Preserving life, or promoting death?

As MPs go to the Commons tomorrow, Friday 29^th November, to debate and vote on the so-called “assisted dying” Bill put forward by Kim Leadbeater MP, it follows weeks – on top of years – of debate on the subject. Christians and church leaders are almost uniformly against the proposals. But what happens when we bring people from both sides of this debate together to discuss the details? 

Recently Premier Unbelievable spoke to Professor Keith Brown from Bournemouth University, who has senior roles in adult safeguarding, who is against assisted suicide in principle.  However he also raises particular concerns about the Bill brought before Parliament in November due to his experience in safeguarding, particularly protecting the vulnerable from “coercive control,” where a vulnerable individual is subtly manipulated, often for financial gain. 

Of course the Bill is just the latest attempt to introduce doctor-assisted suicide for those with a diagnosis of terminal illness – though in practice it could be broadened out, a “slippery slope” that is often disputed vigorously. Prof Brown discusses the details with euthanasia supporter and devout humanist Neil McCain, who is also a Religious Studies teacher. 

In previous years, Unbelievable has also discussed the subject with a number of people on both sides of the debate. For example, the chief executive of the Christian Medical Fellowship, Dr Mark Pickering– who says he’s a big fan of Premier Unbelievable - spoke against assisted suicide in two separate debates with pro-euthanasia speakers: Rabbi Jonathan Romain, and Dr Ellen Wiebe. The latter runs an abortion, contraception and euthanasia clinic in Canada, and was notoriously interviewed in the informative documentary Better Off Dead by disabled activist and actress Liz Carr. As one commentator said, her presentation might “give you nightmares.” You can judge for yourself in this clip or watch the whole documentary on BBC iPlayer. As host Roger Bolton commented in the Unbelievable debate, Dr Wiebe appears to relish the prospect of assisted suicide for the mentally ill in Canada, and she even calls euthanasia her “very best work”.

Here are some of the vital issues in the debate on assisted suicide:

Slippery slopes 

In the jurisdictions where assisted suicide has been introduced, it is often broadened out to include more people than was originally advocated for, a phenomenon termed the “slippery slope”. A long post from “post-liberal Pete” says: “My worry is that ‘assisted dying’ is a slippery slope towards a death-on-demand service in which suicide becomes normative and soft-eugenicist attitudes towards the elderly, infirm, disabled and the mentally ill crawl out from the darkness and towards the light of the public mainstream.”

While advocates for this Bill argue it can’t happen, that’s not the opinion of Philip Murray, a College Assistant Professor in Law at Robinson College, Cambridge – who has warned that human rights legislation means that the criteria for the Bill could quickly be broadened out to include the disabled and the mentally ill. 

An ethical “boiled frog” 

The legal potential for “slippery slopes” is one thing – but what about the effect state-sponsored suicide would have on our social fabric and our attitudes towards the vulnerable and the dying? It is useful to ponder how we even got to a point where killing the suffering is seen as a better answer than loving them. The CMF’s Dr Pickering notes in response to Dr Wiebe’s enthusiasm for her work: “surely there’s been a massive distortion of ethics, that’s got us to that point slowly, we talk about boiling the frog slowly, and of course we look at that now think ‘wow that that’s just incredible that doctors are are almost looking forward to this next opportunity [to assist suicide]’.”

Host Roger Bolton mentions the play “Good” by CP Taylor – also a film starring Viggo Mortensen – a chilling portrait of how a “good man” in the Nazi German society gradually inches towards ethical positions he would never have thought he would believe, and keeps trying to reassure himself he’s doing it for the right reasons. “That’s what would haunt me in your position,” says Bolton to Dr Wiebe. 

Suffering

Of course the main concern that advocates for the Bill cite is to alleviate suffering at the end of life. Rabbi Romain explained this is his reason, as does Dr Wiebe.

However they differ from many palliative care doctors who manage that pain, such as Dr Cajetan Skowronski, who says that in his professional career he has only seen three cases of unmanageable pain. 

Yet Rabbi Romain says: “My views began to change because the more time I spent in hospital and hospices, yes of course they do wonderful work… but there are some people who they cannot help they cannot reach, and there are also some people who are not so much dying in pain but dying in great distress or indignity because of the nature of the illness they’ve got. I just thought ‘this can’t be right’.”

An interesting thought experiment is to ponder what we might do in other situations where someone is in physical or emotional pain. “You’re pushing this narrative of fear and hopelessness,” said Dr Pickering. “If I came to you suffering in some way psychologically, would you say ‘yeah it’s tough maybe you should kill yourself?’ Of course you wouldn’t say that. You’d say, ‘well let’s see if we can see it differently and let me tell you a story and let’s see what we can do can we put can we put something in place to help and support you better’.” 

Public support for “assisted dying” 

The assisted suicide lobby often cite surveys that suggest public support for their cause. Dr Pickering points out that although the public and even doctors appear to show support for “assisted dying” when it is presented as a “utopian idea” of suffering prevention - when the details and the potential risk for the vulnerable are presented, they change their minds. “Most people think ‘yes of course of course I support choice and control and compassion and dignity at the end of life,’” said Dr Pickering. “[But] when you get down to the brass tacks of what that actually means, people start to think ‘oh there are actually problems in there’.”

