Assisted Suicide Topic Guide

Assisted Suicide Everything you need to know about the end-of-life debate

No man is an island, Entire of itself; Every man is a piece of the continent, A part of the main.

If a clod be washed away by the sea, Europe is the less, As well as if a promontory were: As well as if a manor of thy friend’s Or of thine own were.

Any man’s death diminishes me, Because I am involved in mankind.

And therefore never send to know for whom the bell tolls; It tolls for thee.

John Donne

Contents How to think about Assisted Suicide as a Christian...................................................4 10 things you should know about Assisted Suicide.....................................................6 A Black Friday ..........................................................................................................................................8 Assisted Suicide legislation in the UK..................................................................................10 Who are the key players in the debate?............................................................................12 Problems with the Leadbeater Bill........................................................................................14 Alison Davis - the most compelling advocate against ‘assisted dying’...................................................................................................................16 The problem with autonomy......................................................................................................18 Lessons from Canada.....................................................................................................................20 We need a better story for Old Age......................................................................................24 The Christian origins of palliative care..............................................................................26 7 Ways to Pray about Assisted Suicide.............................................................................28 For further research.........................................................................................................................29 What will CARE do in Parliament?.......................................................................................31

How to think about Assisted Suicide as a Christian

Dignity

Assisted Suicide is a deeply personal topic for many people; almost everyone has been affected by death, or seen a loved one suffer.

As Christians, we believe that suffering is an evil: it is a sign of something that has gone wrong in this world, and it will be banished from God’s new creation. We want to alleviate it as much as we can. And we worship a Jesus who wept at his friend’s tomb and who was deeply troubled at the suffering of those around him (the Greek word the Gospel-writers normally use literally means he ‘felt it in his guts’), who didn’t just heal the sick himself, but sent his disciples out to do the same.

But as Christians, we also want to make wise decisions which will help everyone, as people made in the ‘image of God’, to flourish.

We want to tell the world a better story for all, including those at the end of their lives, who are just as valuable as the rest of us; for we believe in a God who gives life and destroys death, a God who who defends the weak and the vulnerable, and a God who loves us intimately and wants the best for us.

Advocates for Assisted Suicide normally say one of three things: it provides dignity, it reduces suffering, and it gives us autonomy.

Each of those aims are good aims in and of themselves. Yet when those aims become the ‘ultimate goods’, rather than being kept in balance, we are left with an impoverished view of what it means to be fully human and what it means to be in community.

Many people are afraid of dying without dignity, with their capacity in mind or body in decline. The philosopher Frederick Nietzsche said: “I want to die proudly when it is no longer possible to live properly.” This is an understandable impulse: the Bible is completely realistic about the difficulties we face in old age, and how our bodies begin to fail us (just read Ecclesiastes 12).

But as Christians, we don’t believe that anyone’s worth is determined by their body or their mind, or what they can no longer do.

Everyone has a dignity which is innate and infinite, made in the ‘image of God’ (Genesis 1:27) simply by being human. GK Chesterton once wrote, “People are equal in the same way pennies are equal. Some are bright, others are dull; some are worn smooth, others are sharp and fresh. But all are equal in value for each penny bears the image of the sovereign; each person bears the image of the King of Kings.”

No one is worth any less than anyone else, from the highest king to the smallest baby.

Suffering

Others worry about suffering, perhaps even more than they do about dying. Stories are told by campaigners about people dying in pain, amid ‘unbearable suffering’, and they claim it is not compassionate to force people to suffer in this way; we treat our pets better, they say.

4

We all want to reduce suffering. That is why at CARE we advocate so strongly for palliative care, which means that in most cases, death can be dignified and pain can be managed. We do not believe in artificially keeping people alive when they are in pain: the great preacher Martyn Lloyd-Jones eventually refused treatment in hospital, saying to the doctors, “You are keeping me from glory”.

But we do not believe in actively ending life, which is what Assisted Suicide entails. When Elijah said to God, “I have had enough, Lord.

Take my life” (1 Kings 19:4), God relieved his suffering and gave him food and water and rest. The doctor and Christian ethicist John Wyatt writes: “Biblical thought always draws a distinction between removing suffering and removing the sufferer.”

steward our physical bodies accordingly.

John Stott wrote, “The proper name for this frame of mind is not autonomy but hubris, presumption before God. Although the lines of demarcation between God’s responsibility and ours are not always sharp, and although God does call us into a privileged partnership with himself, yet we human beings may not trespass into his territory or assume his prerogatives.”

Protecting the vulnerable

“No man is an island”: we do not exist in isolation, and one person’s actions have repercussions for another. Even those who believe in autonomy recognise that we are not free to behave how we like when it harms others.

The introduction of Assisted Suicide legislation would not be safe for many people; they would not feel in control. Its introduction undermines regular suicide prevention efforts, a number of disabled people have voiced concerns about being made to feel like they are a burden on society, and many would feel under pressure to take their own lives, whether for relational or even financial reasons. As Christians, we know that God has a special heart for the vulnerable, whether it be the widow, the orphan, the foreigner or the poor.

We do not believe that introducing Assisted Suicide is the right move for our society: it would actually put people in danger. While the impulse behind it might be compassionate, it is our conviction that God’s word can lead us towards a better story, one which protects life, which values the elderly and those experiencing illness or disability, and which safeguards the vulnerable.

Autonomy

Others want to feel in control, at a time of life when it feels like we are losing it. The actor Sir Patrick Stewart once said: “We have no control over how we arrive in the world but at the end of life we should have control over how we leave it.” And freedom and liberty are good things. But they are not the ultimate good.

There are, rightly, limits to human freedom.

As Christians, we believe that life is a gift from God, who not only creates life, but sustains and preserves, and even takes away, life.

Our existence is not of our own making. Jeremiah declared: “I know, O Lord, that a man’s life is not his own” (Jeremiah 10:23). Indeed, as Christians, we are not just created by God, He lives inside us through his Holy Spirit: what we do with our bodies matters. We are not our own; we are temples of the Spirit, “bought at a price” (1 Corinthians 6:20), and we are to

5

10 things you should know about Assisted Suicide

1

‘Assisted Dying’ and ‘Assisted Suicide’ are contested terms

2

Assisted Suicide does not mean the withdrawing of treatment

Although campaigning groups like to use the term ‘Assisted Dying’, this is a euphemism used to refer to the supply of lethal drugs so that the recipients might actively end their own lives.

To do this is prohibited under Section 2 of the 1961 Suicide Act and is a criminal offence.

The appropriate term is Assisted Suicide, as this describes what is actually occurring, the wilful act of ending life prematurely.

In the UK, 57% of people do not actually know what Assisted Suicide is. Although they believe that Assisted Suicide refers to doctors withholding treatment, or reaching a natural but more accelerated end, this is not the case: this is a common part of end-of-life palliative care, and every patient is entitled to refuse medical treatment which will extend life. Assisted Suicide refers to the giving of lethal drugs, not to letting disease take its natural course.

3

4

Assisted Suicide undermines suicide prevention efforts

Most people do not choose to die to avoid ‘unbearable suffering’

Despite the debate being dominated by ‘scare-stories’ of people dying in pain, evidence from around the world suggests that this is not the main reason why people choose to die; in Oregon, it does not actually appear in the top five published reasons, and it is below being a burden on friends, family and caregivers (a reason selected by 47% of people).

A number of studies have demonstrated a causal link between the introduction of Assisted Suicide laws and an increase in non-Assisted Suicides (particularly for women) in both Europe and North America. In Oregon, suicide rates have risen by 24% since Assisted Suicide was introduced.

