A Good Death?

Just last week I heard a pastor from Ontario in Canada describe how an elderly friend in urgent need of residential nursing care was told that she would have to wait for several months before a bed would become available. Or, she was told, she could opt for medical assistance in dying (MAID) and the death team would come to her house the very next day and put her to death. This option was held out as if it were just another medical option, as routine as a course of antibiotics or a round of physiotherapy.

It so happens that yesterday in Ireland the Dáil (Parliament) voted in favour of the Government bringing forward an assisted suicide Bill. The day before, Labour MP Kim Leadbeater introduced a new private member’s bill for the legalisation of assisted dying into the House of Commons in the British Parliament, which also passed.

Very few nations in the world allow the practice of assisted suicide, but the UK and Ireland seem determined to join this very small group. This shouldn’t surprise us, given the wholesale secularisation of values that has been gathering pace in recent years in these nations. If human beings are not by God with an intrinsic dignity that comes from being his unique image-bearers, if we did just evolve from ‘goo via the zoo’ as a friend of mine puts it, if human existence is nothing more than the survival of the fittest, why wouldn’t we claim the right to end our lives?

What should we say as Christians in the face of this increasing pressure to make suicide a legally protected right? I’m thankful for the excellent work done by the Christian Institute in the UK and Ireland, helping believers to understand the issues of the day and respond to them in a wise and reasoned way. Here are some points made in a recent briefing that I’ve supplemented from other sources. This has turned out to be a much longer than usual article, but I hope that gathering these illustrations in one place will be a useful resource as this debate continues.

First and fundamentally, we need to be absolutely, unswervingly clear that the Word of God, which is our only infallible guide for life, declares that human life as such is intrinsically inviolable and sacred. The sixth commandment forbids all forms of murder, including self-murder and acting as an accessory to any form of murder. Both the person who commits suicide and the doctor who facilitates this in any way are guilty of serious sin.

No doubt many who campaign for this right are doing so for the best of intentions, out of care and compassion for the dying. They may have had to watch loved ones suffer extremely difficult and protracted deaths. But a law of this magnitude will have all kinds of harmful unintended consequences:

1. If assisted suicide becomes normalised, it will put many vulnerable people under pressure to end their lives for fear of being a financial, emotional or care burden on others.

Baroness Ilora Finlay of Llandaff, who worked as a palliative care consultant for nearly 40 years is Wales’ first consultant in palliative medicine. She was appointed to the UK House of Lords in 2001 where she is a deputy speaker, resident palliative care expert and vocal campaigner against assisted dying. In an interview with the Daily Telegraph this week she said, “I remember one patient whose family were terribly worried about her pain control and they kept on wanting her to have more morphine. And then her birthday came and went, it was fairly muted, and they visited less.

“We discovered that her fixed term life insurance policy ran out on her birthday, and they had missed out on quite a lot of money. We were all taken in, we all thought they were a loving family.”

The possibility for coercion, when an elderly person feels as if they are a burden, is all the more profound when the option to die is given to you, she argues.

“You can just see the conversation: ‘Look at the gas bill, it’s gone up again. No, Jason, you can’t go on the school trip because we can’t afford it because we’ve got to pay the gas bill that keeps mum warm’. You can just see that coercive pressure of ‘I love my grandchildren, I don’t want to be denying them opportunities and I’ve had a good life.’ It becomes a subtle pressure that you’re being a burden.”

In Oregon, one of the eleven States where assisted suicide is legal, over half of those who are helped to kill themselves say they are concerned about being a burden on those around them.

Canada provides a useful case study, since MAiD was introduced there in 2016 and the consequences of the practice are now being more clearly understood. The first official report into assisted dying deaths in Ontario found that vulnerable people face “potential coercion” or “undue influence” to seek out the practice. According to a report in the Daily Telegraph, “sixteen experts across medicine, nursing and law identified people whose lives may have been wrongly terminated at the hands of the state, where the action is called Medical Assistance in Dying (MAiD).”

