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.
Eric, excellent analysis. After I read Orr’s somewhat strange pontifications, I had the feeling I have every time an ‘expert’ tells me: “You can’t possibly be in that amount of pain: someone in that much pain would not-be-able-to/want-to do (insert any activity)!”, or if someone tells me what they would do if they were me, as though they understood perfectly just how it was to be me.
What hubris these people have to announce or publish that they know just how it is to be the person they are speaking of! In Orr we have yet another, using a position of influence, telling the rest of the world exactly what it would be like to be me or Elizabeth or Tony, just how it is that we see (or ought to see?) our lives. She is frightfully rude. She has, in fact, no possible way of knowing how it is I that I experience the value of my life or what is is that makes my life feel like a good life to me. It has never occurred to me to think of assisted suicide as a romantic exit – how totally ridiculous can she get? As for not burdening other people – that’s not in my picture. I do think of it as rational exit. The very fact that I am (and expect to be) in control of my way of living and my way of dying is the bedrock of my current quite rational life-view. Orr is appropriating the voices of people whose shoes, with any luck, she will never inhabit. Thank you, wise Orr, for telling us, and the world, how we feel!
Even a first-rate imagination in a well-educated (perhaps even intelligent!) person is not adequate for understanding the inner workings of others: for example, without experiencing first-hand long-term unrelenting pain, loss of motor function, etc., the human mind is incapable of grasping the enormity of their effects on a life. I have learned this.
Corrie, I know. I really do know. I can remember Elizabeth saying, only two or three months after her first symptoms, in response to the question, “On a scale of 1-10, how severe is your pain now,” quite simply, “Eleven!” For her it was simply off the scale, and even with morphine, sometimes up to 12-15 40 mg capsules a night, it was still almost unbearable. And yet I do not know how bad that was, what it felt like for her. She used to say, very early on in her days with MS, that she would look down at her leg and wonder why the bones weren’t shattered and sticking out through the skin, because that’s what it felt like. I simply can’t imagine what that was like. And yet she was as full of life as ever, and went on for nearly nine years like that, running her business, helping in the parish, living life to the full as only she could, until, as the paralysis began to affect her speech and her ability to swallow, and the strength of her arms and hands, she felt she had to call it quits.
And then some idiot like Orr comes along and spouts such arrogant — and arrant — nonsense. It makes me simply want to scream. She simply has no idea, no idea at all, what she is talking about — and it shows! Nor has she an idea in the world what people who are asking for assitance in dying are asking for and why. Where in hell did she get the idea that this is thought of as somehow romantic?! What a complete idiot! And then, it strikes me, the Guardian thinks she is a leading commentator on social issues, and the unreality of it all simply undoes me with anger, simple, screeching, explosive anger! Where do they dig up these freaks?!
I have learned it too, and one thing it has taught me is not to trust people who approach issues from a religious point of view, for they are the least able to understand. There is always the loving god somewhere in the wings who pulls every claw and is a balm to every sting, so they, least of all, seem able to reach the place where pain really dwells. I learned this, actually, in a lifetime of ministry, where I could not use the words ‘god’ and ‘grace’ to speak words of comfort. What one had to do is simply to be with people in their suffering, and try to experience it too, even though that is impossible. But it was, I think, the trying that made the difference. God and grace, the promise of eternal life, and all that stuff, just made the suffering that much more searing, that much more impossible to understand. Never prayed with those who were dying — never, unless they asked, and very few ever did. Somehow they knew that this was just a dream, and they were experiencing the reality. (And my prayers, I’m afraid, were always distantly related to the supposedly real thing, which I don’t think I ever understood.)
I am too old these days to view anything as romantic. But when I move out of an apartment I don’t leave furniture strewn all up and down the curb or filth in every room. I am tidy, responsible, organized, and considerate. I think it is legitimate for me to think that I am behaving better than the many others who do leave the debris and filth they’ve been accumulating in their apartment for as long as they’ve stayed there strewn around for everybody else to ignore or cope with as the case may be.
And I do think that this sort of attitude might reasonably apply to departing this life as well. That is I hope to be tidy, responsible, organized and considerate, and this may very well mean that I terminate my life while I can still make those things be true. And I may consider myself superior to those who leave an unnecessary amount of mess behind them for others to cope with.
