Reply to the Archbishop of Canterbury
The Rev’d Canon Eric MacDonald
26 Katie Court
P.O. Box 3638
NS, B0N 2T0
The Most Rev’d. Rowan Williams
Archbishop of Canterbury
London, SE1 7JU
1 August 2009
Dear Archbishop Williams,
Thank you for your response to my letter.
You may not want to start a correspondence with me, but you can scarcely expect me not to respond to some of the things that you said, and the claims that you made, since your response to my letter comes in the form of an argument so stunningly biased that it deserves, in my view, not much more than a fairly curt dismissal. (I will try to provide more than that, but you must know that your letter to me is very, very troubling.) In the argument of your letter the suffering of my wife Elizabeth is turned rather dismissively into one of the nameless and featureless “stories of such terrible circumstances,” which you think, in fairness – and I bid you to consider (in the italicised words) your tendentious use of language here – must be contrasted with the “powerful testimonies from those who consider that their own security or quality of life would be threatened by legislative change.” That suggestion is in itself offensive, and offensively put, as I shall point out in more detail later. When I first read your letter, reading this was like being kicked in the stomach – it is so devoid of honesty, justice and compassion.
This may not be important to you, but it was this same lack of integrity and empathy, so evident in your 2006 House of Lords speech, that precipitated the final collapse, for me, of anything that might resemble religious faith. I used to think of theology as a critical discipline. I now think that both that it is an oxymoron to speak in terms of critical theology, and that theology is itself a danger to the possibility of reasoned public discourse. Theology pretends to a status that it cannot attain, and trespasses, therefore, into regions where critical thinking is of the first importance.
One claim that you make stands out so boldly that it was the first sentence of your letter that I read. It might have been outlined in neon lights. You wrote: “To have a conviction about the risks of assisted dying is a matter of conscience.” This is not true. I will try to sort out the kinds of risks involved in a moment, but intuitively it makes no sense to make the mere possibility of risk a matter of conscience. Since there are jurisdictions in which assistance in dying has been legal for some time, the risks involved are, in principle, assessable, and they have, as a matter of fact, been assessed. It is not a matter of conscience. It is a matter of fact. We will come back to this; but it is simply misleading to speak of this without qualification as a matter of conscience.
Having made it a matter of conscience, however, and not a matter of fact, you can scarcely go on to use, in support of your position, evidence which, you say, in an unusual turn of phrase, is “regarded as solid by people whose professional standing is reliable and who have no religious axe to grind.” While not altogether clear, this sounds as though you want to make an evidence-based claim, but this is not what you are doing. You refer, in your speech to the House of Lords (12 May 2006), to reports by the Royal College of Psychiatrists and the Royal College of Physicians and Surgeons, but you take these reports as, in themselves, sufficient to ground an unswerving conviction, without any indication that, if the facts were to turn out differently, you would change your mind. It is essentially an appeal to authority, an argumentum ad verecundium, not a matter of evidence at all, and you do have a religious axe to grind.
This becomes very plain when you say this, and attach your concern about risk to it:
All religious believers hold 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. They would say that to suggest otherwise is to limit the possibility of faithful and hopeful lives to those who are in charge of their circumstances or who enjoy a measure of control and success. Believers hold that even experiences of pain and helplessness can be passed through in a way that is meaningful and that communicates dignity and assurance. Of course this is not universally held in our society but, if it is true, we should expect that to ignore it would bring disastrous risks.
This is an entirely religious argument, not based on evidence which is ‘regarded as solid’ by authorities in the medical or legal fields, as you suggest. Quite aside from the peculiarity of the expression, it is hard to tell what you take the words ‘evidence regarded as solid’ to mean, if what you mean by ‘risk’ is to be understood in this religious context.
Before the above words about what ‘all religious believers hold’, you had already said defensively that “it would be a lazy counter-argument to suggest that … opposition [to the church’s view of the matter] can be written off because it comes only from those committed to a world view not universally shared,” but then you go on to remind the House that “the secular or ‘enlightened’ view of human autonomy assumed by many of the Bill’s defenders is no less a particular world view rather than a self-evident and universal truth.” Again, this is very unclear. On the one hand you say that you want to base your stand on ‘solid evidence,’ and so, presumably, on reasons which are plausibly held to justify, to individuals, the limitation of individual autonomy; but on the other you seem to want to hold that the disagreement is based on a confrontation of world views, one of which includes “the secular or ‘enlightened’ view of human autonomy.” (Which, of course, leads one to wonder what other view of human autonomy you had in mind.)
But surely it is not a particular world view to suggest that reasons must be given for one’s beliefs, especially if those beliefs will impose limitations on personal autonomy? Isn’t that just what your arguments are for – that is, to provide reasons? If there is, as you suggest, in proposals for legalising assistance in dying, a slippery slope that would put vulnerable people at risk, you must provide evidence for this, and did you not mean that this evidence was such as to weigh with autonomous persons? Surely you do not think that your moral conviction alone is sufficient to satisfy others? Of course, if you do consider the need to provide reasons to be, in itself, a particular world view, and one that you do not share, then of course there is very little more you have to say to me, or to anyone else, for that matter.
