What might it mean this Advent to follow St Benedict’s injuction to keep death daily before our eyes? Perhaps our friends might think us morbid; but we could discover in this embrace a better way to live. Keeping death daily before our eyes means thinking about how our own death could be happy. This challenges us to accept the reality of death as part of life and can release us to live life in the present for to what is truly important. We may also find that we are happier.
On Tuesday of this week The Commission on Assisted Dying was launched in the Offices of Demos. It has attracted some mixed and cynical publicity which reflects the ever increasing polarized debates taking place both in the Media and in Parliament. The Church of England has taken a clear stand against any moves to change the law (www.cofeanglican.org/protectinglife) and the Bishops in the House of Lords have offered an unequivocal stand in opposed to any change in the law, or medical practice, to make assisted suicide permissible or acceptable,(see the letter of The Archbishop of Canterbury and the Chief Rabbi in the Press last year – see , www.archbishopofcanterbury.org/2471).
Despite these principled stands the legal and ethical status of assisted dying in our society continues to be an unresolved public policy issue. The Director of Public Prosecutions’ (DPP) policy for prosecutors in England and Wales has clarified the circumstances in which somebody who assists another person to commit suicide is likely to be prosecuted.
This policy effectively decriminalises amateur assistance with suicide (if this assistance is motivated by compassion), while stipulating that healthcare professionals who provide assistance are likely to be prosecuted. The policy therefore creates the expectation that people must rely on friends and family for assistance, with all of the practical risks that this might entail. To date, over 150 Britons have travelled abroad to die and no one has been prosecuted for accompanying them or assisting them.
The commission is made up of a number of experts and senior practitioners from a range of fields including palliative medicine, social care, nursing, psychiatry and law. The commissioners have been selected on the basis of their open-mindedness and expertise.
Why should we be concerned with this work? Death is a spiritual issue that faces us all despite our denial and fears. Listen to the voice of Debbie Purdy when asked to address a Church Group :
‘I want to be able to decide what’s best for me. I believe that the only person who can decide whether my life is worth living is me – and however much pain or uncertainty you face – it is difficult to rely on our medical profession or our
politicians if they refuse to discuss openly the right to die and assisted suicide.
I think it is amazing that the church has organised this debate and a huge step
forward – what we need is to talk – openly, all the organisations – social workers, medical profession, the legal profession – our needs at these times are spiritual, social and medical – and everyone needs to be more open about it. The only person that can decide on the value of my life is me.’
It is the need to listen and reflect that led me to accept an invitation from Lord Falconer to join the Commission. It is also grounded in the conviction that the Church has something very important to offer to the conversation. There are important spiritual and pastoral issue that we can bring to the process of discernment. It is important that the Church learns alongside others who want to reflect on the meaning of dying and death and help others to do so. Theology is not about dogma or ideology but rather a way of engaging and being open to discussion.
Why is the spiritual agenda so important? Life is full of interesting gaps. I doubt whether many of us have really come to terms with our mortality. There is a gap between head and heart; between what we say and how we act. We know that we will all eventually die. In our work of care we may regularly come across death, but somehow our fears can take hold.
Our own fears can then leave us failing to grasp the questions that take shape in those who are closer to death than us. The map of dying and death remains foreign, an un-negotiable land remaining strange.
If we as individuals have a contradictory relationship with death then it is hardly surprising that our society and the health systems we construct often fail those they serve at this crucial time in their lives. I want to change the map of life and death – to enable people and systems to ensure that everyone is given the opportunity to live well and die well in the place and manner of their choosing.
In the early 1980s after University, I worked with Cicely Saunders, a pioneer in the modern Hospice Movement who said this to those she cared for: ‘….we will do all we can not only to help you die peacefully, but also to live until you die’.
Dame Cicely created a place where this could happen and I learnt the value of watching and waiting with those who were dying. This vision has gained widespread acceptance but has yet to be fully realized in our practice. However the ideal, the theories of ‘a good death’ need to be held alongside the untidiness of death and a profounder grasp of the depths of human suffering.
Three issues emerge for me as I reflect on the gaps in both theory and practice: firstly a failure of imagination that, secondly, shapes our humanity which can result, thirdly, in the depth of compassion that we can communicate.
Only human beings have the capacity to imagine a future that could be different from the present. Can we imagine what it might be like to be in someone else’s shoes – to see and feel what life looks like for those who are in pain? Imagining what it is like to be someone else is at the core of our humanity. It is the essence of compassion and the beginning of morality.
Can health care professionals and our structures of care demonstrate the imagination of the sheer fragility and preciousness of life in the face of death? This has political implications for the use of resources, our investment in staff training and support, and our desire to organise systems with the constant reminder that it is the patients that pay our wages. Our public ethic is one of service. Cruelty is a failure of imagination!
None of us can prepare for our birth but we can prepare for death. The way we grow old and get ready for death is a key part of the quality of our humanity.
We each have our own story, like and unlike anyone else’s. We have to discern what is good, how to make choices that set us free and marvel at the sheer wonder and beauty of it.
Making mistakes and learning lessons are part of deepening our life enabling our humanity to be rounded so we can see how our experience can be harvested at the end. We can become more human if we attend to these opportunities to affirm, value and celebrate the parts of our experience that are fearful.
I once asked someone what they most needed at the end. ‘People who try to understand, that’s all,’ he said. ‘It’s not possible to completely understand – just effort to grasp a bit of these last weeks’.
I remember sitting with a person who was dying in a busy acute hospital ward – the whole culture of that place failed to engage with these last moments. This failure was more than just the inevitable task! Focussed activity of the place, the attitudes of staff, showed little effort to understand and support.
I have been present when doctors wanting to protect a patient have offered half truths about diagnosis; nurses who cannot allow their protecting defences to shift towards a deeper respect for the vulnerability of another human being.
The foundation of a good heart is kindness, affection, honesty, warmth and careful listening. Surely this is not a subject for complicated theorising but a matter of common sense!
Failures of humanity will always happen and there are many wonderful people who care with enthusiasm, but we should be brave enough to challenge inadequate care. Medicine is both art and science: the exercise of head and heart.
The poet John Donne expressed it in this way: “This is a melting heart, and a troubled heart, and a wounded heart, and a contrite heart; and by the powerful work of thy piercing spirit such a heart I have.”
There is a fundamental need for virtue that can shape compassion – a confidence that those we trust with our bodies can demonstrate that there is more to the practice of medicine, nursing and social work than the pursuit of money and status.
Love and compassion can enhance the value of those we work with beyond the reductionism economic categories we confine life within. So how do we mind the gap and improve our practice? How might we put humanity back into health care? What is the heart and soul of medicine? Is it possible to inspire compassionate care rather than just adequate care?
I believe it can be possible but this change will need courage to ask questions and challenge both ourselves and others to redraw the map of death and dying.
Some of these questions will be opened up at today’s conference – I hope that we can stimulate public involvement and debate so that we can all play a part in the development of quality services at a time in our life when we are most in need of them.
I commend the work of the commission to the Church and hope that many might be prepared to offer evidence for its work.