Article by Eric MacDonald

Conservative Christians are increasingly intruding themselves into matters of public concern about which they apparently either know nothing, or choose to ignore what they do know. The example that I will use is a short essay, recently published in the ultra-conservative Catholic journal First Things.1 Written by Thomas M. Ward, an associate professor of philosophy at Baylor University of Waco, Texas, the article shows all the hubris of conservative religion at its worst. It is written as though its author lives in a vacuum, without access to any other word than his own. It is as though no one else had written on his chosen specialist subject, so that he can simply make it up as he goes along, using words that seem to have no connexion with anything in the world.

As an example, consider the title: “Indi Gregory and the Future of Death on Demand.” Death on demand is something, apparently, already available. All Ward is doing is to spell out, given his starting point, the future of death on demand. And yet, despite beginning there, he provides no evidence that there is anywhere in the world where death on demand, as he calls it, is legally available. Nor does he even attempt to define what he means by this term of art, which gives him the liberty to hoover up anything that is even remotely associated with whatever it is that constitutes what he means by death on demand, giving him carte blanche to say anything at all that he thinks relevant to his purpose.

Even the examples that he uses do not provide any evidence of death on demand. One concerns a little girl in Britain, Indi Gregory, born on 24 February 2023, in Derbyshire, sadly afflicted by a mitochondrial disease, a genetic condition that, according to the Guardian’s Josh Halliday, the National Health Service says is incurable.2 In the end, the courts decided, based on medical argument of what was in Indi’s best interests, that treatments for her condition should cease, because it was only prolonging the suffering life of a child, and that Indi should be removed to a hospice and given comfort care until she died.

Had death on demand been available in England, what need was there to bring all this before the law courts in London? Why was Indi not killed immediately if demand were all that was required? Yet the case was argued before the High Court and the court of appeal,3 where it was deemed not to be in Indi’s best interests that treatment for her incurable condition should be continued, not only because of the costs of treatment which had no chance of success, but because of the cost to Indi in the suffering involved in needlessly prolonging her life. In the end specialists removed life support and Indi died.4

Despite this, Ward tries very hard to link Indi’s death, and the basis on which it was determined, with the choice of an Italian actor who, having no choice of assistance in dying in her native Italy, went to Switzerland where she was able to receive the assistance to die that she sought. “Italy did not want her to kill herself,” Ward says, “but Switzerland was indifferent.”

This is the type of argument in a vacuum that I mentioned above. What does he mean by saying that Italy did not want her to kill herself, but Switzerland was indifferent? The law certainly forbade it in Italy, but what did Italians think? And where are the thoughts of Italy recorded? Laws prohibiting assisted dying are often very unpopular. In Canada more than 80% of Canadians were in favour of its legalisation before the Supreme Court ruled that it was a human right. What does it mean to say that a whole country was indifferent to the choice of an individual to receive help to die? Especially in view of the fact that the Swiss are almost unanimous – and have said so in a referendum – that help to die should be provided, not only to Swiss citizens, but also to those who are not citizens; notwithstanding a few religious holdouts who condemn assisted dying for religious reasons. Indeed, the actor, Sibilla Barbieri, whom Ward takes as his example, like many others who come to Switzerland for this purpose, made a public occasion of her choice to highlight the injustice of laws in Italy which prohibit the practice, thus publicising her view of the injustice of preventing people who are suffering intolerably from choosing to die when that seems better to them than remaining alive in conditions of great misery. No doubt many Italians agree with her, is the case also in many other places; though the Constitutional Court in Italy has refused to allow the question to be addressed by a referendum. In the UK polls have shown that the approval rates vary from as low as 66% to a high in 2019 of 84%.

But now, mark the difference. Ward wants us to think that the cases of Indi and Sibilla are similar in relevant respects, although he seems to misjudge where the similarity lies. The similarity resides solely in his belief that to help someone die is a harm.5 For Ward, the question of choice is irrelevant. Ms Barbieri chose to receive help to die in Switzerland where assisted suicide is legal, and has been legal since 1942 — without, it needs to be added, the grim sequelae that Ward predicts.6 Little Indi Gregory was dying, and at some point attending physicians believed that it was time to withdraw life support. She could not have chosen, given her age, and it is ridiculous to suppose that this does not matter.7

Yet Ward thinks it germane to say:

On the surface, death and Italy are the only commonalities between the Barbieri and Gregory cases. But these events taken together grimly foreshadow a world that will become increasingly difficult for opponents of assisted suicide to navigate.8