So, what are the reasons? You speak about risks, but what are the risks? You do not tell us very clearly, though you do claim that many ‘vulnerable’ people – mentioning in particular a member or members of the House of Lords – fear that their lives would be endangered or devalued should assisted dying be legalised. But this fear is not, of itself, a risk.
Nevertheless, straining at gnats, as it seems to me, you even go so far as to say this:
… whether or not you believe that God enters into consideration, it remains true that to specify, even in the fairly broad terms of the Bill, conditions under which it would be both reasonable and legal to end your life, is to say that certain kinds of human life are not worth living.
This doesn’t make sense to me. You cannot argue that someone’s life is not worth living, despite the fact that that person ascribes value to their life, just because of the possibility that someone else in similar circumstances might not ascribe value to theirs. I am quadriplegic, say, and Daniel James – who, as you are no doubt aware, was helped to die in Zürich – also a quadriplegic, says that his life is no longer worth living. And he did. But let us say that I do not. Why must Daniel James’ assessment of the value of his life weigh with me, or with anyone else regarding the value placed on my, or anyone else’s, life? It’s the value that we place on our own lives that counts. It is, arguably, the fact that we can value our lives that gives them special value. This is why autonomy is so important. Of course, if you begin with the assumption that personal autonomy is only an aspect of a world view that you do not share, it is not surprising that you get into trouble when you come to the question of whether individuals should be able to choose assistance in dying, and, therefore, not to value continuing to live.
Laws providing for assistance in dying would not define what constitutes worthwhile or worthless life. This would indeed be very dangerous, and no one is proposing this, absolutely no one. When life has ceased to be of value must be left up to individuals to say, when they are (as you say) “in appallingly complex and tragic circumstances,” and only when they say so, and maintain a stable and durable decision that further life would no longer be of value to them. They may even say that continuing to live in such circumstances might, in fact, diminish the overall value of their lives seen as a whole – a possibility entertained in Solon’s dictum (discussed in Chapter 10-13 of Book I of Aristotle’s Nichomachaean Ethics) to ‘call no man happy while he lives.’
Let me simply draw your attention to your own words about “appallingly complex and tragic circumstances.” Do you really think it is beyond the wit of society to frame laws which would be applicable only to those who feel that their circumstances are appallingly complex and tragic enough to justify a personal decision to bring their lives to an end? You don’t even ask the question, let alone try to answer it. Instead you slip carelessly into the religious assumption that we must assume that all life is worthwhile, no matter what those who are suffering think, presumably because this is what all religious people hold, and that the risks involved in ignoring the truth of that belief are too high. I leave it to you to judge which is the more reasonable option.
They don’t, by the way. All religious people do not hold that all stages and levels of human life and experience can be lived out in trust and hope. Apparently 63% of those who regularly attend the Church of England do not hold this to be true, since they agree that voluntary assisted dying should be legalised. Anywhere from 71% to 87% of British people believe that the law should be changed. A poll in Canada, shortly after my wife Elizabeth died, indicated that 76% of Canadians were in favour of legalising assistance in dying. At a hazard, these percentages must include many religious believers.
And, as for risk, where is your evidence? You say that, although not everyone shares your belief about pain and helplessness being able to be lived through in such a way as to communicate dignity and assurance, “if [this belief] is [were?] true, we should expect that to ignore it would bring disastrous risks.” Why disastrous? After all, if the belief were true, and assistance in dying were legalised, this would mean that some people would choose not to live through their experiences “of pain and helplessness … in a way that is meaningful and that communicates dignity and assurance.” They would not then be alive to discover whether or not this might have been true of their experiences, if they had had them. They would have chosen not to find out, because, presumably, they did not think this likely to be true of their own experiences. At a stretch, this might be thought to be a loss, but why should we consider it disastrous to risk such a loss? After all, they would not be around to find out that this belief is not true either, if it turned out not to be true for them, as it well might – remember Solon. If there are disastrous risks, I can’t spot them. What will happen is that people who believe that their lives are no longer bearable, will be able to bring their dying more quickly to an end, and will thus miss out on this supposed value of living through experiences of pain and helplessness. But what would be disastrous about that?
The problem here is that you confuse kinds of risk which must be very carefully distinguished. This is often a confusion, I believe, deliberately used by religious opponents of legalised assisted dying to cover their tracks, so I will lay them out in point form (the names are simply convenient tags):
- Empirical risk. Here is where risk to the vulnerable belongs. Vulnerable people might be placed at risk. In principle, this risk is assessable.
- Spiritual risk. This is the risk (as above) that a person will not know fully the spiritual value of pain and helplessness, because they will no longer be alive to find out. This is a risk that cannot be assessed. How serious a risk is involved must be left up to individuals to decide. I do not think that many acutely suffering people will think the risk particularly serious.