As for doctors, although the British Medical Association dropped its opposition to assisted suicide in principle several years ago, this does not reflect the beliefs of the doctors who are most involved with end-of-life care. “The people who deal day-in-day-out with end-of-life conversations: palliative care physicians [are] very strongly opposed, GPs, oncologists, geriatricians,” said Dr Pickering. “As in many situations there is a split, but the closer you get to working with death and the concept of assisted suicide and euthanasia, the more you tend to recoil from it.” 

Is a painless death a fantasy? 

An investigation by journalist Dan Hitchens showed that in reality, the drugs used to deliberately end life can produce a death that is anything but dignified. Such cases have not always reached the ears of the pro-euthanasia lobby. “I’ve spoken to a number of people who’ve taken their husband or wife to Dignitas in Switzerland and no one’s ever reported either distress at the time of death and or any problems with the post-mortem results,” said Rabbi Romain. 

But from a doctor’s point of view, death is not necessarily easy, as the frequently cruelty seen in state-sponsored execution demonstrates. “I think there is a very strong correlation with the situation that we see in legal execution in the states using similar drugs in a similar intravenous way - are they simply paralysed and unable to show the distress?” said Dr Pickering.

Humans are unique – “we wouldn’t treat our pets like that”

It has sometimes been pointed out that we have compassion on animals who are suffering and we choose to put them down – and this principle should apply to human beings. “People aren’t pets we don’t keep them in cages, we don’t sell them in shops, there’s lots of ways that we treat humanity as special,” said Dr Pickering. “So I think having that specialness of humanity is something we need to take really seriously.”

The value of life and religious belief

In the recent debate in the UK, a number of pro-euthanasia commentators have said that religious belief should be sidelined in this debate. Yet as pointed out in the debate between Dr Wiebe and Dr Pickering, that might beg the question: on what can you ground the “right to die”, or even human rights at all, if there is no transcendent reality in which those morals reside? Dr Pickering cites Tom Holland’s work Dominion that argues many modern human rights make little sense unless understood as derivative of Christian belief. 

Double minded attitudes about suicide

When pro-euthanasia adverts appeared on the London Underground recently with a happy, young blonde woman apparently celebrating at the thought of her relatives not seeing her suffer thanks to euthanasia, there was an outcry. Concerned citizens have covered up the offending adverts with posters advertising for The Samaritans, a phone line that anyone who feels suicidal can call to get support. 

As Liz Carr carefully discusses in her documentary, there is a strange double-mindedness in countries where euthanasia is legal, because certain groups of people like the disabled can be “assisted” while others are supported to prevent suicide. 

Musician Michael Schellhorn summarised his concern on X: “While proponents argue that assisted suicide supports individual autonomy, I believe this contradicts efforts to prevent suicide and protect vulnerable people. Legalising assisted suicide risks sending a message that some lives are not worth living. Human dignity, in my view, comes from valuing and preserving all life until its natural end.”

Coercion, protecting the vulnerable and the myth of “choice”

Advocates for the Bill argue that it is merely offering a choice to people. But its critics point out numerous problems with legally defining consent and also with identifying coercion from unscrupulous relatives. “One of the problems for many people… is towards the end of life, particularly if you’ve got some cognitive impairment, you might appear to be capacitors and be able to make capacitive decisions, but actually not really fully understand the full nature of that decision,” said Professor Brown. 

But his “biggest area of concern” about the bill is “how do we protect people from coercion?” due to his experience in observing sinister manipulation in his safeguarding work, including between members of families. “Coercion is very hard to spot, and people that want to coerce people… are very, very clever, and they will sometimes coach people so that they can speak to the authorities and cover up the crime,” he said. “We see that when people are being coerced by criminals to speak to their bank, to go around ways in which for anti fraud measured the point in place to lose their money. 

“How will we be able to spot a coercion, either from within a family or from somewhere around that? You know, ‘we don’t want this burden any more. We want to inherit the money’, whatever it is. It’s not easy for any professional to spot that.” 

Dr Kathleen Stock highlighted cases – that were championed by “Dignity in Dying” – where women subjected to assisted suicide had partners with some evidence of an abusive behaviour pattern. 

Danny Webster at the Evangelical Alliance wrote persuasively of the important limits to “choice” that are relevant to this debate: “Exercising choice is sometimes a luxury, it is utilised most by those with the resources and capacity to make the most of their choices, and the choices of others. Permitting a choice does not create a level playing field, it offers advantages and opportunities to some, usually at the expense of those who have the least. By seeking to give people greater choice and control what we may actually do is increase the potential for those choices to be abused and controlled by others.”

A way forward

Prof Brown argues that there is already a means to request in advance to reject medical treatment, and hopes there will be more discussion about how to manage the end of life. “It strikes me amazing that we have far more lasting powers of attorney for property and finance than we do for health and welfare, people seem to be more interested in where their money goes than actually how they’re cared for at their end of life… it’s good to be having this discussion to broaden it not just about assisted dying, but how actually we live and how we are appropriately cared for towards the end of our lives.” 

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Heather Tomlinson is a freelance Christian writer. Find more of her work at https://heathertomlinson.substack.com/ or via X (twitter) @heathertomli