It is hard to see what he means by the grimly foreshadowing premonitions that disturb his sleep. After all, supposing Italy a common factor derives solely from the decision of the Italian Prime Minister, in an effort to publicise her religious or moral bona fides, in a moment of drama granted Indi Gregory Italian citizenship, and a promise that Italy would carry on with experimental treatments that Britain refused. Sadly, Ward seems not even to notice that in both cases there was someone who was suffering grievously. Further, the assumption that there were experimental treatments that could have been tried is not explored by Ward,9 as it should have been, though it seems to me likely that the High Court and Court of Appeal in London did make sure of this. Nor does he weigh the human costs to Indi herself of using her as a guinea pig at this point in her short life.

The problem, for Ward, really has nothing to do with Italy or with death as such. This is simply window dressing. But Ward’s concern can be quickly stated. According to Ward it applies equally to Indi as it does to Sibilla:

Today, the Hippocratic orthodoxy to do no harm has become optional. In Canada, Holland, and a fifth of American states, doctors are now allowed to kill people who want to be killed.10 Slippery slope predictions are coming true: not just the terminally ill, but also those with physical disabilities and mental illnesses are choosing to die — and in some cases, being encouraged to die.

But it is in fact not true that the Hippocratic oath is now optional. Nor is it true that in the named places doctors can kill people because that is what individuals want. What has happened is that what is deemed to be a harm is undergoing change. It is no longer taken for granted that death is, as such, a greater harm than being forced to continue to live in conditions of intolerable suffering from which only death can set us free.11 Slippery slope predictions are only coming true if in fact we continue to think it appropriate to force people to prolong their lives if life has become intolerable to the suffering person. In Canada forcing a person to go on living without the option has even been declared a human right by the Supreme Court of Canada. Being forced to continue living is now reasonably considered a harm to a person whose life has become for them a living hell. Life is, in itself, no longer considered to be always a benefit. There may be religious beliefs — though Ward does not mention any — according to which a chosen death is always a harm, but there is no reasonable general basis for making this claim, and religion should keep to its own lane in this respect, instead of trying to foist its strange beliefs on others who do not share them.

Notice that this does not mean that help to die should be provided, as Ward so unjustifiably characterises assisted dying, simply on demand.12 Indeed, assisted dying strives to avoid providing on demand assistance in dying. To do this conditions are prescribed in the law in terms of which a request for help in dying can be honoured. It must not be done according to the demand of a person wanting to be killed. Since Ward does not think there is a difference between one act of helping to die and another, which are, he assumes, acts of suicide, or simple acts of killing, he he seems to believe that any provision of assistance in dying is already to stand on a banana peel, but nothing that Ward says shows that our footing is that insecure.

Since law is the operative condition for providing help to die, the scenarios explored by Ward, about freeing up beds that could be filled up with worthier patients than those with severe illnesses that cause great suffering, can be done simply by providing help to die to those who are … Well, yes, to those who are … what exactly? Ward is predictably unclear at this point, for he is really in a cleft stick here and does not want to deal with the options available to him. Who does he have in mind when he says that some beds “will be taking up valuable space that could be given to worthier patients?” A less worthy patient, he thinks, will be one who in the future will just be killed indiscriminately, because he thinks this is the inevitable result of legalising assisted dying. But no one who supports assisted dying laws governing assisted dying reasonably reject such callous disregard of the value of human life. Assisted dying is a matter of choice under the law. It is not something that is compelled, nor should it be encouraged.13 It is Ward, and not those who support assisted dying, who is making this kind of egregious comparison, and then excuses it because he believes this will be the consequence of permitting people to receive help to die when suffering is intolerable and irremediable. But that is because he knows nothing about assisting dying and its protocols.

Ward even goes much further than this, painting as lurid an imaginative picture as possible of what he surmises will happen under the governance of something he characterises as “socialised healthcare.” Despite his misunderstanding, socialised medicine is healthcare which is available to every citizen as a matter of right, so that, unlike the United States, patients do not need to impoverish themselves, as in the United States, to receive health care. Instead, it is free, because everyone has a right to healthcare, and everyone’s life is valued. In other words, if Ward wants to understand things better, socialised healthcare is not socialist health care, but healthcare that is provided to everyone as a matter of social justice. The misunderstanding that welfare states are socialist is a mistake that could be made only in the United States, where anything that provides assistance from state or federal resources is widely held to be socialist or even communist and thus deeply suspect.14

Nevertheless, having done the American thing by merely positing that where socialised healthcare is provided, dangers will abound, he continues undaunted on the wings of fancy. The debate about Obamacare looms when Ward says:

In places with socialized healthcare, like the United Kingdom, agents of the government (“death panels”) rather than insurance companies will determine the threshold at which interventions [to save lives] are impermissible.

