This Post is now available in Polish at Racjonalista. Thanks to Malgorzata once again.
There is a column in the Guardian this morning which goes through all the usual misunderstandings of assisted dying, and ends with a claim that, on the face of it, no one would deny, least of all those who support assisted dying, but in such a way as to suggest that the author has made her point, and this is the reductio of anyone who chooses to oppose what she says. As Haggis says below (comment #9), this first one sentence paragraph may not make sense, so I have revised it as follows, trying to say more clearly what I had in mind when I wrote it:
There’s a column in the Guardian this morning which runs through all the usual misunderstandings of assisted dying. However, it ends with a claim that few would wish to deny — namely, that it can be quite rational to cling to life. No one who supports assisted dying would wish to deny that. But she makes this perfectly reasonable claim in such a way as to make support for assisted dying look like a denial that clinging to life can be a reasonable thing to do. Thus she turns a perfectly reasonable claim into an apparent reductio of support for assisted dying, even though those who support assisted dying can themselves reasonably make the claim. This, it seems to me, is a measure of the author’s confusion.
The column is by Deborah Orr, who, apparently, has all the right credentials, being, as the blurb that goes with her name says, “one of Britain’s leading social and political commentators.” If this is a sample of her work, the adjective is in doubt. The column is entitled, “Most of us would rather cling to life – any life – than choose to kill ourselves.” That may or may not be true, but that is not the issue when the question of assisted dying is raised. What is at issue is the choices that people make, and whether or not people should have control over their own dying — or, what comes to the same thing, their own living. And the truth is that most people are in control of their own dying. Not everyone is like Tony Nicklinson, living in a condition that they find intolerable. Most people would rather, as Deborah Orr says, cling to life, any life, rather than die. But some, like Tony Nicklinson, or like my wife Elizabeth, want to be in control in a way that turns out to be a crucial aspect of what it is for them to have worth and dignity. Whether, as some people who receive a legal prescription for a lethal dose of barbiturates in the US state of Oregon, go on to use those drugs, is irrelevant to the question of control. The fact that they have them, and can use them if they choose, is the real heart of the matter.
The problem is that Deborah Orr can’t seem to keep the issues straight in her own mind (which leads one to wonder about her competence as a social commentator). She unhelpfully mixes up, in the same pot, suicides that happen as a result of transient episodes of depression or other mental trauma, and suicides that happen as the result of conscious thought and in the context of a free and thoughtful decision. For example, in connexion with the suicide of the film director Tony Scott, she says:
In truth, sad and tragic as suicide is generally viewed as being, it is also considered the ultimate expression of screwed-up, narcissistic self-pity, the final mistake in a life that was probably heaving with mistakes, an admission of perceived failure, or of genuine guilt.
Well, maybe. I don’t consider myself an expert in the field of suicide and its varieties, but to speak of “the ultimate expression of screwed-up, narcissistic self-pity, the final mistake in a life that was probably heaving with mistakes,” is likely unhelpful in dealing with the issue of suicide as a result of transient depression, and certainly unhelpful when it comes to questions that arise when someone who is in great distress at the end of life, or is living with a degenerative condition, or for some other reason finds life more burden than blessing. Anyone writing about end-of-life issues and assisted dying, should not confuse these with the suicides of those who are suffering from transient psychological breakdown. It is not only misleading, it is quite simply irrelevant, as a look at the literature would show Ms Orr in an instant.
The rest of the article is, however, hopelessly confused, and it is, consequently, not clear what Ms Orr really wants to say. She seems to say that people can make a reasonable decision to die, although few do it, and because few do it, apparently, it would be best simply not to make the option legally available. Make people jump through hoops if that is what they want to do, seems to be the main burden of her column. She repeats the old chestnut that “hard cases made bad law,” which she takes to be very wise. And then she says, with fairly careless logic:
For every person who can make a cool assessment of the quality of life that awaits them, apply enlightenment thinking, and decide they’d be better off dead, there are surely quite a few who struggle to decide what colour they should paint their front door. It is horrible, the idea that these people – as well as those who are blessed, even in great misfortune, with certainty – should have to wrestle, along with a frightening diagnosis, with the thought that perhaps they should just embrace the inevitable right away and “not be a burden”.
What a horrible thing, that people should have to make a decision at the end of life, she thinks, apparently not realising that people make such decisions — and must make them — all the time: whether to continue with treatment, whether to have the respirator turned off, whether to stop dialysis, whether or not to risk surgery, whether to … , well, you get the idea. Does Ms Orr really think that people who are sick don’t have to make decisions that will have a bearing on life or death? They do, all the time. Putting assisted dying in there, as the only life or death decision that a patient must ever make, is absurdly misleading. A generation or two ago people didn’t get to make that sort of decision, but that sort of paternalism, though no doubt still hale and hearty in places, is no longer normative in modern medical practice. People must choose, and having the choice of assisted death, even if few people take it, is just one more thing, amongst a myriad, that patients would have to consider, and should consider long before the occasion for it has arisen.
