Let’s get some perspective, shall we?!
Posted by Eric MacDonald
My last few posts have been about assisted dying — which should come as no surprise to anyone, since this is the ostensible subject of this blog. As I say in the masthead: “Arguing for the right to die and against the religious obstruction of that right.” One thing that annoys me almost as much as religious opponents of assisted dying are those secularists/humanists/atheists who simply seem unable to get it right. These are the people who are not dependent upon religious doctrine to tell them what is right and wrong; these are also people who, in general, are supposed to check and double-check their sources and their arguments, because when you haven’t got doctrine to reassure you, you really do have a responsibility to think a bit more closely about the things that concern you. You may not always get it right, of course — that’s a danger we all face — but we should get it right more often than not, if we really have taken the trouble to think about something, try our best to discover the best evidence or reasoning for what we believe, and then take care, when speaking or writing about it, that we avoid the worst effects of self-deception, emotional loading, and special pleading.
Now, just to be clear about this, if there were conclusive evidence that legalising assisted dying would be impossible without resulting in massive risk to the so-called vulnerable, the mentally and physically challenged who live amongst us, whether because of accident of birth, illness, mishap or age, then I would be the first to say that legalising assisted dying is something we should not undertake for fear of the inevitable consequences of doing so. The trouble is, there is no evidence that this is the case, despite the best efforts of those who have no respect for evidence at all to show us that it is. Recently, José Pereira, in the journal Current Oncology (accessible here), argued in detail that the laws in Belgium and the Netherlands are simply unable to protect the most vulnerable in those countries, and that thousands of people are being killed there involuntarily every year. I was faced with the fact of this paper’s existence in an interview I did for CTV’s W5 programme last year. Victor Malarek gave it to me cold, and, since I hadn’t seen the paper, and did not know how cogent the arguments being used were, I had very little to say about it, though I did point out that opponents of assisted dying regularly make such claims and that so far they have been shown to be entirely bogus, so that I would not myself lend much credence to them without a very serious background check. (The producers chose to edit these comments out, so that no expression of doubt was permitted to dampen the force of Pereira’s claims.) After the interview I located the paper, and wrote a more serious assessment, though it still had no effect on the outcome; and, in the end, no objections to Pereira’s claims were voiced in the programme, and the result, though it appeared to give more time to supporters of assisted dying, gave Pereira and his fears the last word, and represented them as “expert testimony” in such a way as to constitute bad journalism if not out and out prevarication.
It turned out, in the end, that I was even more right than I had thought in my reservations regarding Pereira’s paper, which was taken to pieces sentence by sentence and reference by reference by J. Downie, K. Chambaere, J.L. Bernheim, and also published in Current Oncology (available here), who show, in detail, how Pereira’s paper not only fails to make his case, but how he misuses evidence, refers to non-existent sources, and misunderstands the evidence that he actually cites. Here are the results and conclusions of this minutely critical analysis of Pereira’s paper:
Pereira makes a number of factual statements without providing any sources. Pereira also makes a number of factual statements with sources, where the sources do not, in fact, provide support for the statements he made. Pereira also makes a number of false statements about the law and practice in jurisdictions that have legalized euthanasia or assisted suicide.
Pereira’s conclusions are not supported by the evidence he provided. His paper should not be given any credence in the public policy debate about the legal status of assisted suicide and euthanasia in Canada and around the world.
This is basically what I told the W5 producers, who decided to run with the programme as they had edited it, thus misleading thousands of people across Canada who watched the programme.