6

5

Safeguards do not provide adequate levels of safety

6

Assisted Suicide does not only affect small numbers of people

Although every proposal to introduce this type of legislation includes safeguards, these safeguards have been swiftly abandoned in other countries. Legislation was widened in Belgium and the Netherlands to include euthanasia of children. In Canada, legislation is being considered which would include children, and there are plans to expand it to include those with mental illness.

In Belgium, people have been euthanised due to depression, blindness, anorexia and gender dysphoria.

9

Doctors are not able to confidently determine when someone will die

Recent data from an official report in Ontario, Canada, found that people living in the poorest communities were disproportionately likely to choose to access Canada’s MAiD (Medical Assistance in Dying) programme when their illness was not terminal (they comprised 29% of deaths, but only 20% of the population). Other anecdotal reports from Canada have suggested that people sought to access MAiD because they were homeless (even if they were officially able to access it for other reasons), and a 2023 poll found that 28% of Canadians saw no problem with people accessing MAiD for no reason other than the fact they were homeless.

Although campaigners for Assisted Suicide claim that only small numbers of people would access these services, this is not backed up by evidence from around the world. In the Netherlands in 2023, euthanasia constituted more than 5% of all deaths, with numbers quadrupling since its inception. In Canada, where legislation was only introduced in 2016, euthanasia already constituted more than 4% of all deaths in 2022.

7

8

Assisted Suicide particularly affects those living in poverty

Although doctors are capable of predicting when someone is in their final few hours or even within days, when the prognosis is months (as under typically-proposed safeguards, such as in the Leadbeater Bill), the margin of error can be years. The Royal College of Physicians once told a committee when giving evidence about the introduction of Assisted Suicide: “when they are six or eight months away from [dying], it is actually pretty desperately hopeless as an accurate factor.”

Vulnerable groups will be particularly adversely affected by Assisted Suicide

10

Many disabled groups are frightened by the prospect of Assisted Suicide legislation, and people believing their lives are not worth living. No disability group has come out in support of Assisted Suicide, and in the UK, more than 350 disability groups have come out against it. In Oregon, where Assisted Suicide is permitted only for those with terminal illness, terminal illness has included conditions such as anorexia.

We need more investment in palliative care

Although in exceptionally rare cases, it might be impossible to diminish pain, the overwhelming majority of deaths are peaceful and calm, due to modern palliative care. The average growth in palliative care cases was far slower in countries which had brought in Assisted Suicide than those without it.

7

A Black Friday An Opinion piece by Peter Ladd It was, truly, a Black Friday. 330 MPs in favour.

275 against. It was close. But it just wasn’t close enough. The Terminally Ill Adults (End of Life) Bill passed its second reading.

It was a dark day for so many who are vulnerable, particularly those at risk of coercion. A dark day for many who are fearful, particularly those who are disabled. A dark day for all those who will be diagnosed with terminal illness, who will one day be faced with a choice they should never have had to make.

For many of us, who have been praying, working, campaigning on this issue, in some cases for decades, we might feel grief, a sense of injustice, or even anger.

For our nation has changed. It has sacrificed those most in need on the altar of autonomy.

MPs think they are making ‘progress’, inexorable, that they are ‘on the right side of history’, when in truth, Assisted Suicide would return Britain to a pre-Christian era, a world in which life is no longer sacred, and in which not all lives are of equal worth.

midst of our moral vacuum: ourselves.

It was the repeated refrain from the Assisted Suicide lobby: ‘I deserve the right to choose.’

In a sense, it was ever thus. Just think back to Eden. The serpent said: “God knows that when you eat [the fruit] your eyes will be opened, and you will be like God, knowing good and evil.” And yet Adam and Eve made themselves god, rebelling against His commands. Essentially, they asserted their right to choose.

Autonomy is the one moral absolute still going; it is at the heart of the gender wars, debates around life and death, and the one sexual ethic not yet eroded, consent.

And of course, freedom is generally a good thing. But if autonomy is the one moral absolute, who is the judge of good and evil? Yourself. That is the literal definition of the word: ‘law by yourself’. In this world, if you don’t want an Assisted Suicide, don’t have one.

Tim Farron spoke in the debate about the difference between ‘liberalism’ and ‘libertarianism’. He is, he said, a liberal. He is not a libertarian: libertarians believe in your absolute right to do whatever you want. Liberals believe your right to do what you want is limited by its effect on those around you.

And Assisted Suicide legislation will impact those around us, particularly given, under the Bill, a doctor can raise the prospect of an Assisted Suicide with a patient unsolicited.

We have made an idol of ourselves; our freedom; our choices; our bodies. I’ve been re-

‘All get what they want’

We may well ask: how did it come to this? I actually think that the answer is quite simple; in Britain (and the West more generally), we have made ‘autonomy’ our god.

Gone are the days when the average MP believed in divinely-mandated moral absolutes, or in ‘the sanctity of life’. Our secular nation has lost its faith in God as the Author of Life.

In His place, we have erected a new idol in the 8

flecting on the words of Romans 1: “Although they claimed to be wise, they became fools and exchanged the glory of the immortal God for images made to look like a mortal human being and birds and animals and reptiles.

Therefore God gave them over in the sinful desires of their hearts…”

Ultimately, God says, ‘Have it your way’. In C.S. Lewis’ ‘The Magician’s Nephew’, the Witch gains lasting life for herself by eating the fruit she was forbidden from taking. Aslan says, “Things always work according to their nature. She has won her heart’s desire; she has unwearying strength and endless days like a goddess. But length of days with an evil heart is only length of misery and already she begins to know it. All get what they want; they do not always like it.”

This feels like one of those situations: “All get what they want.” Our nation has, for decades, chosen to prize autonomy above all else. As soon as absolute autonomy is your god in one area of life, it will lay claim to another. The path towards Assisted Suicide has been long in the making, when we forgot our obligations to the community and to God, and prioritised our own desires. This is the result.

cy: the people who know what it is to be excluded from power, to have decisions made for them by bigwigs in distant offices speaking a language they don’t understand…Not the ones who write to us campaigning for a change in the law, but the people who come to our surgeries with their lives in tatters, or who the police and social workers tell us about, the people with complex needs.

“What are the safeguards for them? I will tell you. We are the safeguard. This place. This Parliament. You and me. We are the people who protect the most vulnerable in society from harm.”

It is tragic that this safeguard has now been eroded, and we stand closer to the precipice.

Praying for a miracle

Something did change about Britain on that Black Friday. But the fundamental truths which we believe in, about the fabric of the universe…they hold just as true now as they would have done had we won.

There is a God on high. He is still sovereign. He does know what He is doing. He does raise up kings. His eye is on the sparrow. He does care about every one of us. He has sent His church to be His hands and feet.

Truths are still true. In the meantime, I will be praying to the God who “changes times and seasons.” And I will still be praying for a miracle. Yes, Parliament has voted on the Principle of the Bill, and it will be much harder now to stop it than it would have been before.

But we do believe in a God of miracles. It is almost two years now since the Scottish Parliament passed the Gender Recognition Reform bill, which would have introduced self-ID for transgender people in Scotland. That felt like a dark day. And yet, miraculously, the legislation did not come into force, its architects were removed from office, and now the idea has been almost entirely dropped.

There are still further stages to come. The Bill now goes to Committee stage. It will return to the Commons, at which point MPs who said they would vote for it, but wanted to see changes made, will have to reflect on whether they are satisfied with those changes or not.

We do believe in a God of miracles. If Jesus can defeat the power of the grave, and overturn death, He is more than capable of intervening on an ‘Assisted Dying’ law.

Come, Lord Jesus.

Protecting the vulnerable

At CARE, we have always been mindful of the impact of Assisted Suicide legislation upon the vulnerable. Proverbs 31:8-9 is a passage close to our heart: “Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor and needy.”