That’s why Deborah Orr’s suggestion, after saying that she is not opposed to assisted dying, suggests that an assisted suicide law “would have to be a lot more highly circumscribed and a lot less pertinent than many of its enthusiasts imagine.” Even ‘enthusiasts’ is the wrong word. I’m not an “enthusiast” for assisted dying. I just think that the opportunity should be available for anyone who, in great suffering, wants to avail themselves of it. And it need be neither so circumscribed nor as pertinent (whatever that is supposed to mean) as she suggests. Switzerland has had a very short clause in its Penal Code since 1941 which simply states that anyone who assists a suicide for other than humanitarian reasons is liable to imprisonment or other punishment. In fact, the wording is in the negative:
Wer aus selbstsüchtigen Beweggründen jemanden zum Selbstmorde verleitet oder ihm dazu Hilfe leistet, wird, wenn der Selbstmord ausgeführt oder versucht wurde, mit Freiheitsstrafe bis zu fünf Jahren oder Geldstrafe bestraft.
Whoever from selfish motives entices someone to commit suicide, or renders him assistance [to do so], will, whether the suicide was completed or attempted, be subject to a fine, or to imprisonment for up to five years.
That’s all. Notice how little circumscribed it is, and how little the issue of pertinence is addressed in the law as written. Moreover, there is no sign — and no one thus far has suggested any — that this law has been either widely abused, or has put anyone, or any particular group of persons, at serious risk. So why is Deborah Orr, this leading British commentator on social issues, making such a song and dance about this?
After saying that an assisted suicide law should be very circumscribed and pertinent, Orr immediately goes on to say:
It is little wonder that groups representing the interests of people with disabilities should be so deeply unenthusiastic about the concept of assisted suicide.
However, she has not provided one reason why this should be the case, not one. Being a leading commenter, I suppose, gives her the oomph she needs to have her word taken at face value. Well, she’s not a leading commenter in my part of the world, and, in any event, I like to see justification for stands taken so boldly and unapologetically, and she provides none. Nevertheless, she feels confident enough to continue with this:
From the point of view of those who fear that they might be the ones on the receiving end of the notion that it is brave and romantic to end an impeded life, or a life that is dependent on the ministrations of others, assisted suicide must surely look more like a terrible pressure than an attractive option.
The idea “that it is brave and romantic to end an impeded life” is Orr’s contribution to the debate. No one that I know of is thinking in terms of something’s being particularly romantic about ending one’s life. Perhaps Orr has her centuries mixed up, and thinks we are still dealing with Die Leiden des jungen Werthers. This is not what assisted dying is about. The provision of assisted dying would simply be a recognition that some people, at the end of life, or, if their suffering is great enough, in the midst of life, may sometimes find their condition in sharp contradiction with their own assessment as to what makes life go well or ill, and may choose to hasten their deaths rather than to continue to live with their suffering. What is so hard to understand about that? And, given the point that she is making, and makes again at the very end, that some people cling to life, rather than to give way to nothingness, why should the provision of such an opportunity, any more than the right to terminate treatment, or not to start it in the first place, lead to an endangerment of those who wish, thus, to cling to the very last moments of consciousness, no matter how desperately and in no matter how much physical or mental distress?
Orr ends with this paragraph:
There is a basic problem with assisted suicide. Enshrining self-sacrifice in law, as an option available to rational, admirable people, risks making life yet more uncomfortable for those many among us who would rather not feel guilty about preferring to cling to life, however difficult, uncomfortable and frightening it may become, for every second that they possibly can. And why shouldn’t they? That’s rational too, is it not – the view that life, whatever its quality, is preferable to an eternity of nothing?
Notice how she italicises the word ‘admirable’, as if we do not find someone’s clinging to life admirable, which indeed most people do. The trouble with not having an assisted suicide law is that it tends to confine the word ‘admirable’ to those who do battle with their illnesses, no matter what the cost, for that is to display a kind of courage and determination that most people do, in fact, admire. And what this shows is that we can admire different things. Why does Ms Orr think that our admiring different things must inevitably put pressure on people to die? As Aristotle and Aquinas both said, we naturally tend to preserve our lives, and that, to a greater extent than Orr’s one-sided commentary allows, will continue to drive us so long as human life endures. But that should not be prescriptive, and certainly not prescriptive because doing so is rational too — that is, to value life, whatever its quality, over an eternity of nothing. We’ll be a long time dead. That’s why an assisted dying law would not amount to the threat that Orr seems to imagine. I can’t help but wonder what lies behind her rather strained and confused account of assisted dying.