Is there something wrong with this analogy?
“What one had to do is simply to be with people in their suffering, and try to experience it too, even though that is impossible. But it was, I think, the trying that made the difference.”
Yes, just that.
So few can do this at all, as it must be done without judging (and without adding useless advice and ‘cheering’ words). It is an art.
One can respond to Orr that, yes, people may sometimes make bad decisions about their deaths, just as they sometimes do about their marriages or their affairs or their jobs or the children they choose to have, or the place they choose to live, or the political parties they support, or the religion they believe in; and any or all of these decisions may have catastrophic and irrevocable consequences. But there’s no more reason to imagine they will ‘get it wrong’ about their death than about any of these other important life decisions, and hence no more reason to put legal constraints on the one decision that don’t exist for the others.
I think that this paragraph gets to the heart of Orr’s problem. It’s an emotional one, not a rational one, and it is centred on her own personal fears for herself. Life, life, life, at any price. If it were permissible to simply end it, could she feel secure against the guilt of being a burden, or against the cowardice in not following the example of those admirable individuals who have realised that they just want it to stop and there is only one way in which that can happen? She is full of imaginary fears. I guess that an utter rejection of her horror of contingency and death lies behind her readiness to conflate the issues with those of other suicides and pour scorn upon their supposed inadequacies. Any defence, even a cowardly one, is better than dealing with the reality of people’s actual circumstances and the fact of what one’s personal dignity may involve.
While I take sides on this issue is due to a desire to reduce suffering generally, I can’t help considering the possible circumstances of my own demise as well. It must be great to enjoy generally good health right into your nineties and then, one night, go to bed and not wake up. Unfortunately, not many of us are going to be so fortunate. These people who dismiss the suffering of others so glibly, never seem to consider that they themselves may one day be inflicted with a painful and terminal disease.
These people who dismiss the suffering of others so glibly, never seem to consider that they themselves may one day be inflicted with a painful and terminal disease.
Well, I think that the opposite is the case with many people, like Ms Orr here.
Eric, excellent analysis as always.
Nor mine. Deborah Orr, of whom it has often been said, “Who?” I’ve heard of her husband, Will Self, who can be entertaining on chat shows, but not her. Perhaps I need to read more newspapers.
All of the above comments – YES, I agree! And you’ve all said it better than I could. Thanks!
Eric – is it me? I’ve read the first sentence three times, but still can’t make sense of it. Perhaps the second Martini Dry has something to do with it (well, it is after 5-00pm here).
Haggis, good point. I’m afraid I dashed this off rather quickly, because I had to go out. I’ll look at it again, and see if I can’t sort out what I wanted to say.
Now I have revised the first paragraph, and tried to make it say what I wanted it to say. See what you think.
I haven’t read this piece yet, but I stumbled upon a passage by Bertrand Russell from An Outline of Intellectual Rubbish.
The whole conception of “Sin” is one which I find very puzzling, doubtless owing to my sinful nature. If “Sin” consisted in causing needless suffering, I could understand; but on the contrary, sin often consists in avoiding needless suffering. Some years ago, in the English House of Lords, a bill was introduced to legalize euthanasia in cases of painful and incurable disease. The patient’s consent was to be necessary, as well as several medical certificates. To me, in my simplicity, it would seem natural to require the patient’s consent, but the late Archbishop of Canterbury, the English official expert on Sin, explained the erroneousness of such a view. The patient’s consent turns euthanasia into suicide, and suicide is sin. Their Lordships listened to the voice of authority, and rejected the bill. Consequently, to please the Archbishop-and his God, if he reports truly-victims of cancer still have to endure months of wholly useless agony, unless their doctors or nurses are sufficiently humane to risk a charge of murder. I find difficulty in the conception of a God who gets pleasure from contemplating such tortures; and if there were a God capable of such wanton cruelty, I should certainly not think Him worthy of worship. But that only proves how sunk I am in moral depravity.
This is from a link from Jerry’s blog.
Thanks Eric, I get it now!
Yes, well, you were right Haggis. As written it didn’t make a lot of sense. It’s better now. Thanks are due to you.
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