- Evaluative risk. The risks involved here depend on who is making the evaluation. For instance, permitting third parties to make evaluations of the worthwhileness of the lives of others, especially when those others are quite capable of making choices for themselves, would be unacceptably risky. I should have thought that everyone would agree about this. Yet I ask you to note that this is precisely the form of risk that you are willing to see go in at least one direction, for you are quite prepared to allow others to impose a forced choice upon those who are asking for assistance in dying.
These are plainly very different kinds of risks. By failing to make these distinctions, the issues involved are hopelessly confused. In fact, the slippage that this confusion introduces allows you to confuse perfectly reasonable proposals for legalising voluntary assisted dying, with entirely unacceptable Nazi ideas of lebensunwürdig Leben (life unworthy of life), where ‘evaluative risks’ were completely ignored. When you confuse these two entirely different evaluative processes – individual evaluation and decision vs. evaluation and decision by others – you arouse unreasonable fears amongst those who are socially vulnerable in a variety of ways. In Nazi Germany this fear would not have been unreasonable, since evaluative risks were in fact ignored, and judgements regarding the worthwhileness of individual lives were vested in third parties, in doctors and government officials, for example. It is simply disingenuous to suggest that contemporary proposals for legalised assisted dying have the same shortcomings.
Indeed, in a letter in which you express concern about “the ongoing pain you must still feel at such a loss,” you even manage to compare the suffering of my wife Elizabeth with the completely unfounded anxieties of someone in a wheelchair, or other vulnerable situation including, as you say, “some in the House of Lords too,” being deemed unworthy of life, and you suggest that these anxieties must be taken more seriously than Elizabeth’s suffering. In other words, you think that, because of the means Elizabeth herself took in order legally to hasten her dying, when pain and helplessness had overcome her sense of the worthwhileness of her life, others are now put at risk, and their (almost certainly, unfounded) fears of this risk are more to be honoured than Elizabeth’s desperate plea to bring her increasing misery to an end. I find it hard to believe that you said such a horrible thing. You have managed to be disingenuous, condescending, insulting and uncaring all at one go.
Mary Warnock and Elisabeth Macdonald refer in their book Easeful Death to the report by Robin Gill to the House of Lords Select Committee on Assisted Dying, in which Professor Gill, speaking of Diane Pretty’s appeal for assistance in dying, said that,
… for my part I was not convinced on compassionate grounds. In the end I concluded, as my Church has concluded, that more people, more vulnerable people will be made more vulnerable if we change the law in favour of legalising euthanasia.
Who cares what Professor Gill is convinced of on compassionate grounds? Or whether you or any number of people are or are not “complete strangers to appallingly complex and tragic circumstances,” pastorally or personally? (It’s a bit like a white Christian heterosexual saying, “Some of my best friends are black” – or Jewish or Muslim or gay – take your pick.) Within one year of being ordained a priest, after having watched people dying in unremitting pain, I was convinced that the church was, as you so aptly put it, “poisonously and dangerously mistaken,” and said so when opportunity provided. But your position, despite what you say in your letter, is settled, by you, so far as I can tell, “just by unthinking dogmatism.” (We will come back to that in a moment.) You do not provide a single, stable argument for the claims that you make.
Why should it matter to anyone whether Professor Gill is or is not convinced of anything on compassionate grounds? Did Diane Pretty really wonder what Professor Gill’s convictions on compassionate grounds might be? Why is it not a matter for people themselves to decide on personal grounds whether, for them, and for them alone, given their situation in life, and how they regard that situation, choosing to hasten their dying is a reasonable thing for them to do? Professor Gill lets the Christian cat out of the bag, and so do you. If it were a matter for outsiders to decide when someone else’s life is or is not worth living, on so-called ‘compassionate grounds’ – which raises questions of what I have called ‘evaluative risk’ – then of course there would almost certainly be disasters, and there would doubtless be a continuous train of them. These are decisions that should lie with individuals themselves, alone, and are not decisions that an outsider can reasonably make for other people – people who are capable of making their own decisions, and deciding, for themselves, what value continuing to suffer has, for them – and this locus of decision making would have to be made very clear in any change in the law. No one is suggesting anything different. To continue to pretend otherwise is patently dishonest.
“Those who vote,” you say in your letter, “have to balance the possibilities of acute suffering against what many see as a perfectly real and concrete risk to the vulnerable.” (I add the italics.) Again, there is, or there is not, undue risk – what I have called ‘empirical risk‘. It is not a matter of what many see, not at all. This is not a matter of conscience, but of fact. You may frighten vulnerable people by saying that they might be put at risk, but saying that they might be at risk does not make them so; and adducing the fact that a member of the House of Lords says that she thinks that her life or quality of life would be threatened by a change in the law – when there is not a chance that such a forthright person could possibly be in danger of a law that placed choice firmly into the hands of individuals – is a complete non sequitur. It is, indeed, laughably nonsensical, for she has already said all that needs to be said about the value of her life. It is also, as I say, insulting to the dignity of people like my wife Elizabeth, who ask, in desperation, for relief, only to find themselves pawned off with completely inapposite concerns about the vulnerable, who are not asking for such relief, and would not be offered it, unless they were themselves, in their own judgement, in desperate circumstances. Indeed, those who argue in this fashion are guilty of a double offence. They refuse succour to those who are dying in intolerable circumstances, and who have made stable and competent choices to receive the help they need to hasten their dying; and they also arouse disquiet and fear in those who are not, in any respect, the object of or in danger from laws regarding assistance in dying.