• In one notorious case, a 61-year-old man was euthanised even though the only health problem he had listed on his application form was “hearing loss”.
• The report gave the example of a MAiD practitioner driving a 40-year-old addict to his death after his psychiatrist suggested assisted dying as an option.
• Another man in his forties who had been “involuntarily hospitalised” on mental health grounds died by assisted dying after he became convinced he had been injured by the Covid-19 vaccination.

One of the doctors on the committee warned that “the UK should not assume it will manage this better or avoid potential pitfalls”.

Dr Ramona Coelho, a family medicine practitioner in London, Ontario, said: “With the legalisation of MAiD… the dangers of a slippery slope are very real. When Canada legalised assisted suicide and euthanasia under MAiD in 2016, Canadians believed it was intended to be a rare, last-resort measure, reserved for consenting adults enduring intolerable suffering at the end of life.” In fact 13,000 euthanasias were carried out in 2022, a rise of more than 30% on the previous year.

According to Dr Coelho, “…lobbying efforts have steadily pushed for broader access and eligibility.” And so, in 2021, new laws were introduced allowing non-terminal patients to access assisted dying.

Even more worryingly, the data shows that a disproportionate number of people who died by assisted dying who were not terminally ill (29 %) came from Ontario’s poorest areas:

• “A 50-year-old depressed woman, Ms B, was allowed an assisted death because the state could not find housing that “satisfactorily” addressed the symptoms of her multiple chemical sensitivity syndrome (MCSS) in one case.”
• A 41-year-old woman, who had been euthanised in 2021 after telling doctors she could no longer stand the pain caused by her fibromyalgia, had told friends in private that she actually wanted to die because she was so poor.

2. Making assisted suicide an option will undermine the good work done in suicide prevention campaigns.

3. Our current laws against assisted suicide protect people in their darkest moments. Someone diagnosed with a terminal illness may immediately have feelings of despair and hopelessness. But, given time, many such people will come to terms with their illness and live fulfilled lives. How many people have seriously considered suicide at their lowest point, only to recover and be thankful they were not able to act on that desire?

4. Legalising assisted suicide will reduce the rate of investment in high quality palliative care. Instead of spending time debating assisted suicide, politicians should be discussing how to improve this kind of end-of-life care.

Baroness Finlay cites a study conducted of European palliative care services: “…it showed that there were greater improvements in palliative care in those countries that haven’t changed the law [on assisted dying] than there were in countries that have changed the law.”

5. Doctors involved in caring for terminally ill patients and the elderly do not want assisted suicide legalised. The Irish Association for Palliative Care is firmly opposed. Baroness Finlay highlights the example of Oregon, the first US state to legalise assisted dying in 1994. She notes that many local medics are still unwilling to participate in the process, meaning it falls to a small number of doctors. In some instances, they have never met their patients beforehand.

“In 2021, a single Oregon doctor was involved in prescribing life-ending medication for one in every eight cases in the state. Finlay argues it is impossible for a practitioner with such a large case load to give the required care and attention to each patient before deciding to give them the fatal drugs.”

6. The Irish Hospice Foundation has raised concerns that ‘assisted dying’ could “be seen as a more ‘cost-effective’ approach to addressing the needs of those facing end-of-life”.

7. Once legalised, the eligibility criteria for assisted suicide or euthanasia always expand. Canada introduced euthanasia and assisted suicide in 2016. MPs have already scrapped the requirement for a person’s death to be ‘reasonably foreseeable’, and voted for it to be widened to include those with mental illness.

Michael Deacon, writing in the Daily Telegraph this week makes just this point: “MPs may insist that assisted dying will be available only to people who are a) terminally ill and b) judged by doctors to have less than six months to live. But a great many campaigners won’t be satisfied with that. They’ll fight tooth and nail to ensure that the eligibility criteria are widened, to anyone who wants it. Because that, fundamentally, is what the mantra of “my death, my choice” is all about. If you say you’re suffering, and can’t bear to go on living, then the state must grant you your wish to die. And those campaigners, I predict, will win.

