There is nothing holy about agony: religious people and leaders support assisted dying too: George Carey in the BMJ

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9 Sept 2021 A new alliance of faith leaders has formed to ensure the voice of religious proponents of legalised assisted dying is heard. The former Archbishop of Canterbury George Carey and rabbi Jonathan Romain argue that nothing in the scripture directly prohibits assisting a death to end suffering

We are leaders of a new religious alliance in support of doctor assisted dying (along with Archbishop Desmond Tutu and Reverend Canon Rosie Harper). We have launched this initiative because we are concerned about the impression being conveyed that all faith groups are implacably opposed to changes in the law to help people longing to die on their own terms, without discomfort, indignity, or extreme pain. This is not the case. A massive change is going on in religious attitudes to assisted dying (by which a person is given a prescription for life ending drugs, which they themselves then order and take). Not least the fact that most church goers are in favour of assisted dying; a 2019 poll, for example, found that 84% of the British public, 82% of Christians, and about 80% of religious people overall supported assisted dying for terminally ill, mentally competent adults.1

Far from being modern, the problem of having to endure a painful end to your life has long been recognised in religious circles. The Book of Ecclesiasticus, for example, which is accepted in the Roman Catholic canon and is non-canonical but esteemed for Jewish and Protestant people, even expresses the view that “Death is better than a miserable life, and eternal rest than chronic sickness” (30:17).

More than physical suffering

A key motivation for people who want to die is the desire to avoid pain. It is not just physical suffering that appals them, but a range of other situations: the humiliation (in their eyes) of failing powers; the limitation of their ability to enjoy life; their dependency on other people; the lack of control over their bodily functions; the sense that they have nothing to look forward to, except ever worsening decline; and the unwelcome image of being sedated into a state of narcotic stupor in their final days, or with their bodies sprouting a forest of tubes.

Of course, many people regard such a death as a regrettable part of the natural cycle of life, to be mitigated through medical care if possible and to be endured if not. That is entirely their prerogative and must be respected. But should people who want to avoid pain and indignity in death have the right to do so? And should other people have the right to prevent them making that choice about their own life?

Who chooses when?

A biblical passage that—deliberately or accidentally—may be relevant to the challenge today is the famous line in the Hebrew Bible and Old Testament: “There is a time to be born and a time to die” (Ecclesiastes 3.2). Notably, it does not say who chooses that time. In previous eras, theologians and leaders assumed that both were pre-ordained by God and that any human interference was sinful, but now it can be read differently. The time to die could just as well be our decision.

Some mainstream faith leaders might claim that this is contradicted by the verse from Job: “God gives and God takes” (1:21), and we cannot usurp that prerogative. Yet the God barrier has long been pushed aside both at the beginning and end of life, with humans acting in lieu of God, whether by doctors’ efforts to create life using test tubes or to postpone death through heart transplants.

If the religious ideal is to imitate God’s ways, then it is our duty to use our God given abilities as much as possible. We could argue, therefore, that assisted dying is part of the constant act of playing God in the sense that God wants us to help people in distress: to heal where possible, to comfort when needed, and to help let go of life when desired—this is what being religious means.

Sanctity of life

Belief in the sanctity of life—in other words, how precious it is—does not mean believing in the sanctity of suffering or disregarding steps to avoid it. There is nothing holy about agony. If terminally ill people do not want to live out their last few months in pain, for what purpose should they be forced to do so, and in whose interest is that life being prolonged?

One concern, though, is that the right to opt for assisted dying might have a deleterious effect on others, especially people in a similar position who do not want to end their life. Might they feel pressured to do so?

The legislation to permit assisted dying currently proposed in parliament by Molly Meacher, who chairs the Dignity in Dying campaign, replicates the 2015 Marris-Falconer Bill and is based on the law in the US state of Oregon, where assisted dying has been legal since 1997. It includes several safeguards that should allay any fears.2 It stipulates that its provisions would apply only to an adult who is terminally ill (defined as with six months or less to live), mentally competent, fully informed of all options, and making a settled request of their own free will in writing. Two independent doctors would have to approve a request, and a High Court judge would have to approve it.

As a result of the experience in Oregon, we are in the fortunate position of knowing in advance what the likely effects of permitting assisted dying will be. The Oregon Death with Dignity Act has remained tightly controlled and has provided choice and reassurance to dying Oregonians. Of the 370 people who received a prescription for assistance to die in 2020, only two thirds (245) took the drugs, comprising a total of 0.6% of all deaths in the state.3

This figure has increased steadily over 20 years and is not shooting up. This indicates that many people want to have the emotional safety net of knowing they can resort to getting help to die if their situation makes life intolerable, but never find they reach that stage. Those who do take the option tend to be people who are used to controlling the course of their life and want to determine the nature of their end too. This may not be everyone’s choice, but why should they be denied it because others do not want it?

