Assisted Dying: “Compassion is not a Crime”

Three years ago this month I watched my mother die. It was brutal for her and for me. She had recently been admitted to a care home following a short spell in hospital. A few weeks before, she had still been living at home in her ninety-fourth year, glad to have retained her independence for so long.

It was becoming clear that the end would not be far off. Like any son, my hope for my mother was that it would be quick, dignified and free of pain. But the reality turned out to be none of these things.  When she lost consciousness, the presumption was that death would soon follow. But it didn’t. She clung on to her life for a full two days, contorted by a pain the morphine administered by the medical staff seemed unable to assuage. I sat with her in the darkness through her last night with my memories and my prayers while she cried out in distress. Next day the morphine ran out, so I was dispatched to the hospital pharmacy to get some more. While I was gone, she died. 

The previous week in the hospital, she had asked the young doctor who was looking after her, “why can’t you give me something to help me cross this final threshold?” He replied, gently, “no, I can’t do that, but when the time comes for you to make that journey, we won’t get in the way”. She knew that he had no choice about his answer. She accepted it and didn’t argue the point. She knew that he had her best interests at heart. But she also knew that prolonging her life by not intervening to bring it to an end was not really about living at all. It was simply prolonging her dying. To her and to me, this was heartless.

My mother had long been an advocate of voluntary euthanasia. I found this out by chance one day when I was rummaging around the upper levels of a bookcase in the living room. There I came across a publication that bore the intriguing imprint EXIT. I asked her about it. She told me she believed that there were circumstances in which to choose to die was not only permissible but responsible. What circumstances, I wanted to know? Terminal illness for one thing, she said. Or the loss of your mental or physical faculties. Or any situation where your quality of life would be so diminished that death was preferable. I now think she had the Nazi death-camps in mind, in which members of her family had perished.

I can’t have been more than about twelve when we had that conversation, but I recalled it as I sat by my mother’s death bed. And I wondered what could be said for a law that prevented her from being relieved of her suffering had she chosen in advance, as she assuredly would, that in these desperate circumstances she would want her life to be terminated. I wondered why anyone would think that my mother’s pitiful condition during this ordeal was a good way to die, a dignified and compassionate way to bring a long human life to its close.

I could rehearse the ethical and theological objections to assisted dying and euthanasia, of course. I had (still have) every sympathy with those who argue that reverence for life must underlie all our decisions about palliative care and what we used to call the end of life pathways on which terminally ill patients were set. In all things there must be the imperative to “do no harm”. I understand the risks inherent in changing the law, the abuses that could follow bad legislation, the fear that the right to die could slide into a duty to die on the part of elderly people who could come to feel they had outstayed their welcome on this earth. 

But there’s another side to this. For one thing, at a time when every moment of human life can be, and is, managed by decisions we make for ourselves, including life’s beginnings by planning whether and when to give birth, it seems artificial to exempt life’s ending from this good and wise decision-making. Indeed, we don’t do this - in a case like my mother’s, every aspect of care in the final days and hours is highly managed until the end comes. But not the end itself. Yet in the face of terminal illness and the collapse of our mental or physicality capacity, not to be permitted to make a free and informed decision about bringing our life to a close is to subvert an aspect of our human responsibility to make moral choices. We make decisions about our healthcare throughout our lives, advised by professionals we trust. Why should the ultimate decision, the awesome choice whether to go on living or to die be denied us?

But a pastoral theologian wants to go further. It seems to me that this is fundamentally a matter of loving your neighbour as yourself or, as the Golden Rule has it, to treat others as we would have them treat us. We do not want to see other people suffer. We do not want to suffer ourselves. Contrary to how the Christian tradition is sometimes presented, there is surely no virtue in pain per se, which is why people of faith don’t regard relieving suffering as somehow frustrating the will of God. On the contrary. To alleviate suffering wherever we find it is an act of love and compassion that is motivated by the very same reverence for life that is often invoked against assisted dying. 

This week Parliament has once again been debating assisted dying. This debate will not be concluded any time soon. And it is right not to rush to conclusions, for these are matters literally of life and death. But I’d like to think that the churches’ contribution to it would not be implacable a priori opposition. I believe as a matter of Christian ethics that legislation could be enacted that would allow people - if they chose - to be spared the kind of suffering I watched my mother go through in her final hours. In an important book, Professor Paul Badham* considers the arguments for and against assisted dying in the light of biblical, theological and ethical considerations. He also presents evidence from places (such as the Netherlands, Switzerland, the State of Oregon) where the law permits assisted dying. He concludes that there is a Christian case for it that needs to be taken seriously. Which is why I support the Campaign for Dignity in Dying in pressing for legislation that will permit it in this country. As they say, “compassion is not a crime”. 

Sitting with my mother as she lay dying, while being profoundly aware of my own helplessness was not what brought me to this conviction. I had come to it long before that. But my belief about a principle had now acquired a personal dimension. What she suffered at the end of her life was in no way what she would have wished, in no way what I or anyone else who cared for her could have wanted. We ought to be allowed to be spared such an end. All our pastoral instincts surely point in that direction. It’s often pointed out that we are kinder to our pets when they reach the end of their lives than we are to our fellow human beings. Are we not of (even) more value than they?

It’s true that in all things, l’homme propose, Dieu dispose. We don’t know how we are going to die. But as I grow older I find myself echoing the petition in the Litany that we may be protected from a sudden catastrophic death. How much better to die peacefully, and whatever the poet says, to go gently into that good night. How much better to allow the artistry with which we have tried to shape our lives to help shape our deaths too, to the extent that is possible. This is what assisted dying is about, in the settings I’ve described.

So for myself, I hope to be able to make the decision while I am of sound mind to ask, if I need it, to be helped across that final threshold with dignity and grace, in the presence of those who love me and before my God who I trust will help me to pray, “Father, into your hands I commend my spirit”.

*Paul Badham, Is There a Christian Case for Assisted Dying? Voluntary Euthanasia Reassessed (SPCK, 2009).