This post is now available in Polish at Racjonalista — thanks once again to Malgorzata.
A few days ago, over at the New York Times, a selection of letters in response to Ezekiel Emmanuel’s article on assisted dying, and to Ben Mattlin’s piece on his reasons for opposing the Death with Dignity law that is on the Massachusetts ballot today, were published. I want briefly to address myself to one of these letters, which in my view is particulary powerful. I copy the letter here:
To the Editor:
Dr. Ezekiel J. Emanuel uses a flawed rationale to challenge the legitimacy of assisted suicide. While he seems to agree that it would be acceptable in cases of severe, intractable physical pain, he suggests that it is not legitimate if motivated by emotional pain or depression. The appropriate response in such cases, he maintains, is to provide “counseling and caring.”
As a retired clinical psychologist, I must note that there is a vast difference between the depression of a terminally ill patient, who realistically perceives his situation to be hopeless, and a physically healthy patient suffering from clinical depression.
In the case of a physically healthy patient who is clinically depressed, feelings of worthlessness and hopelessness are the product of inaccurate perceptions of self and circumstances — mental distortions produced by the illness itself. For such patients, treatment can produce marked improvement.
The same cannot be said for terminally ill patients, whose feelings of hopelessness are, sadly, all too realistic and whose depression is often a normal response to a disheartening reality. While the “counseling and caring” Dr. Emanuel recommends can provide comfort to the terminally ill patient, they cannot change the reality of a patient whose quality of life has diminished to the point where each day is another round of frustration and pain, be it physical or emotional.
If I should become terminally ill, I would not want to cede to a third party the right to determine when my life is no longer worth living.
JAMES HAWTHORNE Baltimore, Oct. 29, 2012
I want to shout it from the housetops: Precisely! So much hand-wringing about assisted dying — and all the laws in the United States, unfortunately, get this wrong, and Scotland is about to get it wrong, too, if it passes the bill introduced by Margo MacDonald – is about the fact that people who are dying, or who are suffering from long-drawn-out degenerative conditions like MS and ALS, are depressed. Some will even add “clinically depressed,” just to make the point clear.
However, it has always seemed obvious to me — and it is an obviousness that does not move the opponents of assisted dying — that being in some situations, and finding them to be existentially distressful — what some choose to call clinical depression — is a perfectly reasonable thing to find. As James Hawthorne points out, with great clarity, dying people, and I would add, those suffering from degenerative conditions, or even, I would also add, those who are suffering from conditions or disabilities which they find intolerable (such as Tony Nicklinson or Daniel James), are people
whose feelings of hopelessness are, sadly, all too realistic and whose depression is often a normal response to a disheartening reality.
Why, I wonder, is this not obvious? Why is the distress or depression or existential angst of people who are dying, or who are living in what are to them intolerably painful or undignified or meaningless conditions, not recognised as perfectly natural? To think of these mental states as mental pathologies which bring into question the ability of those who have them to make autonomous decisions is simply perverse. And, I might add, to continue to confine the range of people to whom assisted dying laws apply only to the terminally ill is also perverse, for they are not the only ones for whom it is perfectly natural to have such feelings of existential despair.
Polls which suggest that people will support assisted dying for the terminally ill, but would not do so for those whose suffering is not terminal within a specified period, are not, I suspect, asking the right questions. The public response to Tony Nicklinson’s case suggests this, for it seems clear that a majority of people would have supported Nicklinson in his legal campaign to receive legal permission to receive help to die. And it is not, as so many people seem to think, that people like Tony Nicklinson want to die. They do not. But they know that death is the only way out of situations in life that have become intolerable and burdensome to them. Elizabeth might have lived for many years more in the complete paralysis which was soon to be her misfortune, and yet those years would have been years of torment that she did not want to experience. Her torment was already great enough, and she just wished that she could die.
To confine assisted dying to the terminally ill is not enough, and it should be seen to be not enough, and so confining it reflects such a lack of understanding of the reasons why people elect to die that those who support limited assisted dying of this sort need to have a short sharp shock to bring them to a recognition of the realities. They may be working within what are the political realities as polling numbers seem to reveal them to be, but they do not reflect the reality of people’s lives, and their reasons for choosing to die. It is high time that the death with dignity movement grew up, and stopped pandering to the religious forces of unreason which, at a stretch, can be brought to see that those who are already dying may be helped to hasten death, but who cannot be brought to see that other lives may be even more intolerable, because their torment will go on sometimes for years without remission. It is time that those who support assisted dying began to think beyond the narrow confines of their prison houses, where they have been locked away because of religious opposition to assisted dying, and to come to recognise that there are many other reasons, besides the imminence of death itself, why people may reasonably wish that they were dead.