The General Synod of the Church of England yesterday supported a motion opposing the Commission on Assisted Dying’s recommendations regarding assisted dying, and claiming, mistakenly, in my view, that it was insufficiently independent to protect the interests of the vulnerable, the vote going 284 to none, with 4 abstentions. The problem with the Commission’s recomendations does not lie in its lack of independence. In what may be considered the deciding speech, the Archbishop of Canterbury called on Synod members to vote against the proposal of the Commission on Assisted Dying to change the law in such a way as to enable those with a terminal condition (with a prognosis of 12 months left to live) to choose assistance in dying, and to reaffirm the church’s stand in opposition to assisted dying under any circumstances, as well as to reassert the church’s conviction that British palliative care provisions for the dying are second to none in the world, and thus offer a satisfactory resolution to the worries of those who are appealing for assisted dying. (The archbishop’s speech and the General Synod motion is accessible here.)

Strange as it may seem, I agree with at least part of the decision of the General Synod, and for at least one of the reasons given by the archbishop. In his speech he said:

To say that there are certain conditions in which life is legally declared to be not worth living is a major shift in the moral and spiritual atmosphere in which we live.

As I said in an earlier post, the position, adopted by the Commission on Assisted Dying, that terminal illness within one year be a necessary condition for permitting legalised assisted dying, puts the emphasis in the wrong place, by defining a class of people of whom it may be said that their lives are no longer worth living. The decision as to the value of a life should not be made by the law, nor by any officer of the law, but only by the suffering persons themselves. Saying that terminal illness within 12 months is the sine qua non is altogether the wrong way to go, and could conceivably be dangerous, since it seems to make terminal illness itself an objective measure of the value of life.

Those who support assisted dying often make the same mistake. Dignity in Dying, the British advocacy organisation seeking a change in the law, accepts this position. Indeed, Dignity in Dying defines assisted death in precisely these terms:

An assisted death is where a doctor prescribes a life-ending dose of medication to a mentally competent, terminally ill adult at their request, and the patient then chooses to administer the medication themselves.

And then assisted dying is specified more clearly:

Assisted dying is different to euthanasia and assisted suicide. Euthanasia is a term often used to describe life ending medication being administered by a third party. Assisted suicide refers to providing assistance to die to someone who is not dying.

What is being missed here — and it is a serious lacuna in Dignity in Dying’s understanding of what assisted dying should be — is the voluntary nature of assisted dying, and its relation to the choice of the person involved and that person’s own assessment of the continued value or disvalue of staying alive. Making assisted dying dependent on any one feature, aside from the person’s own reasoned conclusion that their life is no longer worth living, is to endanger all those who fall within the class possessing that feature – in this case, terminal illness. The Archbishop of Canterbury is right in this case, but in practically every other respect his speech to the General Synod on Tuesday (6th February 2012) is hopelessly muddled and misleading. Despite his vaunted intelligence, Rowan Williams continues to get this part wrong, a wrongness which is entirely due to the fact that he is still looking through faith-coloured glasses even when he most pretends to be secular.

Why can’t he get it right? There are two basic reasons. First, there is the hospice myth, and the belief in Britain’s pre-eminence in this area of medical care. As the archbishop said:

Our level of palliative care in this country remains the envy of Europe, if not the whole world, and I want to say very emphatically that anything which prejudices or jeopardises that level of palliative care is to be resisted with all our power.

I simply have no idea whether palliative care in Britain is the envy of the whole world, but that is strictly irrelevant to the point he is trying to make. There is simply no inconsistency between good palliative care and assisted dying. Assisted dying is about choice, not about standards of care. It may be, of course, that lack of adequate care and pain control at the end of life may contribute to the decisions of some individuals to seek assistance in dying, but there is no reason to believe that this is the or even a primary reason for requesting assisted dying, and there is no inconsistency between a person receiving top flight palliative care and still requesting assisted dying.

Anyone who has read Julia Lawton’s The Dying Process will understand why. Lawton is an anthropologist who spent six months doing field work in an English hospice. The conclusions of her study show clearly that, while palliative care does offer important care to those who are dying, the hospice myth, despite the many failures of hospice care to achieve it, is still very strong. The myth consists in

… an image of dying in which others wish to believe; an image which can be sustained precisely because the suffering that patients actually experience may be hidden away in in patient facilities, eluded and avoided in wider culture discourses which elide suffering into pain, or mystified and idealised in cultural scripts that elevate dying to a ‘heroic status’. [182]

This idealisation of dying as living fully until death is a far cry from what often happens to people as they die, as so much of the evidence in Lawton’s book testifies. As she says:

In highlighting the ‘bodily realities of dying’ this study raises the question whether, in the end, a ‘dignified death’ is something we can ever realistically hope for, let alone expect. [182]

And it is intolerable that in places like the General Synod, people like the archbishop can get away with speaking of palliative care in general terms which conceal the reality of dying for so many.

This is one side of the archbishop’s misrepresentation of the processes of dying, and the omnicompetence of palliative care in dealing with them.

The other problem with the archbishop’s position is that it is largely just a matter of scare-mongering. Law exists, the tells us, to protect people, and especially the vulnerable. And then he says, in a statement that can be interpreted in two ways:

… when the law seeks to move outside that sphere [of protecting people] it exceeds its proper functions.

What he is suggesting is that when the law sets out to enable assisted dying it extends beyond its mandate, suggesting thereby that, by extending beyond its mandate it puts people at risk rather than protecting them. As he says:

What we are faced with in these proposals from the Commission is a legal outcome in which protection is diminished, not only for vulnerable individuals but also for medical professionals.