A detailed study of the statistics for assisted dying in the Netherlands and in the American state of Oregon has been done, and it concludes that there are in fact no such risk in places where assisted dying is legal. The authors of the study state their conclusions as follows:
Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS [Physician Assisted Dying] or euthanasia will have a disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.
And we can, as well, question the whole basis of the argument to disproportionate effect. The argument seems to be that the main problem is that certain groups in society would be harmed more than others by laws governing assisted dying. Look at it, though, from the other side. Would it be acceptable, for instance, if it were shown that, the impact would be more evenly distributed? Then we must ask, as Ronald Lindsay does, whether achieving equal distribution would be “a morally appropriate goal.” Surely the answer to this is no. In fact, a law governing assistance in dying would inevitably affect one particular class of people: those whose misery has become, in the judgement of those who are suffering that misery, intolerable. That attribute does not pick out a distinguishable social group, as ‘the vulnerable’ vaguely does, or ‘the old’ certainly does. But it’s not the social group that people belong to that matters, but whether their choices are their own, and are not made for them by others. Accordingly, Lindsay goes on at once to ask:
Should we not be more concerned with ensuring that there are few coerced or manipulated requests relative to the number of persons requesting assistance in dying as opposed to the identity of the persons who are coerced or manipulated?
He points out, rather tellingly, that one reason that the disparate impact argument is sometimes used, despite the argument’s rather questionable moral assumptions, is because the people using it “are simply adamant opponents of lawful assistance in dying under any circumstances,” and so have not really considered the implications of the argument. I am bound to ask you to think carefully whether or not this is why you make use of the argument.
But there is still more. There is, for instance, the simple fact that in common law a patient has a right to the withdrawal of treatment, or the right to refuse treatment, the right to refuse nutrition and hydration, or to have nutrition and hydration withdrawn (a group of choices often called ‘passive euthanasia’); and there is not the slightest moral difference between this actively assisting someone to die (‘active euthanasia’). When you add to this the consideration that refusal of treatment, nutrition or hydration, or the withdrawal of treatment, nutrition or hydration, are as open to the same risks of abuse as assistance in dying, there is no obvious reason to continue to single out assistance in dying for special consideration and prohibition. Indeed, there is, arguably, a case to be made for carefully regulating and recording situations in which treatment, nutrition and hydration are refused or withdrawn, since these may be as open to abuse as assistance in dying. The issue of competent, durable decision is as vital in cases of refusal or withdrawal of treatment, nutrition or hydration, as they are in cases of assistance in dying, and it simply confuses things to fail to note this. There is widespread discussion in the literature of the supposed distinction between ‘passive’ and ‘active’ euthanasia, of which you should be aware. Let me refer you to two studies already mentioned, Easeful Death and Future Bioethics, and introduce you to a work by the Canadian legal scholar, Jocelyn Downie, Dying Justice: A Case for Decriminalizing Euthanasia and Assisted Suicide in Canada, each of which deals with the issue in some detail.
What you must not do is to suggest, as you do in your letter to me, that those who disagree with you have not also come to conclusions different from yours, and have continued in those conclusions, after serious study of the empirical evidence and moral reasoning involved here, which includes what some members of the legal and medical professions, for example, also say. Nor must you suggest, as you also do in your letter to me, that the “powerful testimonies from those who consider that their own security or quality of life would be threatened by legislative change,” are appropriately contrasted with “specific stories of such terrible circumstances,” or can be weighed in the same balance with the personal experiences of those dying in helplessness and misery. I began this letter by suggesting that this way of looking at things is biased and offensive, and in fact I find it deeply offensive. I direct you specifically to your use of rhetoric here: where ‘powerful testimonies’ are opposed to ’specific stories’; and the use of the declarative ‘would be’ is used instead of the more appropriate subjunctive ‘might be’. There is simply no justification for using this plainly prejudicial language, and you use it more than once in a short letter.