It is well known that many in the disabled community feel afraid about the impact of legislation. Stories from Canada show that it has a disproportionate impact upon those living in poverty. In the debate, Jess Asato spoke superbly about how women are particularly at risk of coercion from men, and the impact of domestic violence.

Florence Eshalomi, Labour MP for Vauxhall and Camberwell Green, who spoke powerfully about her own mother’s experience, concluded her superb speech, “true compassion must have equality at its heart. That is why I will be voting against this Bill.”

My heart is grieved for those who feel that little bit less safe. It should not have been so. Danny Kruger closed his speech like this: “I’m talking about the people who lack agen9

Assisted Suicide legislation in the UK Northern Ireland

At the moment, there is no Assisted Suicide legislation under active consideration in the Northern Ireland Assembly. However, there have been rumours of a potential Non-Executive Bill (a Bill brought forward by an individual member of the Legislative Assembly) being brought forward.

A new pro-Assisted Suicide group in Northern Ireland was also launched in July 2024, saying it will work towards a ‘compassionate assisted dying law in Northern Ireland.’

Isle of Man

There is an Assisted Suicide bill that has already passed key stages in the Tynwald, the Isle of Man Parliament. The Assisted Dying Bill 2023 would allow adults with a prognosis of 12 months or less to choose an Assisted Suicide.

In July 2024, the legislation passed its Third Reading, and it is now with the Legislative Council (the upper Branch of the Tynwald) for consideration.

There are various stages the legislation must still go through to pass, and at each stage, a majority of the Council is needed to progress the legislation. At any point, the Council may refer the legislation to a Select Committee for further consideration.

10

Scotland

Earlier this year, Liam McArthur introduced his Assisted Dying for Terminally Ill Adults (Scotland) Bill. If successful, this would legalise Assisted Suicide for anyone aged 16 or over (the legal age to be an adult in Scotland), who has an advanced and progressive disease which is expected to cause their premature death.

The legislation is currently being scrutinised by the Health and Sport Committee, who are taking evidence from stakeholders and will make a recommendation to MSPs about whether the Scottish Parliament should support the legislation.

MSPs will then have the opportunity to debate the general principles of the legislation in the Stage 1 debate, after which there will be a vote. It was at this point in 2015 that the last Assisted Suicide bill failed to pass.

England and Wales

Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill recently passed its Second Reading in the House of Commons, and moved to Committee Stage. This is a line-by-line examination of the Bill by a small group of MPs who can suggest amendments, though few changes are typically made at this stage.

Next will be Report Stage, when the legislation comes back to the House of Commons for all MPs to consider and where further amendments can be put forward. It is up to the government to make time for Report Stage, amid other government business.

Then comes Third Reading, the last chance for a debate to take place on the contents of the Bill in the Commons. It normally happens on the same day as Report Stage. Debate is short and is limited to what is in the Bill, rather than debating what should have been included. MPs must vote on the Bill at the end of the debate.

A number of MPs voted in support of the Bill at Second Reading this time, to signify support for the principle of ‘Assisted Dying’, but they have said they want to make changes to it, or else they will not support it at Third Reading.

If the Bill passes, it will go to the Lords for its First Reading, Second Reading, Committee and Report Stages, where further amendments can be made, and finally, its Third Reading, before going back to the Commons again.

We will then enter a period known as ‘ping pong’, where MPs can delete amendments made in the Lords and send the Bill back. This might happen several times. Once the Houses are agreed, the Bill can receive Royal Assent.

Jersey

In May 2024, the States Assembly on Jersey voted to approve plans to allow Assisted Suicide for those with a terminal illness ‘causing unbearable suffering’.

The law is currently being drafted and this is expected to take a further 10-12 months. A debate will take place by the end of 2025. If it is successful at this stage, a further 18-month implementation period would begin. The earliest the legislation is expected to come into effect is summer 2027.

11

Who are the key players in the debate?

For:

Esther Rantzen

Kim Leadbeater

Of all the celebrities to support Assisted Suicide in recent years, it is Dame Esther who has had the most cutthrough. The tv presenter, who founded the charity Childline, has Stage IV lung cancer and has signed herself up to go to the Dignitas Clinic in Switzerland when she feels the time is right. Keir Starmer made a pre-election promise to Rantzen that he would make Parliamentary time for a debate on the issue.

Kim Leadbeater has been the Labour MP for Spen Valley (formerly Batley and Spen) since 2021, and is the younger sister of Jo Cox, who had been MP for the constituency until her tragic murder in 2016. She was drawn first in the ballot for private members’ bills in September, and announced on 3 October that the subject of her bill would be Assisted Suicide, despite having not previously shown particular interest in the subject.

Dignity in Dying

Formerly known as the Voluntary Euthanasia Society, Dignity in Dying adopted its new name in 2005, and is the leading campaign group for Assisted Suicide. Having initially struggled to shake off an association with eugenics, the group has grown significantly in recent decades, and is currently headed up by Sarah Wootton. They have a number of celebrity supporters, and have spearheaded recent attempts to introduce legislation, including Bills by Lord Falconer, Rob Marris MP, and Baroness Meacher.

Keir Starmer

The Prime Minister is a known supporter of Assisted Suicide, having been a prominent voice in its support back in 2015 when it was last debated in Parliament. The Government is committed to a free vote on this issue, and Sir Keir has promised to stay neutral during the debate, having not spoken at Second Reading, although he did vote in favour of the Bill.

Starmer was responsible for dealing with cases related to Assisted Suicide while he was Director of Public Prosecutions for the CPS, and generally decided prosecutions were not in the public interest.

Others:

David Cameron, Christine Jardine, Lord Falconer, Harriet Harman, Kit Malthouse, Ed Miliband, Andrew Mitchell

12

Against: Wes Streeting

Liz Carr

As Health Secretary, Wes Streeting’s intervention in speaking out against Assisted Suicide is being perceived as highly significant, given he would be the Minister tasked with implementing the policy if legislation passes. Although he has spoken openly about having a Christian faith, he has also made clear that he does not oppose Assisted Suicide on religious grounds, having voted for the policy in 2015.

Instead, he has expressed concern about the possibility of vulnerable people feeling coerced or like they are a burden, and has stated that he does not believe palliative care is in a strong enough position for people to feel like they have an adequate choice at the end of life.

The actress and comedian Liz Carr, who has used a wheelchair since the age of 14, is a long-term advocate for disabled people and their rights. In 2024, she presented the BBC documentary ‘Better off dead?’, advocating against the introduction of Assisted Suicide. The hour-long show included multiple disabled people recounting times they had been told by people that they were ‘a drain on society’ and that if they had had the same condition, they would have killed themselves.

Rachael Maskell and the APPG for Dying Well

The All-Party Parliamentary Group for Dying Well is made up of Parliamentarians across the political spectrum, both within the Lords and the Commons, who oppose the introduction of Assisted Suicide and advocate for more palliative care. Its chair is Rachael Maskell, the Labour MP for York Central since 2015, who is a Christian. She previously served on the Commons health select committee during its 14-month inquiry into Assisted Suicide.

Palliative care doctors

Although some medical professional bodies, such as the BMA, have dropped their official opposition to Assisted Suicide, the palliative care profession, comprised of people who work most closely with the terminally ill, remains overwhelmingly against it: polling suggests just 9% of palliative care doctors support law-change, with 76% in opposition. Baroness Finlay of Llandaff, former President of the Royal Society of Medicine, and now a Crossbench Peer, is well-known for her opposition to Assisted Suicide.

Others:

Diane Abbott, Gordon Brown, Ed Davey, Tim Farron, Baroness Grey-Thompson, Danny Kruger, Shabana Mahmood 13

Problems with the Leadbeater Bill It was less than three weeks before the Second Reading of the Terminally Ill Adults (End of Life) Bill that Kim Leadbeater published its text.

