Since the expert legal panel in Québec has now released its report recommending medically assisted dying under certain conditions (more on that in a later post — they are not so prohibitive as I was led yesterday to believe) which is accessible in French on the Dying with Dignity site here, the voices for and against are going through their warm-up exercises once again. In the National Post this morning, we are regaled with one article in favour of assisted dying, and one against. Predictably, Margaret Somerville is put back up on her soapbox so that she can say, over and over again, what she continues, without much foundation, to say, that it’s just wrong, though it’s hard to say why.

Let’s start there. Here’s what Margaret Somerville says, comparing the cases for and against:

The case for euthanasia is logical, direct and utilitarian, so it’s easy to make. That against it is much more intangible, indirect and ephemeral, so it is much harder to communicate effectively, especially in a predominantly visual culture. We need to set up “spaces” where all our human ways of knowing, especially our moral intuition, examined emotions and ethical imagination, can function in relation to all aspects of euthanasia, in making a decision whether to legalize it.

This is scarcely compelling. The argument for assisted dying is not simply “logical, direct and utilitarian.” For Somerville, this is tough talk, because she suggests that the argument against assisted dying (which she simply calls killing) is much more culturally thick than the argument in favour. The argument in favour, she is suggesting, simply doesn’t take into consideration the depth of the issue in relation to society, community, tradition, and all the complex emotions and rich imaginative scenarios that are necessary in order to understand our ethical intuitions. What she seems to be trying to do is to discredit the arguments in favour of assisted dying by suggesting that they are culturally shallow, that they fail to take cognisance of what Clifford Geertz called the “thick description” of a culture. Arguments for assisted dying are in some sense imports from a completely artificial conception of human relationships, and if we take the complexity of real human relationships into consideration, we will find, Somerville thinks, that not only is this so, but that it is in fact seen to be so by increasing numbers of young people, who find contemporary society unsatisfyingly peripheral.

This is interestingly in conflict with what she has said elsewhere about convincing her students about the illegitimacy of assisted dying. In her presentation to the Québec “Consultation on the question the right to die with dignity,” (Consultation sur la question de la droit de mourir dans la dignité) she had this to say (I apologise for quoting at such length, but it is important to see how at odds her present position is with a position taken as recently as February 2010):

I taught a course, “Ethics, Law, Science and Society,” to upper year and graduate law students at McGill, in which euthanasia and physician-assisted suicide was one of the topics we studied. As mentioned previously, I’ve researched euthanasia, physician-assisted suicide, the ethics and law of palliative care and pain relief treatment, decision-making at the end of life, and related topics, for nearly three decades and published a 433-page book on these topics.

Yet, I came away from the class feeling that I had completely failed to communicate to most of my students what the problems with euthanasia were — that I was hitting a steel wall. This was not due to any on their part; rather, they seemed not to see euthanasia as raising major problems — at least any beyond preventing its abuse — a reaction I found very worrying.

The one student who tried to express a contrary view, although normally very articulate, ended up by saying, “Well, it’s what I believe and I guess my background has something to do with that.”

My concern went beyond failing to convince my students there was, at the least, a strong case to be made against euthanasia. It included the fear that their response was likely to be true also for the wider society.

So, I e-mailed my students explaining I felt “that I had not done a good job in presenting the euthanasia debate … [and] decided to see if I could work out why not by writing about it.” I attached an early draft of an article that, with the students’ permission, I hoped to publish in a newspaper and asked for comments; I received several, very thoughtful replies.

The difficulty of communicating the case against euthanasia and the ease of communicating the case for it, is a serious danger, in the current debate about whether we should legalize euthanasia in Canada.

So why is the case against euthanasia so hard to establish?

When personal and societal values were consistent, widely shared and based on shared religion, the case against euthanasia was simple: God commanded “Thou shalt not kill.”

In a secular society based on intense individualism, the case for euthanasia is simple: Individuals have the right to choose the manner, time and place of their death.

In contrast, in such societies the case against euthanasia is complex. It requires arguing that harm to the community trumps individual rights or preferences.