But this kind of thing continues to be done, without apology, without understanding, without even a shred of evidence to support the claims being made. The latest, I’m sad to say, comes from someone who is an Honorary Associate Member of the National Secular Society in Great Britain, Joan Smith. In an article in the Independent on Sunday, 26th August 2012, entitled “Tony Nicklinson’s legacy: his case will save lives,” an apparently secular argument against assisted dying is allowed to stand as a reasoned case. One strange thing about the article is that there is not one word about saving lives in the article. It’s one of those articles that can be written with one’s eyes shut, because all it does is to rehash old arguments that have been used thousands of times, and have been found wanting, and yet there they are, in their lurid stupidity, posing as a serious piece of journalism, reminding anyone who remembers having done it, of that last-minute essay that you wrote, minutes before it was due, during your first term at university. You pray silently that the prof won’t recognise it as a hack job, although you know, almost to a certainty, that he or she will. When you come away, in the end, with that not quite deserved C-, a mark that lets you know that the prof hadn’t entirely given up on you, and expected you to do better next time — probably with a comment or two expressing disappointment at your poor performance this time — you know how close you came to the F you really deserved. Smith’s article is like that.
Smith begins by saying that she
was troubled by the images of his [Nicklinson's] distress that circulated widely after he lost his case, and not just because they felt like an intrusion into private grief. There’s a clear danger that ethical issues will get lost in this focus on a handful of tragic individuals.
The first thing to notice is that it wasn’t private grief at all. It was an expression of profound disappointment, and its public representation carried an important message to those who continue to claim, against the evidence, that people in some situations really do not want the opportunity to be helped to end their torment, despite their urgent request for such assistance. But also notice that dismissive ”handful of tragic individuals.” How many might that be? Consider that about 1 in 800 deaths in Oregon occurs as a result of assistance, and that there were a total of 493,242 deaths in the UK in 2010. Supposing the figures in Oregon accurately predict the numbers of those who would choose elective death in the UK, should assistance in dying be legalised, that 1 in 800 would result in roughly 617 assisted deaths. And that would depend on the UK law being as restrictive as the one in Oregon, which would not include people like Tony Nicklinson or my wife Elizabeth. Still, slightly over 600 may seem like “a handful of tragic individuals,” but it would amount to an incredibly large amount of torment and suffering that could have been avoided. Of course, if the Tony Nicklinson case had managed to set a precedent, as Richard Dawkins thought it should, then there would likely be a larger number of tragic individuals that Joan Smith thinks can simply be fobbed off with the suggestion that their right to die should be trumped merely by the fears of those “vulnerable” people whose lives, it is claimed, would be put at risk by the legalisation of assisted dying.
The really objectionable part of this is that Joan Smith has taken up the religious cause in defence of the status quo without acknowledging it. Religious opponents of assisted dying would dearly like to be able to say that life belongs to God and we have no right to take it away, whether by suicide or in any other way — except of course for those traditionally legitimate forms of killing, such as war or capital punishment — but they are reduced to using second-best arguments, such as risk to the vulnerable, diminishing respect for human life, and so on. And Joan Smith walks right into their trap, because the religious have simply not been able to make a plausible case of risk to the vulnerable. If she were to look for a moment at Switzerland she would see in a moment that such a risk does not really exist. The religious think that once we let go of the central religious conviction that human life is infinitely precious and sacred – fancy any religion actually thinking that in view of the multiple offences against human life committed by the religions! — the value of the disabled, the blind, the mentally challenged, and those with various other deficits, will instantly plummet.
However, there is no reason to think that this is true. As I have pointed out a number of times already, Cardinal Cahal B. Daly, in his little book Morals, Law and Life, tells us that once we start using contraception, we are well on the way to killing off surplus old people (to use the idiom adopted by N.T. Wright when he was Bishop of Durham):
… man’s attitude to contraception [says Daly] determines whether he will think it wrong or right for a mother to kill her defective child, or for a doctor “gently and humanely to extinguish his patient’s life.” 
Notice the language of determination. These things, apparently, are logically linked. Contraception, therefore infanticide, therefore euthanasia. And not a valid argument in sight!
Joan Smith does roughly the same thing — though, presumably, she isn’t quite so enthusiastic about the rhythm method. She tells us, as though this were simply a fact of logic, that
[t]here is a huge difference between withdrawing medical treatment in terminal cases and actively helping someone to die, especially when the patient – as in many of these cases – is not actually dying.