Within the debate, a number of MPs who voted the Bill through made it clear that they were voting on the principle only; and that they would want to see a number of changes made to the Bill if they were to vote it through at Third Reading.

Kim Leadbeater has claimed her Bill is safe, and that the safeguards are “the strongest in the world”. Whenever Assisted Suicide legislation is introduced, proponents always talk a lot about safeguards. This is central to their argument for law change: they know that the weakest part of the case for Assisted Suicide is the very real prospect that cases of abuse and exploitation could take place.

As Christians, we do disagree with the principle of Assisted Suicide. But it would be wrong for us to not seriously engage with the text of the Bill, and to ignore what legislation would look like in practice. As we might expect - for we do not believe that an Assisted Suicide Bill can ever be made safe - there are a number of significant flaws that fatally undermine the claim that the safeguards would actually work.

1) The legislation relies on an accurate prediction that a patient has six months or less to live. But anyone who knows anything about medicine knows that predicting someone’s death is notoriously difficult. Doctors suggest that generally a prognosis can only really be predicted with any confidence in the final few days, or in some cases, hours, of someone’s life. A recent report indicated that doctors providing a six-month prognosis 14

were wrong in around half of cases, and that a third of those they had predicted to die within that time were still living twelve months on. Within the debate at Second Reading, MP Mary Kelly Foy spoke of her daughter Maria, who was non-verbal and had cerebral palsy; she was often given just six months to live.

She lived for 27 years.

2) There are just three weeks from asking for Assisted Suicide to being dead. This might be dressed up as a safeguard, but that is still a really short period of time. Does this properly allow for due diligence? Are we confident that courts will have time to consider all the requests that will come their way in detail? The courts are still dealing with huge backlogs. This is likely to mean that requests will be rubber-stamped, rather than properly considered.

3) Complications can and do occur when taking the lethal drugs that end your life.

The legislation acknowledges this when it says that doctors involved must discuss the patient’s wishes with them, in the event of complications. But the mere fact it makes this concession is significant. In other countries, like Belgium, where both euthanasia (doctor administers the lethal drug) and Assisted Suicide (where the patient takes it) are legal, there was a recent case where a patient did not die after the lethal drug, and so the doctor and nurses suffocated them. Palliative care doctor Ilora Finlay recently wrote for ‘The i Paper’ about how taking these lethal drugs does not necessarily result in instantaneous deaths, and that in Oregon, about half of patients had taken between 53 minutes and 137 hours to die.

4) All the Bill says about talking with family is that if the doctor thinks it appropriate, they should advise the patient to ‘consider’ discussing the request with their next of kin. That’s a shockingly low bar for family involvement given the gravity of the decision. This is one of the major flaws behind the Bill. It is the product of our culture’s obsession with autonomy. But no man is an island. All our decisions have an impact on our nearest and dearest. This legislation does not do justice to the role of the family.

And while courts will be involved, it is slanted one way. If the High Court says no to your request for Assisted Suicide, you can appeal.

But if the High Court approves, there is no appeal process open to family members who

are concerned about abuse. How is this right?

5) Despite multiple doctors needing to be involved, if the ‘independent doctor refuses to make a statement’ supporting the request for Assisted Suicide, the coordinating doctor may refer the patient to a different doctor. In other words, if you don’t get what you want the first time, you can try again. To a degree, you can ‘shop for a doctor’ who will approve your desire. Furthermore, it is highly likely that, given that doctors who will approve Assisted Suicide will be a self-selecting group, the doctors will not be truly independent.

6) It is doctors who are expected to spot the signs of coercion, despite not being formally trained to do so. Coercion is notoriously difficult to identify, and can take many forms. It is rare that it is as simple as someone trying to outright convince another person to take a course of action. Generally it is much more subtle, and in this case, there will not be a witness around to ask about it afterwards. The MP Diane Abbott spoke in the debate at Second Reading about how “Coercion in the family context can be about not what you say but what you do not say— the long, meaningful pause.” There is also a strong chance that some will fall prey to an unspoken ‘societal coercion’, where they feel they do not want to be a burden on their friends and family, or even upon the NHS. 7) The Bill does not make any provision for palliative care. As a number of people have pointed out, choosing between the prospect of an Assisted Suicide and non-existent or sub-standard palliative care (in much of the country) is no choice at all. We need to properly invest in and support the provision of palliative care, so that people are not faced with a postcode lottery. The genius of this approach is that it provides holistic care for the patient, and in the vast majority of cases, it makes a good, dignified death possible.

In summary, there may be attempts to fix some of these problems at Committee Stage, or through amendments at Report stage, but we should conclude that this Bill is unworkable. It will cause chaos in our healthcare, in our justice system and will also create pressure on some of the frailest in our society. If this is genuinely representative of the ‘strongest safeguards’ in the world, it merely proves the point: Assisted Suicide cannot be made safe.

15

Alison Davis - the most compelling advocate against ‘assisted dying’ as it was too dangerous to attempt. Doctors anticipated that her life expectancy was a matter of months. In August 1989, I decided to interrupt my university course to assist Alison in the final stage of her life. This would be no longer, I thought, than the end of that year. I had no idea I would remain as Alison’s full-time assistant and carer until her death in December 2013.

If there had been a law to allow Assisted Suicide or euthanasia during the 1980s, Alison would have welcomed it, would have qualified for it, and her life would have been ended. Hearing about the circumstances of her life and horrendous suffering, many would have applauded the ‘humanity’ of such a law, and proclaimed that for someone suffering as Alison did, with no possibility of improvement, living in such a wretched state, it was ‘compassionate’ to let her ‘die with dignity.’

Nobody would have known that Alison would still be alive more than 25 years later - the prognoses of doctors can be seriously wrong!

- and that she would become an implacable opponent of “right to die” laws.

Alison’s subsequent opposition to ‘assisted dying’ laws, based on an exceptional experience, deserves to be heard. Unlike many of the high profile advocates of ‘assisted dying’ she actually knew what it was like to greatly desire death. And her change of mind about the rightness of an ‘assisted dying’ law began even when she still wanted to die.

Alison wanted to die for ten years from 1985 and 1995. For the first five or so years she made serious attempts to end her life. However, from about 1990, even though she still longed to die, two reasons convinced her that ending her life would be morally wrong.

First, she said that the encouragement to live that she had received from me and others had made an impact on her. Secondly, she said that if a friend of hers wanted to die,

WRITTEN BY

Dr Colin Harte Colin was a full-time carer for Alison Davis, a severely disabled woman, from 1989 until her death in 2013.

He is now a speaker, writer and academic.

My friend, Alison Davis, represents the best possible reasons for changing the law to allow euthanasia or Assisted Suicide. Those wanting to change the law have based their campaign on highly-charged, emotional personal stories of suffering people like Alison, but they never present her story - because it also contains, paradoxically, the most compelling reasons against changing the law.

Born in 1955, Alison was about 30 when she wanted to end her life. She was born with the disability spina bifida, and used a wheelchair.

Unlike most people with her disability, the deterioration of her spine caused a pain that became uncontrollable and unbearable. She would pass out from the pain and when she revived, she would be unable to see or hear, usually for a short period of several minutes, but sometimes for hours, and even once for a couple of days.

I got to know Alison in January 1988, and witnessed her pain countless times. I have never seen anyone bear such pain. The anticipation and the experience of the pain was frightening for her. Alison taught me to fingerspell so that I could communicate with her when she couldn’t see and hear.

In addition to the pain, Alison was doubly incontinent, constantly nauseous, had osteoporosis causing broken bones, and was subject to frequent infections. The wretchedness of her life was obvious. Alison wanted to die. She tried to end her life several times.

