They raise uneasy questions and anxieties, reminders of our own frailty and vulnerability, and fears about the impending loss of loved-ones. But I am absolutely convinced that we cannot avoid these painful issues and it’s much better to face them head-on.
Just as we can’t escape being confronted with death and dying in our personal lives, so also these topics have taken on strategic importance in the public arena. Scarcely a week goes by without another high profile media story highlighting the inadequacies of end of life care in our health services, or the tragic story of an individual who committed suicide to escape the suffering and indignity of a terminal illness.
Sophisticated campaigning organisations across the world are using these personal tragedies as the driving force to change the law to allow various forms of medical killing. Their efforts seem to have been highly effective in influencing public opinion in favour of legislation for medically assisted suicide or ‘assisted dying’ as it is increasingly (but misleadingly) called.
Of course these are much more than philosophical, political or legal issues. We must never forget the personal tragedies and fears that lie behind the public debates. Our first responsibility is to empathise, to try to comprehend and enter into, the human suffering, fear and desperation which many people face at the end of life. We should talk about and debate these issues not with condemnation, judgement and rhetoric in our voices but with tears in our eyes.
For two thousand years the medical profession has been dedicated to the protection and preservation of human life. This is the reason why all medical doctors are extensively trained in various forms of life support, all intended to combat death, and in a range of measures to prevent suicide. In the UK, the commitment to life means that doctors have refused to participate in judicial executions, in the use of medical techniques for coercion and torture, in participating in killing as military combatants and so on. Although doctors are professionally committed to life, we recognise that ultimately death is inevitable. There is a time at the end of life to say ‘enough is enough’, and to allow death to occur by withdrawing life-sustaining treatment. This has always been part of good medical practice.
But over the last 30-40 years, there has been a move across the world to allow doctors to take on various forms of intentional medical killing. On the one hand there is euthanasia, the intentional killing of patients by doctors in order to eliminate suffering, and on the other there is medically assisted suicide, in which a doctor provides a combination of lethal substances to their patient, with the intention that they should die quickly and cleanly. But it is the patient who must take the drugs by mouth or press a button for a lethal injection to be administered.
The fundamental arguments in favour of euthanasia and medically assisted suicide are first, the argument that medical termination of life is an expression of compassion for suffering individuals, and secondly the argument that suffering individuals have the right to end their own lives based on personal choice and self-determination.
Campaigners in favour of euthanasia and assisted suicide often present a stark choice. Either we as a society respond with compassion to those who are suffering, or we harden our hearts and abandon them to their fate. But in reality there is a better alternative. Yes, of course we must respond in compassion to those who are suffering at the end of life, but compassion can lead us to excellent, skilled and well-resourced care, aimed to address every aspect of the dying patient’s needs.
Although the legalisation of some forms of medical killing may seem theoretically desirable, in reality, quite apart from the ethical concerns there are many practical problems and risks.
Although there are a small number of determined individuals who wish to end their lives, there are large numbers of vulnerable older people in our societies, who are just trying to cope with the pressures and demands of their lives. If assisted suicide becomes a ‘treatment option’ for everyone at the end of life, what subtle pressures may be placed on those who are lonely or who are concerned about ‘being a burden’ on loved-ones? Our individual choices are always influenced by the wider social context and by the explicit and implicit views of those around us.
There are also practical concerns about the implementation of any legal process, medical errors and the difficulties of determining life expectancy, the use of lethal mixtures of drugs which haven’t been properly tested or licensed, the potential complications when the attempt to end life goes wrong, the negative impact on the medical profession, coercion and abuse by relatives and the potential for incremental change and ‘slippery slopes’.
The UK is an international leader in palliative care, which has been proven to be effective at addressing physical, emotional, relational and existential suffering at the end of life. However palliative care requires a trained and skilled professional workforce properly funded and resourced to care for the many individuals who die in uncontrollable pain and without adequate care. Palliative care represents a tiny fraction of total government spending in the UK and elsewhere. If we wish to tackle suffering and distress at the end of life, our main priority should be to enable all terminally ill to have access to high-quality and adequately resourced palliative care.
Historical perspectives on euthanasia and assisted suicide
There is a strong tendency in current debates about medical killing to ignore the historical perspective. The implication is that this is a new problem which requires new solutions. Yet the reality is that euthanasia has been actively discussed in the UK for almost 150 years, whilst the morality of suicide and mercy killing has been a matter of debate for more than 2000 years, starting in the pre-Christian era. This article provides a brief review of the history of euthanasia both in the UK and internationally.