The reference to insurance companies and imagined death panels derives from his equally imaginative idea that insurance companies (at least in the United States) will someday, because of the availability of assisted dying, likely “refuse to cover life-prolonging and life-improving interventions when patients are past the [quantifiable] threshold” of suffering15 as determined by insurance companies themselves. This is ridiculous, of course, because there is no way to quantify suffering. As Elaine Scarry says (The Body in Pain), pain and suffering are known with certainty by those who are suffering, and doubted by those who are not. Each person suffers in their own way; and there is no way to quantify it. Undaunted, however, Ward suggests that where medicine is “socialised” this function of judging the quantity of suffering will be performed by government “death-panels,” instead of by insurance companies. There is no basis for any of this speculation. His wings are beating furiously, but he has not achieved liftoff.

Of course – to continue along the same dream sequence for a moment longer – Ward assures us that the heartlessness of insurance companies will have no purchase in the United States, because in the US insurance companies “are still accountable to the law and its judges.” Does he really imagine that dreaded “socialism” in the United Kingdom means that insurance companies in England are not responsible to the law and its judges? The mind reels at the mere suggestion that the United States and Britain differ in the way imagined. Ah, but you are forgetting the chief difference — Ward will no doubt assist me at this point — that in socialist Britain, while what might be done by insurance companies in the United States can be reined in by the law, decisions by government death-panels in the United Kingdom will be done by government itself and will therefore be beyond the reach of the law. If that is what Ward really believes, then he is believing things in a vacuum that he established long before he began writing; for in a government ruled by law, even the acts of government are not beyond the law. The idea that where healthcare is free as a matter of justice there will be death-panels that will be beyond accountability “to the law and its judges” is absurd. There is no more reason in Britain that government will ever decide (socialistically, in Ward’s sense) when the sick will die than there is in the United States, for both are governed by law, and are not directed by the whim of either business or government. The case of Indi Gregory is not an example of England saying no, and Italy saying yes, as Ward avers; it is as clear a case as could be hoped for that matters like this are answerable to the law, since the decision was made by the High Court and upheld on appeal.

This was the entire reason that Ward raised the issue of Indi Gregory in the first place. For he thought it gave him reason to say that despite the willingness of Italian doctors and the Italian government to try additional experimental treatments and do their best for [Indi], England said no.

Actually, it was English medical authorities who argued before the High Court that further treatment was futile, and should not be done, because at the centre of the dispute was a dying child who continued to suffer while attempts to save her were fruitless, and could only prolong her suffering. Ward seems to forget the suffering child at the centre of the dispute. For him the use of experimental medicine on a dying child was not too long a moral reach, since death is for him an unquestioned harm, and further treatment, no matter the harm done, is always morally more acceptable without demonstration than helping to die or letting die. It never occurs to Ward that using little Indi as a guinea pig for experimental treatments is not obviously the best course to take when dealing with a child unable to make her own judgement about what she might prefer, were she able to say.

The rest of Ward’s article is devoted to highly imaginative scenarios that could only, it seems, be dreamed up by an American whose jaundiced view of government thinks that we are best served by individual action rather than by government sponsored services. Forget the fact that individual action in the United States allows more poverty in a highly developed and immensely rich industrial power than is tolerable anywhere else in the developed world, and increasingly in the developing world as well, while charity medicine is the only form of healthcare that is available in the United States to the lamentable poor, if it is available to them at all. Forget the fact that one of the political parties of record in the United States never stops trying to get federal sponsored health insurance (which the American poor cannot afford) declared unconstitutional, or attempts to do the same for social programmes that help the poor to survive at all.16 Forget the fact that there are more privately owned small arms designed for war in the hands of American citizens than there are in many militaries around the world, so that people can be killed indiscriminately by those upset by some trivial matter that accessible mental health care might mitigate. Also worthy of remark is that America is the only country in the world where school children are routinely murdered en masse to satisfy a lust for weapons that can be carried about as if the United States as a whole were modelled on the Wild West where every man (and now, as equal opportunity dictates) every woman too can walk the streets armed to the teeth.