In 1989 her hospital consultant ruled out the possibility of corrective surgery on her spine 16

she would think there must be a better alternative. She accepted that if she would do everything possible for suicidal friends to help them to re-establish a will to live, then logically she should extend that same attitude towards herself, even though she was convinced her situation was hopeless.

If there had been an Assisted Suicide law in the 1980s it is unthinkable that I could have given Alison the sort of support she needed and later welcomed. After a (short) while, my encouragement for her to live would have been regarded as cruelty if the law had said she was entitled to end her suffering by ending her life. If Assisted Suicide ever becomes an option, then it will be regarded as legitimate an option as any other. The vulnerability of those who want to die is increased by the existence of a law that presents suicide as a valid option.

And then - totally unexpectedly - Alison discovered a will to live, after we visited a project for disabled children in south India in 1995.

Alison ‘fell in love’ with the children and wanted to help them. The night we left the project, after our short visit, Alison said to me. “You know, I think I want to live.” She said it was the first time she had wanted to live in ten years. Alison set up a charity, and went on to support many hundreds of disabled children and young adults, who would get to know and love her as “Mummy Alison.”

Importantly, Alison’s physical health did not improve. In fact, as the years advanced her

health deteriorated further with a variety of conditions, and her pain was, as she put it, “unbearable, except that I have to bear it.”

What changed was Alison’s outlook on life.

What is the rationale for allowing someone to terminate their life? Nobody is advocating for the self-termination of a “fit and healthy” 30-year-old woman who might desperately want to end her life. Alison came to recognise that the restriction of Assisted Suicide to specific targeted groups - such as those who are dying, disabled or chronically ill - was deeply prejudicial. It assumes that these people are uniquely “right to want to die” but in fact the vast majority of them do not actually want their lives to be ended prematurely.

Alison thought advocates of Assisted Suicide were motivated by false compassion. She said that true compassion entails immersing oneself in the suffering of others, not in terminating the person to end suffering.

Compassion does not tell suffering people that their situation is hopeless but demonstrates hope by pledging never to abandon them. Where there is life there is always hope.

Alison recognised that there would have been fatal consequences for herself if there had been an Assisted Suicide law in the 1980s.

Hundreds of disabled children in India, Alison’s many friends, and not least myself, are eternally grateful that there was no such law.

This piece was first published at parliamentnews. co.uk 17

The problem with autonomy

WRITTEN BY

John Wyatt John was an NHS consultant neonatologist for over 25 years, specialising in brain injury and neonatal palliative care. He now addresses ethical, philosophical and theological challenges caused by scientific advances.

“I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it’s time we learned to be as good at dying as we are at living.”

Terry Pratchett On the surface it seems so simple. Human beings have the right to choose – end of story. If we can control every other aspect of our lives, such as where we live, how we spend our money, how we spend our time, then why can we not choose how and when we end our lives?

Philosophers call this the principle of autonomy, a word derived from Greek, meaning selfrule, or more crudely, ‘I make my own laws’.

Autonomy is the principle behind patient choice. It is enshrined in the Patient Charter, the NHS Constitution, the Mental Capacity Act and in General Medical Council guidelines for doctors. It is the patient who should be at the centre, choosing and controlling what treatment should be given.

English judges have repeatedly ruled that patients with legal capacity have an absolute right to refuse life-sustaining treatment,

even if death becomes inevitable, whatever their motivation. But should the same respect for autonomy lead to a legal right for patients to kill themselves?

Terry Pratchett argued that everybody had the right to control the time and manner of their death. But this is not as simple as it sounds.

Would we wish to belong to a society that assisted suicidal people to kill themselves whenever they wished? A society that made suicide an easy process for lonely, elderly, disabled or despairing people?

Of course, the Leadbeater Bill would not have legalised assisting a suicide in any circumstances, even if the person had legal capacity.

Instead, it made a series of stipulations. The following criteria had to be met: 1. being an adult (over 18 years) with a settled and ‘uncoerced’ will to kill themselves, and 2. having a life expectancy of less than 6 months, and 3. having legally defined ‘capacity’ So the principle of autonomy was restricted. But the restrictions appear uncomfortably arbitrary. Why should an 18-year-old be able to choose to kill themselves but not a 18

So the burden falls on the attending doctor to ensure there is no emotional pressure or coercion. But this places unrealistic expectations on a busy professional who may only have a superficial knowledge of the patient’s circumstances. The system could easily fail to spot subtle forms of coercion, manipulation and emotional blackmail.

In our centralised and bureaucratic NHS, public health planners will perceive a duty to ensure that Assisted Suicide becomes available to every terminally ill patient across the country. After all, we must avoid ‘a postcode lottery’. In due course, it feels inevitable that Assisted Suicide will be added to the list of ‘treatment options’ to be discussed with all patients, whenever terminal illness is diagnosed.

But once the doctor raises the option of Assisted Suicide, how many vulnerable people might come to perceive it as a responsible course of action? “You don’t need to carry on.

We can offer you a way out that will be better for everyone...”

Matthew Parris, writing in The Times, agreed that legalisation of Assisted Suicide would lead to growing social and cultural pressure on the terminally ill “….to hasten their own deaths so as ‘not to be a burden’ on others or themselves. I believe this will indeed come to pass. And I would welcome it…” As Parris put it, “‘Your time is up’ will never be an order, but — yes, the objectors are right — may one day be the kind of unspoken hint that everybody understands. And that’s a good thing.”

Moreover, the majority of terminally ill people who choose to kill themselves have at least some elements of what we would recognise as depression or persistently low mood. Is the desire for a terminally ill person to end their life based on a rational appraisal of their situation, or is their perception distorted because of mental illness? One psychologist who studied people seeking Assisted Suicide in Oregon stated, “…of the people who pursue this option, a sizable portion are rationally appraising their situation. And a sizable proportion are appraising it through a lens of depression.”

In summary, the apparently simple principle that people should be legally allowed to achieve their desire to end their lives turns out to be much more murky and complex than it seems.

17-year-old in the same predicament? In other areas of medical law it has been agreed that adolescents as young as 13 are capable of making autonomous decisions about their treatment, without the agreement of parents.

And why should I be able to choose to kill myself only if I have under six months left to live, but not twelve months or more? Why should the law restrict personal autonomy so arbitrarily?

The rhetoric of choice sounds compelling from the philosopher’s chair or the politician’s rousing speech. But in the complexities of human relationships and the play of tragic life circumstances, it is not so simple.

Our choices and desires are all influenced by our societal context and the web of relationships in which we find ourselves.

A previous Commission into Assisted Suicide concluded that “…it is essential that any future system should contain safeguards designed to ensure, as much as possible, that any decision to seek an Assisted Suicide is a genuinely voluntary and autonomous choice, not influenced by another person’s wishes, or by constrained social circumstances, such as lack of access to adequate end of life care and support.”

But although this is well-meaning, it is frankly absurd. How can we be confident that a person’s choice to kill themself is not influenced by the wishes of others, or limitations in social or medical support? In reports from Oregon, 40-55% of those requesting medically-Assisted Suicide gave “Burden on family, friends/caregivers” as a reason. Desiring to act responsibly and altruistically, people may perceive that it would be better for everyone if their life ended.

And can we always detect the covert influences and emotional factors which lie behind our choices? Professor Nigel Biggar writes that the notion that we are all rational choosers is “a flattering lie told us by people who want to sell us something”.

19

Lessons from Canada WRITTEN BY

Amanda Achtman Amanda works to prevent euthanasia and encourage hope across Canada and beyond through her project, Dying to Meet You. She is also the Ethics Education & Cultural Engagement Lead at Canadian Physicians for Life.