Euthanasia and assisted suicide – current realities internationally
This article reviews the international spread of legalised euthanasia starting in the Netherlands in 2002.
The most up-to-date information on developments in Oregon and Canada are found in my recent report on the 2024 proposed bill to legalise assisted suicide in Britain.
Euthanasia and assisted suicide – the argument from compassion
The argument from compassion seems so simple and compelling. Common humanity demands that we try to reduce the suffering of others and therefore as a humane society we must provide legal means for individuals to end their suffering by ending their lives. We wouldn’t allow a dog to suffer but would humanely end their lives. Why can’t we do the same for human beings? But compassion is not as simple as it sounds…..
Essay: Euthanasia and assisted suicide – the argument from autonomy
If we can control every other aspect of our lives – where we live, how we spend our money, who we decide to marry – then surely we have the right to end our own lives whenever and however we choose. “Whose life is it anyway?” The philosophers call this the principle of “autonomy”, a word derived from the Greek “auto-nomos”, meaning self-rule, or more crudely, “I make my own laws”. Some experts in medical ethicists have argued that the principle of autonomy has become the single most important principle in all medical decision-making. But in reality all our choices are influenced by the societal context we find ourselves and by the wishes and actions of other people. As theologian Nigel Biggar has argued, the notion that we are all rational choosers is a flattering lie told to us by people who want to sell us something. Across the world ‘becoming a burden to others’ is one of the main reason that people give for requesting euthanasia or assisted suicide. Is this a good reason to end your own life? Are suicidal people genuinely autonomous and uncoerced? This article explores the question of autonomy in greater depth.
Euthanasia and assisted suicide – underlying social forces
We cannot separate the increasing push for legalisation of euthanasia and assisted suicide from the societal context. This article pushes into the realities of increased life span and the health, social and economic pressures on an ageing population. It is surely naïve to imagine that the enormous challenges raised by an ageing population can be entirely separated from the growing clamour to legalise medically assisted suicide.
Excellent medical care for dying people
What does it mean to provide excellent medical care at the end of life? How can we decide when it is time to stop invasive medical treatment and how has the development of excellent palliative care transformed the experiences of dying people across the world. After all the bad news of the previous articles, here is some excellent news. Excellent palliative care is able to treat all aspects of suffering at the end of life. Not only physical pain, but also psychological, relational and existential or spiritual suffering can be helped and addressed. Palliative care is not a magic wand that fixes every problem, but in my personal clinical practice I have observed time and again that with expert care apparently intractable suffering can be ameliorated and controlled. It genuinely is good news. Yet palliative care is tragically under-resourced, and astonishingly it is regarded as a low priority for the NHS and health services across the world. Far more money and resources are spent on massively expensive but frequently futile medical treatments for elderly patients with advanced illness, than are spent investing in excellent palliative care for all.
I recently produced a report for MPs in the English House of Commons who are debating the legalisation of assisted suicide. It is available here.
Christian responses and perspectives on euthanasia and assisted suicide
A Christian response to legalising choice and control at the end of life starts with the recognition that I am not the centre of my own universe. I am part of a bigger narrative. The ultimate meaning of our human nature is given to us by our Creator, and the way of wisdom is to live our lives in tune with the way that we and the rest of the universe have been made. As theologian Gilbert Meilaender put it “we are most ourselves not when we seek to direct and control our destiny, but when we recognize and admit that our life is grounded in and sustained by God”
Not only that, but I am locked into a human community. What I do affects you and what you do affects me. And if I choose to throw my own life away, this can have devastating consequences which ripple out to hundreds of others. What it means to be human – and what it means to destroy human life – is not ours to create and invent; it is given to us. It is part of the created order, of the way things are. And true freedom is to live your life along the grain of the deep hidden order of the creation.
To many modern people this is outrageous and unacceptable. They demand the right to make themselves whatever they choose. The idea of the created order is seen as a straight-jacket, a constricting, limiting, and demeaning force. We want to break out from those old rules and make up new rules for ourselves. But the truth is that I can only be truly free if I become the person that God created me to be. Christian freedom is freedom to be truly myself.