And, to the extent that the Commission proposed criteria which would in fact define the lives of certain people as in some sense inherently no longer worthwhile, he is right. But this is not the reason that the archbishop has in mind. This is the old saw that assisted dying legislation would put the disabled, the mentally challenged, and others who are unable to care for themselves at risk. But this is just scaremongering, as Tom Chivers says over at the Telegraph. What we need, he says, is grown-up arguments, not scaremongering. Of course, Chivers makes his respectful nod in the direction of the complexity of the arguments involved, as journalists feel compelled to do, but in this respect at least he is right. The archbishop’s scaremongering is itself a diversion. There is no evidence that the so-called “vulnerable” are in any danger from assisted dying legislation, and those, like the archbishop, who use this kind of argument, simply have not been paying attention. Indeed, Chivers gives some detailed statistics that show beyond a doubt that this is not a worry. And this leads us to the second interpretation of the archbishop’s words. For when the law is used, in the way that it is, to protect people who don’t want that protection, but want to be helped to die, the law is, in the archbishop’s words, exceeding its proper functions.

Important evidence for the archbishop’s argument comes, he thinks, from the case of abortion. In 1967 Parliament (UK) passed the Abortion Act 1967, a private member’s bill which was supported by the government, and specified that abortion would be permitted, subject to the conditions:

(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or

(b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or

(c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or

(d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

The expectation of many people was that, given these restrictions, the number of abortions would be very few, and yet, as many church commentators have said, “what was never foreseen was that legislation to allow abortion in ’hard cases’ would lead to 200,000 legal abortions a year” (as Paul Badham says in his book, Is there a Christian Case for Assisted Dying, 50), and it is precisely on this ground that the archbishop suggests that laws governing assisted dying would likely produce the same result. Legalised for exceptional cases, the law would gradually extend to more and more cases until, in the end, the result would be a disaster. As he says:

The default position on abortion has shifted quite clearly over the past 40 years, and to see the default position shifting on the sanctity of life would be a disaster.

However, the notion that this was, in reality, the default position rested on a mistake. Abortion is a matter of the rights of women to control their reproductivity, and anyone who was knowledgeable about illegal abortion in Britain in 1967 must have known that the ‘hard case’ assumption did not reflect the reality of abortion in the UK at the time. While I do not have the book with me, it has been estimated that there were as many illegal abortions in Canada before Canada’s abortion legislation was struck down as there were legal abortions following the 1988 decision of the Supreme Court of Canada that the law was unconstitutional. I assume that much the same could have been said about the UK in 1967. The analogy with what is likely to happen if assisted dying were legalised simply does not hold, and its repetition by churchman like the archbishop of Canterbury is simply misleading.

The real reasons for the archbishop’s and the church’s opposition to assisted dying lies in their belief that every life is infinitely valuable in the sight of god. As Rowan Williams said in his speech to the General Synod:

We are not, as I say, committed to the notion — the eccentric notion — that Christians believe that we should cling to life at all costs. We are committed, as Christians, to the belief that every life in every imaginable situation is infinitely precious in the sight of God. To say that there are certain conditions in which life is legally declared to be not worth living is a major shift in the moral and spiritual atmosphere in which we live. [my italics]

This is actually a self-contradiction, for if “every life in every imaginable situation is infinitely precious in the sight of God,” then it does in fact follow that he is “committed to he notion — the eccentric notion — that Christians believe that we should cling to life at all costs,” and if he can’t see this, he doesn’t know the meaning of the word ‘infinite.’ If every life is of infinite value, then every moment of every life is of infinite value, and so the Christian, believing that every life is of infinite value, must cling to life at all costs. And it is for this precise reason that the church and the archbishop are opposed to assisted dying.

Once again, to recap: I agree with the archbishop that the proposal of the Commission on Assisted Dying is dangerous. To make assisted dying contingent upon terminal illness with only twelve months to live is to devalue those who are in that condition. Assisted dying should depend on an individual’s judgement that, for any number of reasons, life is no longer worth living. This would not, of course, include those who are going through episodic periods of depression which are remediable, but it might include someone with many years of incurable depression, whose life is made a misery by a mental condition that cannot be remedied. But, in any case, the scope of any law governing assisted dying should not be defined in terms of terminality, but in terms of the personal decision of someone that their life is no longer worth living, and by some reasonably objective assessment, not that that person is right so to believe, but that that person is not irrational so to believe. By restricting the law in such a way, there is no danger of defining specific condition which are, in terms of the law, already deemed no longer worth living in some objective sense. That the archbishop and the Falconer Commission, and so many others in the debate about assisted dying cannot see this is a sign that they are not paying attention. In much of the evidence presented before the Commission on Assisted Dying, this was made clear. That they failed to act on this evidence is a sign that the scaremongering of the disability lobby, which is, in general, a pressure group organised by the religious opposition to assisted dying, and does not in any sense represent all disabled people, has done its work, even though, in acceding to the demand of this lobby, the recommendations of the commission were fatally compromised. So, once again, religion plays its role as a poisoner of public debate. The Archbishop of Canterbury’s blindness on this issue was the straw that broke the camel’s back of faith for me in 2006. He still does not disappoint in this respect. Religion does, as Christopher Hitchens says, poison everything. Everything it touches turns to dross. This might be called the Theologian’s Stone — in contrast to the Philosopher’s Stone, which, in legend, would turn everything to gold.