In 2016, Canada’s Minister of Justice introduced a bill that had many similar features to Kim Leadbeater’s bill. Since then, Canada has become the euthanasia capital of the world. More than 70,000 Canadians have had their lives ended prematurely and euthanasia is now the fifth-leading cause of death. Nearly a decade into our euthanasia experiment, here are some reasons why so-called “safeguards” are doomed to fail.

Criteria are Entirely Subjective

Initially, in Canada, only someone eligible for public healthcare, age 18 or older and with decision-making capacity, with a “grievous and irremediable medical condition”, with death being “reasonably foreseeable”, making a voluntary request “not made as a result of external pressure”, and having provided informed consent, could have their life ended by a doctor or nurse.

Similarly, Leadbeater’s bill proposes that Assisted Dying be restricted to a registered patient in England or Wales, aged 18 or older, with “the capacity to make a decision to end their own life”, who is making a voluntary request free from coercion, who is able to express “a clear, settled and informed wish to end their own life”, and whose natural death should “reasonably be expected within 6 months”.

Devising eligibility criteria for ending human life is entirely subjective. Why should the timeline be 6 months, rather than 12? Or, what about those whose diagnosis is not terminal, but who might be enduring even worse suffering at any given time?

If Assisted Suicide is seen as a compassionate means to end suffering, there is no reasonable basis on which it will remain limited.

If it is regarded as a good, a right, or a healthcare service, it will always be expanded on the grounds of equality.

Wrong Predictions are Needlessly Deadly

As Janet Eastham highlighted in ‘The Telegraph’, doctors regularly fail to accurately predict patient life expectancy. She notes, “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.”

Similarly, persons living with disabilities, chronic pain, and other illnesses often defy their prognoses and exceed all expectations.

Medical professionals tend to rank patients’ quality of life significantly lower than their patients would rate their own quality of life.

The requirement in Leadbeater’s bill that death should “reasonably be expected within 6 months” creates a mirage of precision.

20

Doctor Involvement is SelfSelective

Raising Euthanasia Unsolicited is Coercive

The term “coordinating doctor” appears 93 times in Kim Leadbeater’s bill and the term “independent doctor” appears 32 times; theoretically, these doctors are supposed to ensure patients genuinely meet eligibility criteria.

When Canada first legalised euthanasia, the doctors who wanted to participate quickly secured government funding, formed professional associations, and started devising curricula and programming.

In her memoir, Canadian euthanasia doctor Stefanie Green recalls having explained to a colleague, “‘Mr. Winslow has requested an assisted death, so I’m here to help assess if that’s going to be possible. I’m from the MAiD team.’” She admitted, “In truth, there was no MAiD team: It was a fictitious club that I made up on the spot to try to sound more official.”

The doctors who do Assisted Suicide are self-selecting, and constitute a mutually-affirming group. The so-called “coordinating and independent” doctors will be one and the same.

One of the most egregious problems with MP Leadbeater’s bill is that nothing prevents physicians from raising euthanasia with their patients unsolicited. In Canada, many people are reminded by doctors that they are eligible for state-sponsored Assisted Suicide.

This is degrading and demoralising, and contributes to theirsense of abandonment.

As Roger Foley, a disabled Canadian put it, “It’s completely traumatised me [to have euthanasia suggested]. With me, it’s this overlying option where, in my situation, when I say I’m suicidal, I’m met with ‘Well, you know, the hospital has a programme to help you with that if you wanted to end your life.’ That didn’t exist before MAiD was legalised, but now it’s there.”

The Leadbeater Bill states that “nothing [...] prevents a registered medical practitioner exercising their professional judgement to decide if, and when, it is appropriate to discuss the matter with a person.” Informing a person that they qualify to have their life ended prematurely is abusive.

21

Institutions are not protected

In Canada, our Criminal Code has been clarified to say, “nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” While this protects conscientious objectors, there is nothing to protect institutions being forced to euthanise patients on site.

This has been a disaster in Canada for facilities that do not want killing on their premises. A hospice in British Columbia was defunded and then evicted and expropriated for not allowing euthanasia at the 10-bed facility. A Quebec judge ruled against a Montreal hospice being exempt from participating in euthanasia. And a family has sued St. Paul’s Hospital in Vancouver for not providing euthanasia there and requiring patients seeking MAiD to transfer elsewhere.

The UK is credited with being the birthplace of palliative care, through the work of Dame Cicely Saunders at St Christopher’s Hospice; there are no guarantees that even hospices like this would be exempt from having to have Assisted Suicide carried out on their premises.

euthanised more than 400 people.

Patient privacy is important. However, who would not consider it a red flag that a patient had informed no one in their life about their plans to end it?

Kim Leadbeater’s bill does not require any disclosure to or involvement of family or friends in this life-or-death decision. There is only a recommendation that, “in so far as the assessing doctor considers it appropriate, [they] advise the person to consider discussing the request with their next of kin and other persons they are close to.”

Expansion Can Precede Review

According to the Leadbeater Bill, the Secretary of State is required to undertake a review of the Act after the initial 5-year period following enactment and to prepare and publish a report. But there is nothing to prevent euthanasia from being expanded before the 5-year review is conducted.

In Canada, the bill that eroded safeguards and expanded euthanasia even further - permitting deaths which were “not reasonably foreseeable”, expanding the criteria to include those with disabilities - was introduced prior to the 5-year statutory review that was mandated by our legislation.

The Leadbeater bill promises to have the “strictest safeguards in the world”. In reality, all of the safeguards are doomed to fail.

Family and Friends Are Excluded

In Canada, family members and friends have been devastated by the secrecy and privacy surrounding their loved ones’ deaths.

A father in my hometown had to spend hundreds of thousands of dollars in legal fees to obtain an injunction to prevent his 27-yearold daughter with autism from being killed on her scheduled death date. Similarly, a husband managed to get an injunction at the eleventh hour just before his wife was set to be killed by a doctor who boasts having 22

“It’s completely traumatised me [to have euthanasia suggested]. With me, it’s this overlying option where, in my situation, when I say I’m suicidal, I’m met with ‘Well, you know, the hospital has a programme to help you with that if you wanted to end your life.’ That didn’t exist before MAiD was legalised, but now it’s there.”

Roger Foley

23

We need a better story for Old Age mated that 25% of the population will be over the age of 65. The UK has yet to fully adapt to this new reality, with live debates around retirement ages, social care and end-of-life care for an increasingly aging population.

But perhaps this is the biggest problem of them all: our society is missing a positive vision of aging.

Currently, it feels that to be old is to be defined by what you no longer are, rather than what you are now: you are no longer beautiful, young, or physically active; you no longer have a job and you are no longer productive; you no longer can live on your own; instead, the world says, it is an inexorable, and sometimes painful, road to death and oblivion, the ultimate ‘no longer’.

Not all of this is entirely false, although some of it is; and of course, one person’s experience of being elderly can differ substantially from that of another who is the same age, with people going through different rates of physical decline, or having different experiences of loneliness, or dependency or bereavement.

The Bible has an ambiguous relationship with aging, fully recognising its problems and its pains, rather than just its positives.

God’s word is - as in so many areas - wonderfully and bluntly realistic about the world we inhabit. For many people, old age is hard.

Within Scripture, people fear it. The Psalmist begs God in Psalm 71:9: “Do not cast me away when I am old; do not forsake me when my strength is gone.” Paul describes the aging process as “wasting away” (2 Corinthians 4:16), and when he is close to death, says that he is “being poured out like a drink offering” (2 Timothy 4:6).

Ecclesiastes 12:1-7 provides a particularly graphic description of the aging process.

The writer says that we will say about our later years, “I find no pleasure in them”, and describes them as the “days of trouble.” He describes how old age affects virtually every part of our physical being: “the keepers of the house tremble” (our arms and legs begin to

WRITTEN BY

Peter Ladd Peter has been Head of Content at CARE since 2022. He regularly commentates on cultural issues and the Bible, heads up the 20s/30s work in his church, and is a lay preacher.

