones, even without external coercion.

There are distressing situations when palliative care does not relieve a person’s dying agonies, and there were highly emotive stories told by those who support assisted suicide. Yet when fundamental principles of life and death are at stake, we need not anecdotes but robust philosophical debate, rooted in the most basic values of western society which are, at heart, formed by Christianity. As historian Tom Holland argues, Christianity overturned ancient Greek and Roman cultures that celebrated masculine power, exploitation and domination, by privileging the vulnerable, the weak and the poor. Last week’s vote suggests that secularisation may be hastening a return to those pre-Christian values, when status, power and privilege take priority over care, compassion and the sanctity of life.