Theos have produced a new report: Dignity at the End of Life: What’s Beneath the Assisted Dying debate? This is a guest post by its author, Andrew Grey.
Assisted dying is a topic that seems to be constantly debated. Most recently, the British Medical Journal had a series of articles on the topic, and the Noel Conway case has kept the issue in the news.
For many people, it’s an issue about whether people have dignity in death. When the US state of Oregon legalised assisted dying, the law was entitled the ‘Death with Dignity Act’ (1997). The Swiss clinic where people famously have gone for an assisted death is named ‘Dignitas’.
Here in the UK, dignity is equated with assisted dying by the campaign group ‘Dignity in Dying’. It was originally the Voluntary Euthanasia Legalisation Society, but changed its name in 2005. This was, of course, a very effective marketing move – ‘voluntary euthanasia legalisation’ sounds controversial, but who can argue with a campaign for dignity for those who are dying?
But what does ‘dignity in dying’ really mean? The organisation claims to be campaigning for three things:
- CHOICE over where we die, who is present and our treatment options.
- ACCESS to expert information on our options, good quality end-of-life care.
- CONTROL over how we die, our symptoms, pain relief and planning our own death.
It’s clear that choice and control are central to this description of dignity. It’s a quintessentially modern interpretation of dignity, with a characteristic emphasis on the individual and autonomy.
If we accept this definition of a dignified death, we have to accept two further conclusions:
- Any death with choice, control and access to expert information is dignified.
- Any death without these three things cannot be dignified.
But both of these are hugely problematic.
Beginning with (1). Under this definition, could we not describe as dignified the suicide of a girl in her 20s whose family and community won’t accept her sexuality? If she chooses the method of her suicide and has control over where, how and when it happens – and even minimises the suffering she endures by choosing the least traumatic method she has researched – all the criteria are met.
Or consider the real-life case of Bernd Brandes – a German computer engineer who famously advertised that he wanted to be killed and eaten. One evening in March 2001, he went to the home of Armin Meiwes in Rotenburg, and the events which followed culminated in him being killed and eaten by Meiwes. All of the evidence (including video) suggests that the events happened with Brandes’ full consent.
If choice and control are what truly characterise a dignified death, both the tragic suicide of a young woman and the fully consensual act of cannibalism can (at least under the circumstances set out) be considered dignified.
You might object that these are extraordinary cases, so it’s hard to relate them to the issue of assisted dying for the terminally ill. But this definition of death with dignity has implications for the deaths of thousands of people in the UK every day. If ‘dignity’ means that people need to choose and control where and how they die, and this is currently illegal in the UK, then everyone in the UK must die without dignity.
This sounds implausible – and it is. The professionals who care for people at the end of life all testify to many of the people they care for having dignified deaths.
To understand how, we need to look to the origins of ‘dignity’, before it became equated with modern notions of individual autonomy (a concept explored in the first part of my report). Its origin is in the Latin dignitas, meaning ‘worth’. From a Christian perspective, dignity is an inalienable worth belonging to every human being, demonstrated in their being made in the image of a God who loves them. In contrast to a false notion of dignity based on the individual and his or her autonomy, this understanding of dignity is rooted in relationality: a person’s dignity is best honoured by them feeling valued.
For the professionals I interviewed, this was clearly demonstrated in how they cared for people at the end of life. They honoured people’s dignity by listening to them and showing them that their lives mattered; what they’d done, their likes and dislikes, their beliefs and values, and the people they loved.
This understanding of dignity in death stands in stark contrast to that of some advocates of assisted dying, for whom it is an efficient alternative to the costly and burdensome option of caring for people until they die naturally. This isn’t just a ‘straw man’ to make advocates of assisted dying seem inhumane – it was an argument made by one of Britain’s leading moral philosophers, Baroness Mary Warnock, in 2008, about people with dementia. For Baroness Warnock, if you have dementia, “you’re wasting people’s lives – your family’s lives – and…the resources of the National Health Service”, and may even have a ‘duty to die’. I’ve heard MPs privately express similar opinions.
But here’s the rub for those who oppose legalising assisted dying (including the MPs who voted against it in 2015): they need to show that they are committed to true dignity at the end of life. That means advocating for investment of the necessary time, money and resources for end-of-life care professionals to show every dying person that they truly matter – by properly listening to them, finding out what they most need (physically, emotionally, psychologically and spiritually), and supporting the people they care about too. That’s what dignity in dying really looks like.