Many years ago, I visited a woman – Pamela – living with a degenerative neurological condition. The prognosis was clear, as were the increasing limits to Pamela’s abilities. Initially our conversations happened, painstakingly, in a low voice with much effort. As time went on this transformed into equally lengthy discussions using an alphabet board and a pointer. Today, technology would no doubt enhance this process of communication. I was the vicar of the local parish, and Pamela was a practising Anglican, receiving Holy Communion every couple of weeks.

One Maundy Thursday I took Pamela the sacrament. Unusually, once we had begun, she wept throughout the brief service. When it was ended, I asked if something particular prompted her tears on that day. The response has always stayed with me. Letter by letter she spelled out the sentence: ‘He was only on the cross a few hours’. Pamela’s suffering, her time of crucifixion, was taking place over months and years.

When it comes to debates about a hastened death, I have little doubt about the exceptional and compelling cases those in favour of changed legislation have in mind. As contributors to this edition of Crucible argue, there is pain that cannot be quenched by even the best palliative care. Like Pamela’s suffering, this pain is all the worse for appearing pointless and brings the added trauma of uncertainty about when it will end. For some people the fever of life is less a state of restlessness, than a torture of indeterminate length. Who would deny the appeals of such a person to bring an end to suffering and enable peace at the last?

In this issue of Crucible four papers by distinguished and experienced contributors offer further reflection on the case for assisted dying or, as others argue it is more accurately described, assisted suicide. They represent a range of views, including those of Rabbi Jonathan Romain and MP Rachael Maskell. All the perspectives relate to a position of religious faith and mirror some of the disparity of views in wider society. They chart a complex landscape of sometimes interlocking arguments, where a choice to die represent autonomy while, at the same time, the ‘option to die’ manifests an implicit societal pressure on anyone who begins to see their care as a resource burden to family; carers; or the community. Over many years as a hospital chaplain, I have heard countless older people say: ‘I don’t want to be a burden’. This has usually led to a productive and meaningful conversation. Might it now lead to the reply: ‘Would you like me to bring you a form?’

Jonathan Romain begins with the declaration that he has changed his mind. In any debate, perhaps especially ones that touch on life, death and suffering, the ability to alter our position based on experience and evidence is surely a commendable characteristic. Too often debates begin and end with pre-determined positions. For theological debate and enquiry to be meaningful we must be open to the possibility of conversion, in whatever direction that may lead us. For Romain the fact of suffering, when there is nothing in prospect to redeem it or change it, means that the refusal of assisted dying is analogous to a failure to intervene to end torture. This is a strong argument and one that takes me back to the account which began this editorial. Individual cases are compelling and, perhaps, they outweigh more communitarian arguments. However, this remains a very difficult choice given the strength of arguments from each perspective. 

Paul Coleman, in conversation with Mo Onyett and Charlotte Naylor-Davis, arrives at no definitive conclusion, but importantly draws attention to the contributions of people living with disability. This includes the concern that decisions which may have significant impact for this community are often being discussed and made without meaningful engagement and listening. Worse still, ableist views often occupy this space making assumptions that are at odds with the daily experiences of those living with disability. 

Mark Cobb, drawing on his experience of ordained ministry, begins with a reflection on the many occasions when he has supported someone in their final months and days. While palliative care does some remarkable work, there are limits to what can be achieved. Often terminal illness places burdens and limitations which no therapy or clinical intervention can ameliorate entirely. Cobb notes the two dominant versions of assisted dying across the world: physician administered drugs to end life; and physician facilitated self-induced death, i.e. suicide. Helpfully this paper offers a summary of religious and church statements about assisted dying. There is also consideration given to the reasons people wish to bring their lives to an end, and the reality that some supportive interventions – including the arts and humanities – are not always available.

Cobb develops an argument which includes theodicy and the religious belief that death leads to a new reality. There is reference to hermeneutics and the scope within our understanding of Scripture to adopt a range of positions that can claim biblical support. If we are more than our physical existence then surely death is not the end and, if that is the case, is it to be avoided at all costs across our lifespan? Cobb concludes that there is an ethical case for assisted dying which can be supported by pastoral theology and that, if a law is enacted, there will continue to be a place for Christians to advocate for the vulnerable.

The Central York MP Rachael Maskell, a leading opponent of the current legislation, writes out of her Christian faith and her experience working in the NHS. Like many Christians, Maskell reflects on the nature of life as a divine gift; sacred and endowed with purpose. Palliative medicine has made great strides in the ability to tackle pain, and holistic care is essential to ensure that all necessary support is available. Maskell sees much of the energy in the current debate in favour of assisted dying/suicide arising from a lack of adequate palliative services. Poor or limited care lends weight to the calls for an earlier end to suffering, and the reality of financial pressures in the NHS cannot be a driver for assisted dying. The lack of expertise and experience among those leading the work to finalise the legislation causes Maskell considerable concern. Summarising a catalogue of risks, the York MP highlights the lack of precision in many aspects of the law and its safeguards. While the objections to assisted dying/suicide have a religious dimension that is not the only motivation for Maskell’s condemnation of the Bill. The quality of debate; the lack of expert involvement; and a deliberate intent to avoid some of the truths about the legislation, are a matter of serious concern.

Jonthan Romain makes the legitimate observation, citing Demond Tutu among others, that religious views about assisted dying are not uniform within religions. However, it is equally true that support for assisted dying/suicide – or the specific legislation in the UK – is not univocal among people who have no religious commitments or faith. The emeritus professor of liaison psychiatry at Leeds, Allan House, an avowed atheist, has written recently about the problematic nature of current legislative proposals. He has described the process as ‘a pantomime of manipulation and incompetence’.

For Allan House the legal position is, despite what some MPs might suggest, that ‘people requesting assisted suicide are by definition suicidal’. House wonders whether the decision to avoid this kind of stark language is a campaigning tactic designed to distance the debate from the more complex issues stirred up by the notion of suicide. A key dynamic of the current approach lies in the repeated refusal to allow exploration of the reasons for someone seeking assisted suicide. While assessment for coercion and capacity is included, any broader exploration is not. Consequently, as House argues, there is no enquiry into whether the factors leading someone to seek assistance are linked to any ‘remediable psychological or social influence’. On the contrary, hyper-individualistic approaches are prioritising ‘the wishes of privileged individuals over community or societal needs, and especially over protection of the most vulnerable’.

Many years ago, I was called to a hospital to speak with someone who had attempted suicide and failed. After discharge, despite all the factors leading to this attempt remaining in place, including bereavement and a medical condition that would eventually lead to death, there was no further move in the direction of ending life. However, when death came it happened in circumstances that were far from ideal. Alone, in Intensive Care, surrounded by machinery; clinical lights; and the sounds of monitors. It was Christmas Day and I have no idea whether the words I said brought comfort, or if death was simply ‘tinsel’d over with a few words which glitter, but convey little light and less warmth’. Perhaps one of the things we all find hard to understand in this debate is the mystery that we have no real data from the person to whom death has occurred. We observe, we surmise, maybe we have some clinical data – but whatever we decide to do, ultimately, is an act of faith.

The Revd Dr Chris Swift became Director of the Leeds Church Institute in 2024. He is an Anglican priest who has spent over thirty years working in community ministry and chaplaincy. He has been President of the College of Health Care Chaplains, and published a number of books, including Chaplaincy in the Twenty-first Century. He is a member of the Crucible Editorial Board