As I say, Ward is resident in a vacuum, and has not allowed his highly charged imagination to range outside the limits of the prison house of his own mind. I cannot think of one “good” argument or one “reasoned” explanation in his article that can reasonably be thought able to survive outside of his fevered imagination. I say this with regret, but I say it sincerely believing it to be true. And all of this is offered to us in an orthodox Catholic journal for our instruction in the one true faith.

© 2023 Eric MacDonald

1 Accessible here: https://www.firstthings.com/web-exclusives/2023/12/indi-gregory-and-the-future-of-death-on-demand

2 This is of course careful newspaper speak for we cannot say that it is or isn’t, but that is what is claimed for it, even though it is doubtful that the court would have acted as it did had it not been established that, given available treatments, Indi’s condition was incurable.

3 The European Court of Human Rights declined the opportunity to hear the case.

4 This is not an uncommon thing to do when suffering is great, and no chance of survival is likely. Most of us have experienced the same or similar situations, and all Ward’s agonising over death on demand will not change this fact.

5 He suggests that the only relevant similarity is Italy, and, unbelievably, death, which is a palpable attempt to mislead us.

6But does he really forecast horrors? Or are his horrors what others think it is reasonable to plan for, and have been thought reasonable by some ever since Miguel de Montaigne and John Donne wrote about assisted dying, not to mention support for suicide in the classical world of Greece and Rome — by Plato and Epicurus, for example. Regarding the use of the term “assisted dying” here I am prepared to support the use by referring to the writings of both Montaigne and Donne where they speak clearly in terms of help to die.

7 I will only say here that the only thing that can justify assisting someone to die is choice, voluntarily made in conditions where the stability of the decision is known, and the conditions are such as to warrant it on the grounds that the person making the choice is suffering in ways that cannot be remedied, and that the choice is in accord with the laws that govern assisted dying in the jurisdiction concerned. Choice matters for assisted dying, as all the laws governing assisted dying declare.

8 My italics. A difficulty which we should celebrate, by the way. But notice Ward’s use of the term assisted suicide, which he prefers to assisted dying, even though assisted suicide has undesirable historical associations which assisted dying does not force upon us. Self-killing or self-homicide, which is what the word suicide means, are very different than being assisted to die, yet Ward insists on the former, as though this is what we must mean.

9 Or he might have argued, as is often done, that there is always the possibility, no matter how remote, that a treatment may soon be available – so we should wait.

10 My italics. This is strictly speaking not true. It is not wanting to be killed that justifies assisted dying, but choosing to be helped to die in situations of great and irremediable suffering. Wanting has nothing to do with it, for those who ask for help to die do not want to die, as such, but in their own view, need to die before living swallows up all value in life and leaves them with nothing but suffering.

11 There are important facts here about the increasing severity and frequency of suffering because of modern medicine and its success which I forbear to speak of here. I mention it simply to alert the reader to the fact that other factors enter into the issue of assisted dying that did not obtain before the increasing success of scientific medicine, which leads to the fact that more people now suffer from long-term degenerative conditions that were spared those who more often died of short-term acute conditions than is now the case.

12 I shall continue to use the term assisted dying instead of assisted suicide, or simply killing, as Ward prefers, since there is no reason to use any other term. Dying is something we can do, as many a martyr will testify. There is therefore no reason for supposing that it is not something we do or can be helped to do.

13 The problem with encouraging someone to seek help to die is that it confuses the issue for the suffering person. Assistance in dying must be both informed and voluntary, and anything that interferes with either condition must be avoided. Ward seems to be unaware of such limitations and that is because he is arguing about assisted dying in a vacuum.

14 Of course, Ward does not even mention the fact that in the United States the Catholic Church is making every effort to buy hospitals and other healthcare facilities so that people’s choices in extremis will be limited to those allowed only by Catholic doctrine. Even in Canada, where healthcare facilities are provided by our tax dollars, the Catholic Church still makes every effort it can to make sure that the church has an influence on medical options provided.

15 The problem here, which I will not discuss in detail, is that suffering is not quantifiable. The idea that there is a quantifiable threshold of suffering is simply to imagine such a thing without any sound basis for holding that there is such a metric, but it plays a crucial role in the vacuum which Ward inhabits. I wonder that he is not gasping for breath at this point!

16 Which ends up, for Ward, in describing individual action regarding health care in terms of “members of independent communities of medical care [which] would shoulder an enormous burden of practicing medicine in ways that are just”! And he says this without even a hint that he can see the almost dream-like irony of the idea in a country in which millions have to do without healthcare altogether.