Two challenges for Britain

Modern Britain faces two challenges in relation to assisted dying: the one that medical and legal professions face and the one that churches, synagogues, and other establishments of faith must confront.

The challenge facing medicine and law is the area of consent—a crucial factor for us all. Individual autonomy is a major principle in treating other people with serious medical conditions. Whose Life is it Anyway? was a major film starring Richard Dreyfuss about a successful sculptor who has a car crash that leaves him a paraplegic. In the four decades since the film’s release, the right to die has been explored over and over again. Yet many people have been forced to choose the option of going to another country to end their lives according to their own wishes.

Informed consent entails considering the interests of the dying person as well as those of society. There are still implications from the 2014 Supreme Court judgment on the case of Tony Nicklinson, who was paralysed from the neck down after a stroke and wanted help to end his life but was denied permission because he was not terminally ill.4 David Neuberger, former president of the Supreme Court, pointed out the legal asymmetry between the legality of permission to switch off a life support machine and the illegality of allowing certain drugs to be taken by a dying person.

Of course, on the same moral grounds that dying people should be allowed to choose their end, it would be outrageous if doctors were given no choice about taking part. The current bill states that professionals with conscientious objection for religious or other reasons would have no obligation to be involved.

People of faith

And what of those of us whose lives are shaped by our beliefs? The challenges posed by people dying in pain have led to substantial developments in the religious world. Although many Christian and Jewish clergy—especially those in leadership—hold to the traditional opposition to assisted dying, a growing number of ministers now favour it.

Religious opposition to assisted dying is not uniform. Certain faiths are undoubtedly opposed, such as Roman Catholicism, Anglicanism (as far as the leadership is concerned, with all 26 Lords Spiritual following Canterbury’s line), Jewish Orthodoxy, and Muslim sects. But Liberal Judaism and Unitarians back the current bill, as do the chief executives of the think tank Ekklesia and the liberal Christian society, the Modern Church.

But people ask why there has been such strong opposition to assisted dying by some religious groups. Strangely, it is not largely on theological grounds, because there is nothing in our bibles or prayer books that directly mentions this matter. The principal reason is the threat to vulnerable people—an unintended slippery slope if unscrupulous people try to bend the law. That has not been the case in Oregon and should not be so in the UK as we take steps to legalise assisted dying.

Religious support for reform

The Religious Alliance for Dignity in Dying is composed primarily of Anglicans, but there is a wide range of other denominations—Methodist, Baptist, Congregationalist, Unitarian—along with Reform and Liberal rabbis. We offer an alternative view and show that there can be religious reasons for it.

We may have different beliefs but are one in affirming that dogma is there to serve, not to dictate. There is nothing in our religious texts that opposes tender care at the point of death, to help those people who need it to take medication to end their lives. And, sadly, religious opposition to medical science has hindered a closer relationship between faith and science for centuries. In areas such as obstetric anaesthesia, birth control, stem cell research, and more recently mitochondrial replacement therapy, the response has been fearful and negative. We can surely do better than that.

Our alliance seeks to do more; we want to provide guidelines for the pastoral care of individuals and their families before and after death and to develop rituals for people undergoing the process of assisted dying.

Public and parliament

Attitudes are changing among the laity too. Poll after poll has shown that most of the population support assisted dying. What about parliament? The House of Lords has supported assisted dying in recent years by comfortable margins. But the bill introduced into the House of Commons in 2015 by Rob Marris failed to get support, largely because a new House was not ready to legislate on such a controversial social matter. There is a new mood in the House, however, and members of parliament have been moved by the cases of people like Debbie Purdy and Noel Conway and seem ready now to change sides in view of the overwhelming public support.

Clergy who oppose assisted dying have a right to their opinions, but they do not speak for all believers. There is not a monolithic religious view but a diversity of views, with a considerable number sympathetic to it.1 In a recent poll, over half of religious people said that religious leaders should not have campaigned against the assisted dying bill that was debated in parliament in 2015; only a fifth (22%) said that they should have.5

This is undoubtedly difficult territory, but it is religiously appropriate to try to navigate it. The right to live your life to the very end does not imply the religious obligation to do so, especially if that end is a travesty of that person’s life and everything that has gone before. If there is a right to die well—or at least to die as well as possible—it means having the option of assisted dying, regardless of whether it is taken up. That, surely, is a truly compassionate and very religious response.

Biographies

Rabbi, writer, and broadcaster, Jonathan Romain is minister of Maidenhead Synagogue. He is visiting chaplain to several hospitals and hospices in Berkshire and Buckinghamshire. As vice chair of Dignity in Dying, he founded the Religious Alliance for clergy and laity of all faiths who wish to express their support for assisted dying to be legalised in the UK.

George Carey was Archbishop of Canterbury from 1991 to 2002. In retirement, he continues to be involved in areas of development and inter-faith matters. His views on assisted dying changed through contact with those going through end-of-life crises.

Citation: BMJ 2021;374:n2094