dignity in dying: it sounds really attractive, doesn’t it?

The morning after the Scottish Parliament voted down the Assisted Dying for Terminally Ill Adults Bill (69-57), I was seeing a patient in my GP surgery about a chronic condition. Let’s call her Morag (we are in Scotland, after all). At the end of the consultation, Morag shared how disappointed she was that the bill had not been passed, because she has no family to look after her as she becomes frailer. And so, she wanted to talk about formalising a ‘do-not-resuscitate’ decision. This seemed completely appropriate, and I explained the vast difference between this decision and the proposed bill. Afterwards, I reflected on Morag’s concerns and her motivation for wanting the bill to pass. It wasn’t about managing symptoms or fearing death itself. She was worried she wouldn’t have dignity at the end because the state wouldn’t be able to provide the kind of care she felt she might need. Morag wanted dignity in dying, and there is an organisation claiming to offer exactly that.

Those campaigning for a change in the law on assisted suicide seem to have monopolised dignity, as if the only way to achieve dignity in death is by having control over it. A dictionary definition of dignity is: the state or quality of being worthy of honour or respect.

If this is what dignity is, and it is equated with independence, then we have a problem. Suddenly, a vast number of people are declared undignified – terminally ill and requiring help with personal care, those living with chronic cognitive impairments, or infants unable to express themselves. In fact, anyone lacking capacity or ability suddenly loses their dignity and worth.

As Christians, we need to take a step back and consider what it is that gives us dignity. There are certainly many practical and ethical concerns about any attempt to legislate for assisted suicide – the MSPs have recognised these. But as followers of Jesus, we must also consider a theological angle: how does God define our dignity? Is dignity something we can lose?

Genesis 1:26-27: Then God said, “Let us make mankind in our image, in our likeness, so that they may rule over the fish in the sea and the birds in the sky, over the livestock and all the wild animals, and over all the creatures that move along the ground.” So God created mankind in his own image, in the image of God he created them; male and female he created them.

The exact meaning of the image of God is debated, but what is clear is that we – male and female – are distinct from the animals. Together, we are the pinnacle of creation. God creates us as his image, and he later forbids us to make any other images of himself, because he has declared that we alone are his image. And our image-bearing status is directly related to the value of our lives:

Gen 9:6: Whoever sheds human blood, by humans shall their blood be shed; for in the image of God has God made mankind.

Human life has value because of this fact: humans are made in the image of God, so human life must be protected. In fact, the death penalty is proposed for the unauthorised intentional killing of people.

 

This image is not dependent on how young or old, sick or healthy we are. It’s not as if some humans are more image-bearers than others, more valuable than others. All humans are equally valuable in God’s image. Note the causal link in this verse – shedding human blood is serious. Why? ‘For in the image of God has God made mankind.’

Humans have inherent value, an intrinsic dignity, because we are made in God’s image. If dignity is defined as autonomous capacity and independence, then disability, terminal illness, or dependency are seen as ‘undignified’. But biblically, needing care doesn’t diminish dignity. There isn’t a graph that shows a drop-off as our life expectancy decreases.

We are image-bearers of the divine. Flawed, yes, but image bearers nonetheless. The graph is horizontal. And that brings value and dignity to every life, including that of Morag, with no family to care for her when the time comes.

Christ is the supreme image of the invisible God, revealing true human dignity in all its fullness. And consider the start and end of his life on earth; born as a weak refugee baby, executed in weakness on the cross – mocked, stripped and suffering. He remained the image of the invisible God through all these weaknesses.  Christ shows us that dignity is not lost in weakness. And for us, as his people, we read that God’s power is made perfect in our own weakness. Our worth is anchored in God’s image and Christ’s redemption, not in our ability to care for ourselves.

So, on the one hand, we have the factual, inherent, divine, never-changing dignity of each human, and on the other hand, we have a deep-rooted rejection of that dignity.

How does this help in my conversation with Morag?

• I need to treat Morag as an image-bearer crowned with God-given dignity. Our calling is to honour and uphold the dignity God has given, even when patients feel undignified. I might tell her I believe her inherent dignity is given by God and cannot be taken away by illness. A purely naturalistic (culturally default) worldview produces a dignity that depends on our usefulness to the gene pool.
• I need to demonstrate to Morag that this pseudo-dignity isn’t reality. She doesn’t need a lecture; she needs to trust that I actually believe this. I need to reassure Morag that we won’t abandon her when she needs help. I need to have realistic conversations and link her with local organisations that can provide the community and support she needs. This might involve charities, a local church, social work, etc.
• I need to medically upskill in knowing how to support Morag as she approaches the end of life. I’ve produced a resource to help Primary Care staff improve their confidence in palliative care, which any healthcare worker in Scotland can access here. An alternative module for non-Scottish access is here.
• I need to advocate for patients like Morag, as someone who feels like no one is advocating for her. Each of us is in different spheres of influence. It may be starting a discussion with my team about the opportunities we have to support her. It might be implementing a policy change in my leadership role. It may be speaking to my Royal College or elected political representatives about Morag’s experience.

The decision by MSPs (and the likely upcoming timing-out of the Leadbeater Bill) is good news for Morag. It reminds her that we are not abandoning her to end her life; we now have the opportunity to show her real dignity in dying.