One of the things that having Scott McKenna’s comments have done for me is to force me to focus more attention on assisted dying. Of course, this blog is about that, but it’s also about opposing the interference of the religions in the right-to-die, and sometimes my opposition to religion gets the lion’s share of attention. I don’t regret that, because I do believe not only that religion is one of the biggest obstacles to assisted dying, but that, in other respects, religion is a harmful influence on society, and we would be better off if the religions would take an appropriately marginal place in society, and stop trying to impose their priorities on the rest of us. But I also acknowledge that I have not done as much work on assisted dying as I should have done, so the last few days have taken up the slack a bit, and I have Scott McKenna to thank for it.
I think it is important to note that Scott has received complaints from “head office” about his speaking out in favour of assisted dying, as he mentions in a comment. So, his standing with those who support assisted dying has not been without some cost for him, but, as he says, “head office” isn’t the church. There are people who don’t hew to the party line, and they are part of the church too. Indeed, we know this is true, for, despite the fact that the United States Conference of Catholic Bishops tried very hard in the recent election to convince their members to support Mitt Romney, a majority of them, going by exit polls, did not. So, some Christians are better than their “head office” with their more worldly concerns of power and influence, and it is only fair to point this out, since my temptation sometimes is to tar all Christians, indeed, all religious people, with the same brush, and it is good to remember that many religious people, while remaining, according to their lights, loyal to the best that they see in the message of their religion, do not support the more extreme stands of their leaders.
Of course, one problem with this is that, by remaining in the church, those who oppose the church’s policies give the kind of support, in terms of numbers, that gives weight to church leaders when they speak in public and insist on being taken seriously by politicians and others in charge of public policy. For the churches, remaining relevant, in the sense of maintaining a powerful lobby position with the powers that be, is very important, since once you are truly marginalised, and no one in civil authority is listening to you, the less likely it is that you will be able to help shape laws which reflect the moral preferences of your particular organisation. A lot of people right now are saying that the Church of England has fouled its own nest, and has lost credibility, because, after decades of effort, the bid to enable women to be consecrated bishops has failed. A lot of people will feel that the Church of England is no longer a place for respectable people, because persisting in its rather petulant opposition to women bishops, while allowing women priests, they are showing a kind of selective sexism for which there is no justification. Needless to say, the Roman Catholic Church is worse in this respect, because they won’t allow women to become deacons let alone bishops, and, what with the latest scandal in the form of allowing a woman in Ireland to die, instead of performing a therapeutic abortion (of a miscarrying foetus), the message of the Roman Catholic Church about the value of women has been made rather brutally clear. I’m amazed that people still belong. Hilary Mantel, a few weeks ago, said that the Roman Catholic Church is no longer fit for respectable people, and I’m inclined to agree. If the only way to force change in the church is to refuse to associate with it and its antediluvian beliefs, then disassociation should be the order of the day.
My own breaking point came, as some people will know, when I read the Archbishop of Canterbury’s speech to the House of Lords in opposition to Lord Joffe’s Assisted Dying for the Terminally Ill Bill. In the course of that speech, Rowan Williams expressed the now standard position of the church — though he didn’t give it this name — called the “Sanctity-of-Life” doctrine. And here is how he put it.
All religious people hold, [he said] that there is no stage of human life, and no level of human experience, that is intrinsically incapable of being lived through in some kind of trust and hope.
He doesn’t state the point as starkly as some people do, because you could read this and miss the point that he is trying to make. It was an occasion for fudge. If he had stated the sanctity-of-life doctrine too boldly, he would probably have lost some support, but this is the sanctity-of-life in miniature, which holds that all life is sacred, no matter what stage of life we are thinking about, and regardless of the kind of experience that life is subject to.