Of course, that’s carelessly written. You can’t withdraw treatment in a terminal case where the patient “is not actually dying.” But, that bit of carelessness aside, philosophers nowadays do not see such a bright line between killing and letting die. Of course, Smith is right, if someone is not actually dying, as Tony Nicklinson was not, withdrawing treatment would not in itself constitute killing, but that is another issue altogether; nevertheless, Smith had some responsibility to inform herself about the bioethical analysis of killing and letting die, before making her huge claim.
Besides, the point is not so simple as Joan Smith pretends. No one killed Tony Nicklinson. He simply decided to stop eating — which is a perfect recipe for dying. But why should he have had to starve himself to death, or to starve himself into such a weakened condition so that pneumonia – the “old man’s friend” as our grandparents and great grandparents used to call it — would take him the next stage of the way towards death? Is there a good reason to distinguish between this passive letting die and a positive act to help someone die more peacefully than starvation would allow? Joan Smith has not given us one.
Joan Smith suggests that — well, let her tell it in her own words:
But the debate about assisted dying is weirdly dissociated from the real world, in which relatives and carers often abuse elderly and disabled people. The frequency of domestic violence – and, more recently, “honour”-based violence – shows that the family is far from being the safe place campaigners imagine it to be.
Who does she think she’s kidding? No one who supports assisted dying is supposing that all family members are loving and supportive, or that some of them would not be perfectly willing to shorten a family member’s life if they would benefit therefrom. But does she think that this doesn’t happen now? Of course it does. That’s why so-called honour killing is so prevalent in some religious cultures, because other values do come into play, people do get overburdened by the care of a loved one who, however much loved, can become a financial, physical or emotional burden upon family members. No one who supports assisted dying is simply ignoring this fact. Indeed, this concern exists, not only in cases of assisted dying, but in cases of choices not to treat or to withdraw treatment, to have or not to have surgery, to terminally sedate, or not to do so, to continue to provide nutrition and hydration or to cease provision of these necessities of life. The problem is that Joan Smith seems to think that the choice to die is the only life or death choice that patients and those who care for them must make. It is her analysis of assisted dying which is, to use her own words, “weirdly dissociated from the real world.” She seems to think that the decision to help someone to die takes place in a kind of moral vacuum, when it comes within a human context in which a number of very similar decisions are being made every day.
Joan Smith forgets something else. She forgets that, where legal provision is made for assisted dying, many other things can be included in the law, so that people who are dying, or are likely to die within a short period, or people who suffer from long-term degenerative conditions which can produce life situations arguably far worse than those who are dying from acute disease, will have a chance, long before decision is called for, to consider what their own ideals are, and how they would like to die, given the choice. People like Joan Smith who engineer all sorts of problems about assisted dying as though the whole thing would be suddenly sprung on people for the first time close to the time of death, simply misunderstand the complicated decisions that must be made when someone is dying. But if a law governing how we die were in place, we would have reason to think seriously about our dying long before it comes to the moment when we are dying, or are paralysed and find ourselves, because of our own values — not someone else’s, who might tip the scales for their own benefit – unable to live a meaningful and purposeful life. Joan Smith is the one weirdly isolated from the real world where people suffer and die. People who are dying, or are suffering from degenerative conditions like MS, ALS or Parkinson’s, to name only three, think about dying a lot. Why does Smith think that, in jurisdictions where assistance in dying is legal, people will only start thinking about this at the very last moment, when emotions are running high, and family members are emotionally overburdened and exausted? Surely, where the law governs how we may die, this is something about which we may have thought about long and hard long before we encounter the issues about which Smith worries so much. Why can’t she stand back and get a little perspective on these issues, instead of delivering herself of pretentious nonsense which demonstrates a lamentable and reprehensible ignorance of the issues involved?