Quite aside from these considerations is the fact that, in Britain, as in Canada, the arguments against assistance in dying are no longer compelling, even to many religious people. Too many have seen loved ones die in agony – and have been moved by compassion and principle to question the certainties of religion on this point – to be in any doubt. In a recent British Social Attitudes Survey it was found that fully 80% of those who had seen a loved one die in agony changed their minds, and now approve legalised assistance in dying. Recently, the Medical Association of Québec approved legalisation for limited forms of voluntary assisted dying. A leading Canadian palliative care specialist, Dr. Larry Librach, head of the Tammy Letner Centre for Palliative Care at Mt. Sinai Hospital in Toronto, has, within the last three years, changed his mind about the need for legalised assisted dying. In 2007 he was, significantly, elected as President of the Canadian Hospice and Palliative Care Association. As you will know, the Royal College of Nursing in Britain has recently expressed its neutrality on the issue, showing how quickly society is changing its mind about assisted dying. The unanimous ruling of the Law Lords, to have the Director of Public Prosecutions clarify when prosecutions of people who accompany loved ones to Dignitas in Switzerland would or would not be pursued, is another step in this direction. Finally, as I have already pointed out, anywhere from 71% to 87% of British people favour assistance in dying; and 63% of those who regularly attend the Church of England favour assistance in dying.
In other words, most of us want the assurance that we will not die in agony, because of some irrelevant considerations regarding God’s will, or the recondite hesitations or confusions of a theologian with political clout. We want to take this final area of personal decision and choice into our own hands. We are afraid neither of gods, nor of their minions, except in so far as those minions, much like yourself, seek to bar the door of death, and refuse to allow us to pass through it without undue and pointless pain and struggle.
Two recent cases in Britain underline the fact that people are no longer willing to be shackled by religious dogma about dying. Sir Edward and Lady Downes, for instance, recently went to the Dignitas clinic in Zürich, where they ended their lives together, accompanied by their family, because life was becoming, for them, no longer worth living, and threatening to become even worse. And then, there is the story, in The Daily Telegraph (28th July), of the novelist Jane Aiken Hodge, who took her own life alone, because unwilling to continue to live in circumstances which, given her age, would have become increasingly intolerable. I still remember, with great anguish, that Elizabeth felt that she had no option, and went through the whole process of dying alone – though, in the event, it did not work – without my support or loving presence, because of people like you, who guard the doors of dying as though you had some proprietary claim to them. You don’t, and it’s long past time that you recognised that you don’t, and allowed people to die with dignity, as they seek to do.
Why should people be forced by the law to die alone, just because of the cavils of the religious, or because of the anxieties of those who are afraid because religious leaders have made them so? Why should suffering people be abandoned to the very uncertain, often violent, world of makeshift suicide, when they might be helped to die peacefully and with dignity, enfolded in the love and support of their families? I don’t think you provide an answer, not even the beginning of an answer, though in response to me you suggest that there is one: “I don’t think it helps to suppose,” you wrote, that balancing “what many see as a perfectly real and concrete risk to the vulnerable” against “the possibilities of acute suffering,” “is either an unreal choice or one that is settled by unthinking dogmatism.” Notice, once again, how misleadingly you have framed the choice: “possibilities of acute suffering” against “perfectly real and concrete risk.” Unless you are prepared to put things fairly, what else is possible here, but to think that your position is “settled by unthinking dogmatism”? For the truth of the matter is almost exactly the reverse of what you claim. Acute suffering is not just a possibility. It is a real and concrete actuality, and it happens every day. It is the risk to the vulnerable that is no more than a possibility, and, as I believe there is reason to think, perhaps not even so much as a possibility. I hasten to add that I am not saying that such a law would never be abused, but it could be seen to be an abuse, and the risk could be minimised.
I do not, as I say, think that you are being honest. Your studied use of rhetorical sleight of hand makes it clear that you have something to hide. Let’s consider something said by one of your brother bishops. N.T. (Tom) Wright, Bishop of Durham, wrote this in a Times article:
David Aaronovitch challenged me to justify an “outrageous claim” that I made in my Easter sermon. I said that there was a “militantly atheist and secularist lobby” that believes that “we have the right to kill… surplus old people”. He replied that it was simply not true. But there is clearly a strong body of opinion – part of a larger, albeit unorganised, secularising or atheist agenda – pressing in this direction.
No one, but no one, except perhaps Bishop Wright, is talking about ‘the right to kill surplus old people.’ This is simply slander. And it is not simply an ‘atheist and secularist lobby.’ Many religious people support such a change in the law. Dean Inge was famously in favour of assistance in dying. And Hans Küng’s very powerful testimony to the pointless suffering of his dying brother is very moving, as are his arguments, from a religious perspective, in support of assistance in dying. This is not, despite your suggestion, a battle of titans and world views, religious vs. secular. But to many religious, who can think of no reliable secular arguments to defend their case, it apparently seems to be so.
I assume this is why you and Bishop Wright resort to shifty rhetoric or hyperbole, or, sometimes, slander and outright dishonesty. People are reduced to using gimmicks like this only when they have nothing else to say. If you can’t answer secular arguments that favour assistance in dying, and depend upon confusion, rhetoric or dishonesty, then I fail to see why you expect your voice to be listened to.