However, as I have said, it is not as strongly put as some people might have wished. The real point that is being made by those who support sanctity-of-life considerations is that the value of life is not dependent on the quality or kind of life being lived. All (human) life is sacred, in sanctity-of-life terms, whether it is life in excruciating pain, or comatose life, or the life of a zygote, and we have an obligation to do everything we can to preserve life, regardless of its quality or kind. The American theological ethicist Paul Ramsey put it like this:
One grasps the religious outlook upon the sanctity of human life only if he sees that this life is asserted to be surrounded by sanctity that need not be in a man: that the most dignity a man ever possesses is a dignity that is alien to him. . . The value of a human life is ultimately grounded in the value God is placing on it. . . The sacredness is not composed by observable degrees of relative worth. A life’s sanctity consists not in its worth to anybody. . . [quoted in Keyserlingk, Sanctity of Life or Quality of Life, 11]
Notice that last sentence. “A life’s sanctity consists not in its worth to anybody,” including the person whose life it is. This is why sanctity-of-life is thought to override people’s own wish to die when their suffering has become intolerable, because the value of their lives has nothing to do with the value they place on them, but the intrinsic value that they have, regardless of their “owner’s” or anyone else’s opinions as to their value.
And so it follows that no one is the owner of their own life, and that people must be subject to restrictions as to what they can do with their lives. This used to be expressed by laws criminalising suicide, and while we do not, at least in Canada, have such laws any longer — although the law decriminalising suicide is very recent, having been passed by Parliament as recently in 1972! — this does not mean that the law legalises suicide; it was simply no longer thought advisable, as a matter of public policy, to convict people of attempting suicide. Successful suicides put themselves outside the reach of the law, although that was not always the case. At one time, the body of a suicide used to be treated in all sorts of contumacious ways, and his or her family was often rendered destitute, since the suicide’s estate was destrained by the state.
The question for the moment is: Can you still retain the sanctity-of-life principle and still support assisted dying? Scott McKenna says that this is possible. With the greatest respect, I do not think this makes sense. In his speech at the Royal Society of Edinburgh Scott McKenna essentially said that Christians and other advocates of that doctrine can both have their cake of sanctity and eat it too, suggesting that there is no conflict between the sanctity-of-life doctrine and the right to die, because, as he says, God has given us moral responsibility, so it is up to us what we do with our lives. And if they have become intolerable to us, and we seek relief by bringing our lives prematurely to an end, then that is a degree of moral freedom that God allows, because he has turned over responsibility for our lives to us. If that made sense, I would be only too happy to support Scott in his attempt to change the law in Scotland to legalise assisted dying. Well, I do support him, though I think he is on very shaky ground. Mind you, I think Margo MacDonald’s bill, limiting assisted dying to the terminally ill, is wrong, but, it might be said, it is at least a beginning. Pass this law now, and later people may be willing to consider broadening the terms of the bill, so that people with terrible degenerative diseases, whose quality of life has been diminished to breaking point, will eventually be recognised as legitimate candidates for assisted dying too. I think that’s wrong, politically, but that is not my subject here. My question, as I have stated, is whether assisted dying is compatible with the sanctity-of-life doctrine. I do not think it is.
The reason for saying this is simple. The sanctity-of-life doctrine basically states that quality of life considerations are irrelevant to what we are required to do with respect to the preservation and prolongation of life. That’s why Keyserlingk’s book (written originally on behalf of the Law Reform Commission of Canada) is entitled Quality of Life or Sanctity of Life. It’s a strict either/or question. If what you do for a patient is governed by quality of life considerations, then sanctity-of-life considerations are out the window. On the other hand, if you govern what you do for patients by sanctity-of-life considerations, then there is no room at all for considering the quality of life ramifications of your decisions. Indeed, according to the sanctity-of-life doctrine, the degree of pain or its duration is irrelevant to the question of care for that patient. The only choice, on sanctity-of-life grounds, is that every minute more of life is an unquestionable good, and therefore the physician must do everything possible to wring every last second of life by all the means available — and with highly technological medicine, those means are considerable. And this goes even for a very defective new born, whose short life is going to be one of constant pain and distress. No help may be given to such a new born baby to die, and put it out of its misery. Everything must be done to preserve and even lengthen its suffering, because, by sanctity-of-life considerations, every second of life is as valuable as any other second, and two hours of excruciatingly painful life is better than no life at all.
Intuitively, of course, this simply sounds mad, but these are the criteria that were applied to the “baby” in Ireland, whose life was considered so valuable that a woman was killed in order to prolong “its” life. That “pre-born” baby, to use the ridiculous jargon of the “pro-life” people (which, for emphasis, I call the “death cult”), had a life, so long as there was a heartbeat, which was equally valuable to the life of the woman. Every second of that “pre-born” baby’s “life” was of equal value to the life of the woman in whose body the miscarrying “pre-born” baby was living. The hospital authorities in Galway are going to make the rules more explicit, but, according to the sanctity-of-life doctrine, the policy of the hospital and the actions of the medical staff were perfectly in accordance with the sanctity-of-life doctrine.
