A Time to Die?

The Mental Incapacity Bill and living wills

Editorial by Jonathan Clatworthy

from Signs of the Times, No. 16 - Jan 2005

My grandmother lived to the age of 100. From 70 onwards she often dropped remarks like 'People live too long these days'. It was quite a tragedy for her to live 30 years longer than she wanted to. On one occasion she had a confidential word with my brother, who works with chemicals, and asked him to fetch her something. 'Nobody need know', she said. But he didn't. Another time, when a bishop was staying for lunch after a confirmation, she cornered him in the kitchen and asked if he could do anything for her. It would have been intriguing to know what kind of solution she thought he might come up with, but he also refused.

We understand her predicament: yet we all prefer to refuse the request. We don't want to accept responsibility for someone's death, even if we don't blame them for wanting to die.

The Mental Incapacity Bill is designed to give legal backing to 'living wills', in which hospital patients can demand the right to die by refusing treatment when facing terminal decline. Currently doctors can reject a living will if they believe it would not be in the patient's best interests; the bill would require them to abide by it.

Most of the opposition to the Bill comes from Christian organizations. There are practical problems; relatives, if consulted, may have interests of their own, and the use of compulsory euthanasia by the Nazis in the 1930s has left a bitter taste. But more significantly, behind the Christian opposition lies a long history of emphasis on the sanctity of life. Christians have similarly opposed suicide and abortion. Through the centuries, church leaders have argued that it is not for us mere humans to interfere with God's decision about how long each life should last. At the time of the 1967 Abortion Act, for example, this argument was repeatedly used, even when abortion was the only way to save the life of the mother.

It is as though the choice is between on the one hand intervening to kill, and on the other allowing nature to take its course. Thus a cartoon in the Church Times of 17th December gives a picture of two roads, one marked 'Euthanasia' and the other 'Natural life'. In reality the choices are nothing like this. 'Euthanasia' can refer to active killing, for example of unborn babies with spina bifida, or to passive allowing to die, as with withdrawal of medical treatment from the elderly terminally ill. 'Natural life', whatever it means, cannot mean life preserved by the panoply of medical technology available in our hospitals today.

We are proud of our medical technology, and the increased lifespan it can offer. Nevertheless technology cannot keep us alive for ever; despite 1 Corinthians 15:51, we shall all die. We must accept, therefore, that there comes a time when dying, far from being a sign of somebody's failure, is the right thing to do. We should not impose extra suffering on the terminally ill merely because we have the technology to do so.

When death is the right thing, we are naturally hesitant to make it happen. One reason is the fact, noted above, that nobody wants to be personally responsible for a relative's death. Some non-western societies have systems in which the extended family, or the wider community, acknowledges when it is time for a person to die, and arranges the death accordingly. It should be possible for us, too, to legislate so that the burden of decision-making does not rest too heavily on any one individual.

Another reason for our hesitance is that the traditional Christian affirmation of the sanctity of life has been overlaid by secular reductionism. Life after death is now considered an optional private belief, and is therefore denied any role in influencing legislation. If there is no life after death - or if we must legislate, and behave, as if there were none - death becomes a complete end for the individual, the point at which all sensations cease for ever. It is not surprising that, for a society which affirms this as its official view for practical purposes, a cultural neurosis develops. Death becomes the one thing to be avoided above all else. 'The sanctity of life' comes to mean the obligation to keep people alive as long as possible. Individuals, faced with lonely old age or terminal illness, may long for death, and doctors and nurses may - as they often do - make illegal euthanasia pacts with each other in order to avoid such a tragic end for themselves; but society as a whole has no means to handle death in a positive and constructive manner, and therefore insists on postponing death for all, as long as possible.

It is time to have another look at what we mean by the sanctity of life. Reductionists mean that humans happen to value being alive and that these evaluations should be respected by potential killers. The Christian tradition means more: that there is a truth about sanctity which includes but also transcends human life. The fact that we living humans happen to value our lives is part of the picture of life's sanctity, but what gives it its significance - what roots it in more than just subjective feeliing - is the bigger picture, with its vision of life beyond our current lives, meaning beyond our meanings, understanding beyond our understandings, and within which our current lives have a valued role.

Our account of the greater whole thus tells us is that it would be wrong either to treat human life as cheap and easily dispensable, or to treat it as the only thing available and therefore to be maintained as long as possible. We should value it positively, for the part it plays, but accept that it is not everything. Death, too, has a part to play, along with whatever is to follow it.

If we have, and can articulate, a wider picture of this type, within which our present lives play a part, then it should be possible to treat medical technology as what it is: a tool, to be used only when appropriate. We should not allow it to determine the timing of people's deaths. With a better, more clearly articulated, more holistic understanding of the sanctity, value and purpose of life, we would be better equipped to understand what constitutes a good death at the right time, and would thereby be truer to our Christian tradition.

Jonathan Clatworthy lives in Liverpool and is MCU General Secretary. He has worked as a parish priest, university chaplain and lecturer in Ethics.