Of course, it is listened to, because it is a voice that is still accorded a kind of hallowed respect. But you haven’t said anything yet that I think is deserving of respect, and I have given my reasons for saying so. Churches have enormous influence, especially in the political arena, because politicians know how noisy religious leaders can be at election time. And, in Britain, at least, the Church of England has an a strong voice in the upper house. As a consequence, religious voices have been able to dominate the public discourse about assistance in dying. But its effectiveness is steadily diminishing, and this perhaps explains why it is beginning to sound increasingly shrill. If you cannot appeal to religious conviction – where your loyalty truly lies – in order to dispute the legitimacy of assisted dying, then you have to find secular reasons, but none of these gives you the absolute certainty that you crave, so you simply turn up to volume. Hence ‘the right to kill surplus old people,’ ‘the right to assistance in dying will become a duty to die,’ ‘the vulnerable will be placed at risk,’ and so on. Of course, no one wants to see a law which could be easily abused, but you really must do better than this.
The fundamental reasons for religious opposition to assistance in dying are of course religious. Interestingly, there is very little (if any) biblical support for a prohibition of suicide. Theologians are resourceful and inventive, however. One line of argument, stemming from Augustine, invokes ideas of dominium and usus, the doctrine that our lives are gifts of God, for our use, but not under our control. We are accountable for what we do with our lives (usus), but the ultimate disposition of our lives is not vested in us. Dominium belongs to God alone, and only God may legitimately end life – except, of course, for capital punishment, self-defence and war. The argument is traceable to Plato – possibly even to Pythagoras – but is intensified through Augustine and Aquinas. Classical Greek, Hellenic and Roman philosophy accepted and defended a fairly liberal acceptance of suicide. Indeed, suicide was often regarded as courageous, honourable and even heroic. The early Christian fathers did not really address the question of suicide, and, in fact, it is arguable that early saints, such as Ignatius of Antioch, actively courted martyrdom in ways that make the line between suicide and martyrdom hard to draw. Although Habgood says that “the death of Jesus can in no way be described as a suicide,” one suspects that this is not as clear as Habgood would like, since, as a self-offering, Jesus’ death also had to be, in some measure, self-inflicted.
By Augustine’s day, however, martyrdom in North Africa had turned into a cult of death. Augustine’s answer to this – argued in detail Book I of The City of God – was to interpret the sixth commandment, in an unprecedented way, to rule out self-killing. There is no basis, either in Christian or Jewish tradition, for this reading. Augustine apparently regarded the situation critical enough to warrant a radical (and tenuous) reinterpretation. This is not the place to consider the argument in detail. An interesting feature of Augustine’s argument is that, since the idea of double effect had not yet been thought of, Augustine has recourse to a command of God, which is not a part of the biblical record, to account for Samson’s taking of his own life, amongst hosts of Philistines. Another interesting aspect of the argument is Augustine’s fairly prurient account of how faithful women – by means of “an unwilling mind in a ravished body” – may maintain their innocence in the face of rape and sexual servitude, so that they would have no excuse to “sentence themselves to death.” By taking the most extreme cases, where it had been thought legitimate and even honourable to take one’s own life, Augustine is putting Christians on notice that suicide is never justifiable, an absolute prohibit which is still respected sufficiently to turn Christian morality into cruelty.
Augustine‘s arguments have little to commend them, but, by linking suicide with murder, Augustine’s influence is most likely the reason for the horror and shame that still attaches to suicide amongst so many. This horror is underwritten by centuries of church terror: burying suicides at cross roads or beneath gallows, desecrating the naked bodies of suicides by putting them on public display, and impoverishing their families. (There is no evidence, by the way, that these terrors actually deterred anyone from dying by suicide, though it must have made the last moments of desperate people doubly desperate, since suicide was considered the ne plus ultra of despair and faithlessness, the one sin for which there could be no repentance.) This taste for terror still underlies the Christian insistence that we continue to use the word ‘kill’, instead of either ‘assisted suicide’ or ‘assisted dying’, when we speak about helping the dying or the irremediably suffering to die. This terror is doubtless why, in the article quoted earlier, N.T. Wright thought his point that the other word for ‘voluntary euthanasia’ is ‘suicide’, so very devastating; but, of course, the short answer to that is, ‘So what?’ Most Christians, though possibly not Bishop Wright, are kind enough now to speak of the deaths of those who die by suicide as something done ‘while of unsound mind’! When will the church come to the point of acknowledging that there are times when voluntary death is not only a perfectly reasonable but a courageous and honourable way to die?
You may say that these arguments are only the tip of the theological iceberg devoted to death and dying, and you would be right. Other theological ideas probe much more trenchantly, into even more speculative territory. I believe that we will find the real reason for Christian opposition to assisted dying right here. Karl Barth, for instance, in Church Dogmatics, speaks of death as a “kingdom on the offensive.” He even calls death itself a “slippery slope” – which is rather a neat coincidence, given the fact that religious opponents of assisted dying seem to see slippery slopes everywhere they look! Death represents, for Barth, all the powers ranged against God, what Barth also calls “the invading chaos,” but at the same time it represents the judgement of God, so our suffering when we die (if we do suffer) is ordained by God. As such we are not to “make any arrogant attempt to alleviate our own situation. We simply adjust ourselves to the situation which He Himself has created and in which He himself [sic] has set us.” He concludes, therefore, “that everything that happens to us in death [dying?] will” he says, alluding to Paul, “in some way necessarily work together for good.” He even borders on the completely mad, for example, as in the following:
Sickness in so far as it is still present, the impairing, disturbing and destroying of life in so far as these are an event and cannot be removed by faith and prayer and the most manful fighting, have therefore to be ‘borne’ in the sense that they are drawn by God – who is present in this way, too, as Lord and Victor – into what He wills from and with man, and what in its entirety, because it comes from Him, cannot be evil but only good, and cannot finally be pain but only joy.