The French existentialist philosopher Simone de Beauvoir once wrote: “It is old age, rather than death, that is to be contrasted with life.

Old age is life’s parody.” In her eyes, old age robbed humanity of the things which make life worth living, to the point where it is inferior to death itself. She continued: “The vast majority of mankind looks upon the coming of old age with sorrow and rebellion. It fills them with more aversion than death itself.”

Her views are entirely in keeping with our society which sees old age as something to be staved off, rather than celebrated as it might be elsewhere in the world. Western attitudes towards aging are predominantly negative.

The geriatrician Louise Aronson records the results of a survey where people were asked what words they would associate with ‘old’: the most popular answers were ‘sad’, ‘stubborn’, or ‘lonely’.

We long to stay young; the anti-aging messaging which fuels the beauty industry implies, in effect, that old age means ugliness.

We witness resentment from young people towards their elders who vote a different way at election time. We receive the subliminal and occasionally, open - message that the lives of people who are closer to death are more expendable: during the Covid-19 pandemic, at least one NHS trust put in place a blanket ‘do-not-resuscitate’ order, for patients of a certain age or who had a disability, without getting their consent.

In a world where physical boundaries are being pushed ever further by scientific advances, and in which life expectancies continue to reach new heights, what once would have been regarded as a ‘ripe old age’ has now become an expected norm. By 2040, it is esti24

Dignity: We do believe in innate human worth and inherent dignity, regardless of infirmity or capacity, and that the lives of those who are old are worth just as much as the lives of the young, because our true identity is rooted in our status as creatures made in the very image of God Himself.

Purpose: at a time when people have moved out of employment, some may feel a loss of identity, but we do believe that the elderly can have purpose and have much to contribute, even if it looks different to how it did when we were younger, because we believe in a God who can accomplish things through anyone.

shake), and “the strong men stoop” (we are hunched over with bad backs), “the grinders cease because they are few” (our teeth fall out and we lose the function to chew), and “those looking through the windows grow dim” (our eyesight deteriorates). The elderly live in fear (“people are afraid of heights and of dangers in the streets), struggle with walking (“the grasshopper drags itself along”), lose sexual desire (“desire no longer is stirred”), and eventually die (“then people go to their eternal home”).

Faced with such a bleak view of aging, we might well wonder how the apostle Paul could say “I can endure all things through Christ who strengthens me.” (Philippians 4:13). And yet contentment within our circumstances is a part of Christian living; he writes the verse before: “I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want.”

Indeed, elsewhere in Paul’s writings, we see him encourage Christians to not only be content in their circumstances, but to embrace them and not seek to change them: in 1 Corinthians 7, he tells believers that “each person should live as a believer in whatever situation the Lord has assigned to them, just as God has called them” (1 Corinthians 7:17), whether they be circumcised or uncircumcised, slave or free, or married or unmarried.

So what is the secret to this contentment?

We believe in a positive vision for aging, one which does not dismiss its difficulties, but one in which we recognise what the author of the story has to say about humanity.

Here are five key plot points in the story where a Christian vision and the secular vision come into conflict:

Community: although many who are elderly might feel isolated, particularly if they have been bereaved, we believe that the Church has a vital role to play in ensuring that everyone is cared for and feels loved.

Suffering: many people fear suffering in their old age, but - even though it is a sign that our world has gone wrong - our suffering can be redeemed, for we believe in a great Redeemer, who is at work in all things.

Hope: as people move closer to death, many will believe they are destined for nothingness. But we do believe in hope, rooted in Jesus’ death and resurrection, and that instead of an inexorable march towards death and oblivion, as Christians, we are destined for transformation and for glory, on that day when sorrows are washed away and pain is no more.

This is the better story we need; one which explains why things are the way they are, points us as to how we can live, and gives us a sure and certain hope for the future. The great evangelist Billy Graham wrote, in one of his final books, “Old age may have its limitations and challenges, but in spite of them our latter years can be some of the most rewarding and fulfilling of our lives.” Might this be true of all of us, as we seek to “finish the race”.

This is an abridged excerpt of a new resource from CARE, called ‘Aging: A Biblical Deepdive’. To order a complete copy, please contact us at mail@care. org.uk or check out the Resources section of our website.

25

The Christian origins of palliative care It’s all well and good explaining why we’re opposed to Assisted Suicide. But are we for?

What’s our positive vision for society? The challenge of suffering, especially at the end of life, is all too real for so many people. All of us want a good death. As Parliament considers Assisted Suicide again, those of us opposed to any change in the law need to make the case for something better. One of the main ways we do this is by championing palliative care, which had its origins through a wonderful woman who possessed deep Christian convictions.

Dame Cicely Saunders first trained as a nurse, and then as a medical social worker in the 1940s, at a time when medicine placed little weight on care for those who were dying, many of whom were neglected in their final weeks. Having been profoundly affected by her experience of caring for a terminally ill man for two months, she gave her life to the care of those who were dying, and at the age of 33, began training as a doctor at St Thomas’ Hospital, London.

Today she is considered the founder of the modern hospice movement: in 1967, she founded St Christopher’s Hospice, which promoted expert pain and symptom control, alongside clinical research into looking after people who were dying.

Dame Cicely pioneered the concept of ‘total pain’. Patients would, of course, suffer from physical pain in their final weeks. But they might also be suffering from psychological pain, as they worried about what was to come. They might be experiencing relational pain, anxious about the effect of their illness on their friends and families. And they might also be suffering from spiritual or existential pain, fearing what might come after death, or indeed, not believing there was any-

thing at all.

John Wyatt, who has specialised in palliative care, has written: “It is a common observation of palliative care doctors that when physical pain does not seem to respond, despite the administration of powerful medical treatments, it is highly likely that psychological, relational and spiritual factors are involved, and these must be addressed. Many of the tragic high profile cases of apparently ‘uncontrollable pain’ that are used by campaigners to promote the need for Assisted Suicide, seem to be cases where psychological, relational and spiritual factors dominated.”

Pioneers like Dame Cicely combined the latest research into painkilling with meticulous attention to detail, caring for symptoms like dry mouth, nausea and itching. Patients had access to human contact and were encouraged to enjoy hobbies and their own interests. Family members were to be present as often as possible. All patients were invited to simple worship services, often attending in their beds or wheelchairs, in the chapel which stood in the middle of the hospice.

Underpinning her advocacy was her strong Christian faith, with its emphasis on the immutable and intrinsic dignity of human beings, irrespective of life’s cirucmstances.

She said herself: “you matter because you are you, and you matter to the end of your life.”

Cicely Saunders fundamentally changed the way we look after the dying. Her biographer, Shirley du Boulay, said she proved that “it was possible to live a lifetime in a few weeks; that time is a matter of depth, not length; that in the right atmosphere and with pain controlled so that the patient is free to be herself, the last days can be the richest, they can be a time of reconciliation that makes the dying

peaceful and the mourning bearable.”

Her watchword was: “there is so much more to be done”. The UK consistently ranks as a world leader in palliative care, and as of 2022, every patient has a legal right to specialist palliative care in England and Wales. But research carried out by the Cicely Saunders Institute suggests that 215,000 people miss out on end-of-life care each year, a figure which will rise with our aging population.

It was estimated in 2015 by Deloitte that around £4.5 billion was spent annually on end of life care. It represented just over 1% of the NHS budget for that year (and is far less than we spend on research trying to find a cure for cancer). The problem for our nation is not financial resources: it is our priorities.