What’s the problem here? And why can’t the sanctity-of-life doctrine be stretched so that these consequences don’t follow? Well, the simplest way to put it is this. The only way that you can justify suspending the sanctity-of-life conditions is to advert to quality of life considerations. In the case in Ireland, for instance, where there was no chance that there would be a baby which was going to survive, Savita Halappanavar’s life was sacrificed on the altar of a narrow-minded morality that cannot take quality of life into consideration. There was going to be no baby who would ever have had a quality of life outside the womb. The only life that “pre-born” entity would have would be limited to whatever experiences, if any, it would have in the womb for the brief time left to it. Ms Halappanavar, however, if the medical staff had not been hamstrung by the Vatican’s absurd stand over the value of life, any life, no matter of what quality, might have gone on to live a life full of pleasure and accomplishment.
Instead of that, she was killed. And that’s the important thing to notice here. Despite the value placed on life by the Vatican, Ms Halappanavar was killed as surely as if the doctors had held a loaded gun to her head and fired, simply because they were not allowed to think (or would not let themselves think) in terms of quality of life. Every moment of life is, from the point of view of the sanctity-of-life, of infinite value. That being the case, since any division of infinity is also infinite, they couldn’t make a decision for the woman and against that tell-tale beating heart of the dying “pre-born” baby. The result seems completely bizarre, but it is implied by the sanctity-of-life doctrine. The problem here, and Scott McKenna, much as I admire his pluck and humanity, is stuck with it, if he wants to continue arguing from the sanctity-of-life position, is that the sanctity-of-life doctrine does not permit the intrusion of quality of life considerations, for, once you do that, you have really surrendered the sacredness of life. The Archbishop of Canterbury knows this, which is why he worded his sanctity-of-life doctrine in a deceptive way in order to get it under the radar of the House of Lords. Had he spelled out the implications of what he was saying, he’d have lost votes, so he didn’t. But his point is the same as the pope’s, and no doubt was cheered on from the sidelines by Roman Catholics and others who also believe in the sanctity-of-life.
The truth, of course, as Scott McKenna rightly says, is that we have moral responsibility, and moral situations are often messy and difficult to navigate. Having an absolute hidden somewhere amongst your moral principles doesn’t help with finding the best answer to the moral problems which are constantly thrown up in the course of medical decision-making. McKenna wants to keep the sanctity-of-life doctrine in there, because then it looks as though he is not abandoning the Christian conviction that the value of life does not derive from its nature or quality, but from something completely external to ourselves. But the simple truth seems to be that, once you allow quality of life judgements to affect your moral decisions, you are stuck with quality of life considerations from that point on, because there is no way to make exceptions to sanctity-of-life rules without bringing in quality of life considerations. That, of course, will take some showing, but I think it is true. Attempts are always being made to distinguish cases where letting someone die is not equivalent to killing them. Here’s where the law of double effect comes in. You do one thing intending, say, relief of pain, knowing that a “secondary” effect will be the shortening of life. This is supposed to get you off the hook, but it doesn’t work. You’re still on the hook no matter how hard you fight it, and wriggle and try to dash away. There is no room here to show this, but I am convinced it is true, and so, once you have introduced quality of life as a criterion for decision making in some situations, there is nothing that can keep you from introducing it elsewhere. This doesn’t mean that just anything goes, but it does mean that we are not dealing with absolutes, and that is why Margo MacDonald should rethink her legislation, because it is internally inconsistent. If quality of life at the very end of a person’s life, when they have a terminal diagnosis, is a good reason to allow that person to receive aid in dying, then quality of life, at any stage of life, should be a good reason to allow a person to receive such help. It’s not a matter just of being terminally ill. It’s a matter of the suffering involved, and when someone has determined that their suffering is intolerable, and it is clear that only death can bring that suffering to an end, then it follows that suffering and choice are the only relevant variables here, and that terminal illness has nothing to do with it. But that is entirely a quality of life consideration, and has left the sanctity-of-life doctrine behind long ago.