This, as I say, is verging on the ridiculous, if not the insane, though it might be compared with your own idea about what all religious people hold about stages of life or levels of experience. But whether religious people are convinced by this sort of thing is irrelevant. It certainly cannot be used as a general argument against assistance in dying, which is doubtless why the religious so often steer clear of religious language when debating the issue. Instead of Bishop Wright’s ‘murky moral world’ of assisted dying, we seem to have entered a very murky theological world where theologians flounder helplessly in a sea of ideas about the goodness of God and the miseries of dying.
Hard cases, they say, make bad law. They also make for bad theology. But you do not really acknowledge even hard cases. You speak in your letter, as though with compassion, about “appallingly complex and tragic circumstances,” but, much like Barth, you do not really acknowledge tragedy as tragedy. That’s what the word ‘complex’ is doing here, acting as a moral escape clause. There is, after all, no level of human experience, and no stage of human life, that cannot be lived through in trust and hope, and you tell the old lie that pain and helplessness – what? all of it? – can be lived through with dignity and assurance. Have you really seen anyone die? Have you really heard their pleas to be helped to die, as I have done? Or did you just take such pleas, in John Paul II’s terms (in Evangelium Vitae), as a request to hope when all hope is gone? Quite frankly, the level of prevarication in your speeches on this matter, and in your letter to me, beggars imagination.
This is not just an endless theological debate, that might end up following different ‘tracks’. It’s about real people, suffering people, dying people – that is, about people who are suffering and dying right now – and about what they want, desperately want, and if you cannot understand that, and persist in treating dying people in a pervasively condescending way, as though they are more easily manipulated than others, you simply have no understanding of what it means to die in misery. Time to pay attention to the very real miseries of very real people, and stop hiding behind the vulnerable and the fearful, including a particular noble lady from the House of Lords, whose unreasonable fear of being thought unworthy of life obviously weighs more with you than the desperate appeals of those in acute pain and suffering who are asking to be allowed to die with some dignity and comfort. The failure of compassion in this alone is simply stunning!
Continuing on the same theme of failure of compassion, it was an organisation funded by the Roman Catholic Church that asked the Royal Canadian Mounted Police to investigate my actions upon my return from Switzerland, to investigate this “specific [story – though not, however, powerful testimony] of such terrible circumstances,” to use your considerate words. It was a member of that organisation (a physician) who said, “Perhaps the next person to be bundled onto a plane will not be in full command of her faculties,” suggesting, falsely, that my wife was “bundled” onto a plane, and that there are, as you also suggest, unacceptable risks involved in permitting people to go to Switzerland to receive the assistance in dying that they seek. It would, he suggested, and as your letter to The Daily Telegraph also suggests, put a vaguely defined group of ‘vulnerable’ people at risk. And, of course, we know that he does not think that assisted dying should be available, no matter what the risk, for the Euthanasia Prevention Coalition toes the Vatican line.
Christians were also compassionate enough to say that I had abandoned my wife. One of them said – and these and similar words are still accessible on the net: “I consider the act of her husband to be an abandonment of her needs in this situation. This is not a supportive act.” The Anglican Church of Canada position paper on assistance in dying calls assistance in dying a ‘failure of community’ – another way of speaking of abandonment. From your own words I assume that you are of the same opinion, and that, despite prevaricating words about ‘complex and tragic circumstances’, you really think in terms of abandonment too. This, my last gift of love and fidelity to someone I loved so much, my refusal to abandon her to the paralysis that she feared more than death itself, or to the constant pain and humiliation that she suffered, my promise to accompany her, and to be with her and to hold her while she died, distilled through the contortions of the religious mind, became nothing more than a mindless act of abandonment and betrayal. The church’s compassion at work! It is significant, I think, that the widespread public support that I received did not reflect this jaundiced and cruel religious view.
I’m afraid that I simply do not believe you. I do not believe that your convictions are truly grounded in risks to the vulnerable. They derive, in a torturous and prevaricating way, from a religious conviction regarding the ‘sanctity of life’, and the will of God. They are grounded, too, in the idea – a senseless notion, in my view, and, yes, poisonous and dangerous too – that there is not, for anyone, truly intolerable pain at the end of life, and that “even experiences of pain and helplessness can be passed through in a way that is meaningful and that communicates dignity and assurance.” There are no hard cases, and you are not really moved.