“After all, they’ve won elsewhere. In other countries that legalised assisted dying, the scope of the law has swiftly been expanded, so that it includes people who are physically healthy, too. Take this recent shocking example from the Netherlands, where a woman aged just 29 was granted her wish for an assisted death. She wasn’t terminally ill. In fact, she wasn’t physically ill at all. She was depressed.

“But that’s appalling. Put it like this. If you see some poor desperate soul standing on a bridge, about to jump, what do you do? You do all you can to talk them down. You don’t say, “Fair enough, I can tell you’re suffering – and I must respect your decision. Here, let me give you a kind and compassionate shove.” Yet that, in effect, is what the Dutch state did to that young woman.”

Perhaps no story illustrates the terrifying trajectory of the normalisation of assisted dying than this one, also cited by Michael Deacon: “In 2023, Christine Gauthier, a former Canadian Paralympian told The Telegraph that she’d inquired about installing a disabled lift in her home – only for a caseworker from a government agency to ask her, incredibly, if she’d considered euthanasia. As if death were an exciting new medical breakthrough, a miraculous wonderdrug that cures all ills. Then again, that may well be how the Canadian state now sees it.

8. The legislation is intended to make assisted dying available only to those with a terminal prognosis of between 6-12 months. But this is far from straightforward. Baroness Finlay says “terminal” is a problematic word. “There is no clear definition for terminal illness. Saying someone has a prognosis of six months is impossible, a year is even more impossible.”

In fact recent analysis of 16 years’ worth of research shows that doctors wrongly predict how long terminally ill patients will survive in half of cases. Out of 6,495 occasions when doctors or nurses predicted a patient would die within six months to a year, more than half of the patients – 3,516 – defied expectations and survived. How many people who have been wrongly told by doctors they only have months left to live will choose to die prematurely, if this law comes into force?

9. The tragic reality is that assisted dying does not put an end to suffering. Tim Challies, in his review of Ewan Goligher’s excellent book How Then Shall We Die?, writes, “…euthanasia is an act of secular faith. Euthanasia tends to be offered or accepted where there is the belief that remaining alive is a fate worse than death, and that death is nothing but the absence of life. These claims are said to be grounded in science, yet science cannot prove them, for what comes beyond death is beyond science’s jurisdiction. Hence, lives are ended with faith—secular faith—that what comes beyond death is better than what precedes it. Science may insist that humans have no souls, that we are material and nothing more. But it cannot prove this and therefore cannot prove that souls do not remain when bodies die—a possibility that has terrifying consequences for those whose souls are not prepared for what comes next.” The terrrible truth is that for the unbeliever experiencing the most agonising, protracted death imaginable, racked with uncontrollable, unremitting pain day—that suffering is a pale shadow of the agonies of hell that lie on the other side of that lethal injection.

Let me close with some extremely helpful words written by Kathryn Butler on 24 July 2024 on the Gospel Coalition blog, “Scripture tells us that people do matter. A dignified death, by definition, can’t prioritize self-determination above the intrinsic value of human life. Rather, a dignified death will honor the sanctity of mortal life (Ex. 20:13) while also acknowledging our times are in God’s hands (Isa. 40:6–8). It will strive for mercy and compassion for sufferers (Matt. 22:39; Mic. 6:8) while also cleaving to our hope in Christ (John 11:25–26).

We weren’t created for the express purpose of independence, accomplishment, or even autonomy but for relationship with our loving God (Gen. 1:26–28). The Westminster Shorter Catechism says, “Man’s chief end is to glorify God, and to enjoy him for ever.” A death with true dignity keeps our dependence on the Lord in view and seeks to glorify him even if we aren’t in control of our final earthly moments.”