The All-Party Parliamentary Group on Hospice and End of Life Care wrote in a report in January 2024 that NHS commissioning of hospice services is “currently not fit for purpose”. They also described a “postcode lottery”: there are over 220 hospices in the UK, and they rely upon charitable donations to exist, receiving more money from the charity sector than they do from the government. In more economically-deprived areas, people were less likely to be able to donate to their local hospice. Such inequality among those who are most vulnerable is a tragic commentary on our society.

CARE has always championed palliative care and the hospice movement, because alleviating suffering and showing compassion matter. There will always be hard cases in a fallen world where disease and sickness exist. But we want to show the love of God as best we can by caring and supporting people at the very end of their lives. As Dame Cicely herself said, “We will do all we can not only to help you die peacefully, but also to live until you die.”

27

7 Ways to Pray about Assisted Suicide Sunday Lord of justice, we intercede for MPs over these upcoming months as they repeatedly consider Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill. Please reveal this Bill’s flawed promises of ‘safety, choice and protection’, potential to pressurise people to agree to Assisted Suicide and not be a burden, and the danger of ‘a slippery slope’ towards full-blown euthanasia. Even though it has passed at Second Reading, we ask that You would overturn this result at future stages of the process. For Jesus’ sake, Amen.

Monday Sovereign God, as political and public debate becomes more intense, please raise up respected medical and other experts to bring strong arguments that expose the dangers of permitting Assisted Suicide, persuade the professional Colleges to maintain their stance against it and encourage more people to contact their MP. In Christ’s name. Amen.

Tuesday Father, we pray that in this ongoing debate, there will arise greater advocacy and moral support for individuals with life-limiting and terminal conditions as well as adults and children with serious disabilities who may feel under pressure to end their lives. May they be increasingly heard, appreciated and supported by us all. In Your mercy. Amen.

Wednesday Lord, in a climate of financial restraint and growing demands on the NHS please provide the finances, staff and volunteers to keep UK hospices going; offering individual holistic care for those nearing the end of life in a peaceful, compassionate atmosphere. We intercede for palliative care to be available for all who need it. For Jesus’ sake. Amen.

Thursday Loving God, thank You for the dedication and skills of those working in palliative medicine, therapy, respite care, bereavement support and other services for patients and families.

Please bless them as they work in hospital wards, care homes for elderly people, hospices, and patients’ homes. Grant Your presence and peace. By Your grace. Amen.

Friday Eternal Father, we intercede for tragic situations in Belgium, Canada, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland and parts of the United States where Assisted Suicide was made legal but the criteria is now expanded to include vulnerable people who are depressed, disabled and even just homeless. In Your mercy. Amen.

Saturday Holy Spirit, please draw near to those who are dying. Grant that they may have the opportunity and experience Your kindling of desire in their hearts to make their peace with You and receive Your forgiveness and love. We especially ask You to comfort and relieve suffering of body, mind, heart and spirit. In the name of Jesus our Saviour. Amen.

28

“Let us draw near to the throne of grace, that we may receive mercy and find grace to help in time of need.”

Hebrews 4:16

For further research...

Liz Carr, BBC: Better off dead?, 2024 Fault Lines: Do you want to die today?, 2023 Timothy Keller: On Death, 2021 Ian Knox: Finishing Well: A God’s eye view of aging, 2020 Louise Morse: Dementia: Pathways to hope, 2016 Nancy Pearcey: Love thy body, 2019 Vaughan Roberts: Assisted Suicide, 2017

John Swinton: Dementia: Living in the Memories of God, 2012 John Wyatt: Matters of life and death (2nd ed.), 2012

John Wyatt: Dying Well, 2018 John Wyatt: The Final Lap, 2023 29

“Let us not grow weary in doing good, for at the proper time we will reap a harvest if we do not give up.”

Galatians 6:9

30

Working in a postAssisted Suicide world Ross Hendry, CEO of CARE The second reading of the Terminally Ill (End of Life) Adults Bill was a historic moment in our national life.

I do not believe that saying so is hyperbole, for 29 November 2024 marked the first time a Bill to legalise Assisted Suicide had ever won a majority in the House of Commons. Culturally and politically, a Rubicon has been crossed.

It is tempting to view this as a wholly challenging and negative development. Yet even in the midst of darkness, there might be sparks of light and hope, if we are willing to be faithful and courageous, creative and collaborative, and pioneering and prophetic.

Let me suggest three ways in which at CARE, we intend to lead and contribute to an alternative ‘better story’ on end-of-life issues, and where we can offer realism, grace, and hope.

In doing so, I hope that we can be the catalyst for a wider movement to rise up in response to the environment we now find ourselves in.

First, we will continue to fulfil our mission to call out bad laws and promote good legislation and government action. We will not step back from seeking to protect the vulnerable, marginalised, and exploited from the harm that Assisted Suicide brings. If legislation on Assisted Suicide is passed, we believe it can be reversed. And even where or when this is unlikely, we will continue to draw attention to how legislation is working in practice.

Those who have sought to attack CARE and other faith-based organisations and individuals attempt to portray Christianity as ideological and ignoring evidence. Nothing can be further from the truth. We love truth and affirm evidence-based law making.

There is nothing to suggest that the UK will be different to other jurisdictions where similar laws have been abused and diluted, and are placing more people at risk. We will resist any

expansion of this deadly franchise, seek its reversal, and highlight evidence of harm.

We will present this to policymakers and to the Church. It is essential to do both, because it is a sad fact that where Assisted Suicide is legalised, it often becomes normalised in both society and the Church. We must guard against this by looking back to God’s Word, borne out in experience and evidence, so that the Church remains a distinct witness in its theology, its ethics, and its practice.

And practice will be an essential part of our response. A change in the law presents a mighty challenge – but also a real opportunity for the Church to be a light in the darkness.

If we cannot rely on public services and the State to be a safe haven for the vulnerable, and to protect life rather than to seek its premature end, we will examine what we can do in response. It is essential that people have access to spaces in which they are not surrounded by the prospect of Assisted Suicide.

At the heart of this approach must be a fully-funded palliative care system, separate from Assisted Suicide provision, in which people can be supported and cared for to the end of their lives. But we also want to see similar protections for hospices, hospitals and faith-based care programmes which might desire them. This may not be something we can provide ourselves, but we can facilitate relationships and discussions, and advocate on behalf of all who want to be fully protected from the dangers of Assisted Suicide.

Maybe this is not where we want to be, but it is where we have been placed and to where we are called. Up until now we have listened, learned, educated and campaigned faithfully.

Looking ahead, the challenges may be great, and faithfulness be more costly and require sacrifice, but “let us not grow weary in doing good, for at the proper time we will reap a harvest if we do not give up.” (Galatians 6:9) 31

Donate to CARE Scan here, or visit care.org.uk/donate. Your donation to CARE enables us to continue to work towards a culture and society reflecting a better story for everyone.

care.org.uk

careorguk

CARE (Christian Action Research and Education) | Chief Executive Ross Hendry | Co-Founder Rev Lyndon Bowring | 53 Romney St, London, SW1P 3RF | 020 7233 0455 | mail@care.org.uk CARE is a company limited by guarantee registered in England and Wales at 53 Romney Street, London, SW1P 3RF Company No: 3481417 | Charity No: 1066963 | Scottish Charity No: SC038911 CARE is strictly politically neutral and does not advocate on behalf of any particular party or candidate.All content in this booklet is accurate as of December 2024.

Image Credits: Front Cover: Sir Keir Starmer MP, The Prime Minister (Holborn and St Pancras, Labour), 24/07/2024 ©House of Commons. Used under the Attribution 3.0 Unported (CC BY 3.0) license.

Pages 26 and 27: Photos of Dame Cicely Saunders provided by St Christopher’s Hospice (www.stchristophers.org.uk/about/ dame-cicely-saunders/media/)