I add to this that the reasons of Archbishop Nichols of Westminster – who co-signed, with you and the Chief Rabbi, the recent letter to The Daily Telegraph – for condemning assistance in dying are, whatever other reasons he may give, almost certainly entirely religious, based firmly in Catholic dogma, and unrevisable. And it is, in his case, a lazy counter-argument to suggest that the legalisation of assistance in dying would put the vulnerable at risk. I suspect it is a lazy counter-argument in your case as well, since it is not based on a study of the evidence, but is held simply on the basis of largely uninformed and apparently unchangeable moral conviction.
Of course, given what you have already said in the House of Lords, in your letter to me, and in your recent letter to the The Daily Telegraph, there is, as you say, nothing that you write that will make any difference to what I believe. If all your arguments are as insecurely based as the ones to which I have referred, you cannot change my mind. Trust me, if I tell you that I have much more experience of this than you do – and have probably read more widely too – and forgive me if I do not find your letter, or the expression of concern it contains, either intellectually honest or personally sincere. How can I take you to be sincere? You would have let Elizabeth languish, quite possibly for years, in misery and pain and helplessness, until she died, merely because she had MS and did not have – for example, by God’s grace – a massive heart attack instead.
I merely remark, as a footnote, on the fact that, because I have acknowledged my lack of faith, a lack of faith, I might add, shared by many, many clergy, who are prepared to dissemble, or to stun with theology, you decline to address me with customary respect. I have not resigned, and do not, for now, at least, intend to resign my orders. The adjective “Venerable” does not attach to the office of Archdeacon in the Diocese of Nova Scotia, but I was, when I last looked, still a canon of All Saints’ Cathedral, and if you, or the Anglican Church of Canada, want to take this from me, you must do it publicly, and not by simply eliding the normal courtesies of the church.
Eric S. MacDonald
(The Rev’d. Canon, retired)
cc. The Most Rev’d Fred Hiltz
Ms Ophelia Benson
This letter will also be published, and should appear before you receive it, on the web site, ButterfliesandWheels.com.
 To avoid confusion, quotes from your letter to me will be bolded; quotes from your May 2006 speech to the House of Lords will appear in regular type. Your House of Lords speech can be found in Hansard (House of Lords) for 12 May 2006, Columns 1196-1198.
 I am at present reading Jean Meslier’s Mémoire Contre le Religion (Coda, 2007), and it is interesting how easily and naturally Meslier assimilates Jesus to fanaticism and deceiving intensity – “un miserable fanatique et un malheureux pendard” (p. 214). I sense the same fanaticism underlying Christian opposition to assistance in dying, a case which depends almost entirely on deception, slander and confusion, as I try to show.
 Quoted by Mary Warnock, and Elisabeth Macdonald, Easeful Death: Is There a Case for Assisted Dying? (Oxford: University Press, 2008), p. 12.
 Margaret P. Battin, Agnes van der Heide, `Legal Physician-Assisted Dying in Oregon and the Netherlands: Evidence Concerning the Impact on Patients in “Vulnerable” Groups’, Journal of Medical Ethics 33, no. 10, 2007. (591–597) p. 591.
 Ronald A. Lindsay, Future Bioethics: Overcoming Taboos, Myths, and Dogmas (Amherst, New York, 2008), p. 104.
 Ibid., p. 106.
 Jocelyn Downie, Dying Justice: A Case for Decriminalizing Euthanasia and Assisted Suicide in Canada (Toronto: University of Toronto Press, 2004).
 Tom Wright, “Euthanasia – a Murky Moral World” (London: timesonline.co.uk, 3 April 2008)
 Hans Küng and Walter Jens, Dying with Dignity: A Plea for Personal Responsibility, trans. John Bowden (New York, 1998).
 As an interesting side note, the Bible is mentioned, in John Habgood’s entry under ‘suicide’ in The Oxford Companion to Christian Thought (Oxford: University Press, 2000), pp. 689-690, only in reference to Augustine’s use to the sixth commandment. Aside from that, what the Bible says is ignored. It doesn’t say much, a most that it does say tends to favour the reasonableness of suicide, but that is an argument for another day.
 Ibid., p. 689.
 Though Robert Burton (The Anatomy of Melancholy) generously suggests that there may be time for God’s mercy “betwixt the bridge and the brook, the knife and the throat.” (Quoted by Margaret Pabst Battin, Ethical Issues in Suicide (Englewood Cliffs, New Jersey: Prentice-Hall Inc., 1982) pp. 52–3.)
 Karl Barth, The Doctrine of Creation: Part Two, Church Dogmatics (Edinburgh, 1960), p. 591.
 Barth, Ibid., p. 591.
 Ibid., p. 615.
 Ibid., p. 609.
 Ibid., p. 610.
 Karl Barth, The Doctrine of Creation: Part Four, Church Dogmatics (Edinburgh, 1960), p. 374. The plain implication of this is that we should not even use comfort care at the end of life (but rather only ‘faith, prayer and the most manful fighting’), which is, in its entirety, determined by God, and is not to be arrogantly alleviated.