One student explained that she thought I was giving far too much weight to concerns about how legalizing euthanasia would harm the community and our shared values, especially that of respect for life, and too little to individuals’ rights to autonomy and self-determination, and to euthanasia as a way to relieve people’s suffering.

She emphasized that individuals’ rights have been given priority in contemporary society, and they should also prevail in relation to death. Moreover, legalizing euthanasia was consistent with other changes in society, such as respect for women and access to abortion, she said.

To respond to such arguments, we need to be able to embed euthanasia in a moral context without resorting to religion — that is, formulate a response that adequately communicates the case against euthanasia from a secular perspective.

However, in today’s newspaper report she says this about young people and marriage:

What role does labelling the values that favour legalizing euthanasia as “progressive” play in the debate? The implication is those who oppose such values are retrogressive, out-of-touch with current realities, clinging to a long-gone past and its traditional, conservative values. Just such an approach is clearly articulated in the Quebec report.

But is this correct? Many young people are lamenting that long-term, committed relationships and marriage have been made much more difficult for them to realize. Most agree the cause, at least in part, is radical changes, since the 1960s “sexual revolution,” in the values, norms and mores governing sexual relationships. Interestingly, these rest on the same “progressive” values bases as those being used to promote the legalization of euthanasia: intense individualism; a lack of access to a transcendent reality; moral relativism; a complete rejection of authority — “nobody has the right to tell me what to do”; and so on.

That we are dealing with two entirely different issues is the first thing to notice. But more than that, Somerville provides no evidence that the problem with relationships (if, indeed, she is right in saying that “many young people are lamenting that long-term, committed relationships and marriage have been made much more difficult for them to realize”) is that these problems rest on “progressive” values, especially if what is progressive is understood in terms of “intense individualism; a lack of access to transcendent reality; moral relativism; a complete rejection of authority,” and so on. Somerville has clearly thought, all along, that these characteristics of modern society are destructive, and that they underlie contemporary arguments in favour of assisted dying, so she can pull them out of a hat whenever she needs an argument against something she opposes. Their relevance or effectiveness lies in their moralistic flavour, not in relating them directly to the moral concern being expressed.

However, she provides no reason for supposing that this is a general concern of contemporary young people, nor that, if it is, the concern is related to intense individualism and other things that Somerville reprobates. But, more relevantly, it is not clear what point she wants to make by speaking about modern relationships in this context. For the claim that people who are suffering intolerably have a right to die is not based on a moral relativism, nor on a rejection of authority — nor, when all is said and done, is it dependent on an intense individualism. Indeed, its focus is on the responsibility that societies have towards their suffering members. It expresses moral concern for those whose unrelievable suffering has become, for them, intolerable. Certainly, this moral concern does not base itself on access to “transcendent reality” (whatever that is), as though there is some source of moral authority that is greater than that of the human moral community, or than that of the human ethical project. Speaking of rights immediately raises social issues and social responsibilities. Somerville has simply failed to give sense to some of the words she uses, and uses as if they have a perfectly simply, straightforward meaning, when they don’t. And she refers to social trends without any evidence or confirmation. When she does give confirmation, as when she speaks of her own experience, young people have a completely different take on modernity than the one she attributes to them when she needs their support.

As Udo Schuklenk says, Somerville is not strong on evidence. On his EthixBlog he has some helpfully dismissive things to say about Somerville’s expertise and methodology. Here’s a bit of it:

Evidence has never been Ms Somerville’s strongest point. So, without any evidence to back up her claims  she declares on the Catholic website, ‘One of the things that’s wrong with respect to Justice (Lynn) Smith’s judgment (in Carter v. Attorney  General of B.C.) is that she purports to review the use of euthanasia and  physician-assisted suicide in the jurisdictions that have legalized it. She said  there is no problem, there is no slippery slope. Well, that’s simply not right  factually.‘

It turns out, in our Report on end of life decision-making in Canada we reviewed the empirical evidence on the slippery slope matter and concluded that there is no evidence that assisted dying leads us down slippery slopes to unwanted killings. Of course, we reviewed evidence, Ms Somerville is in full preaching mode. [which makes the picture at the outset pertinent!]

Over at Sandwalk, Larry Moran, with some justice, calls her “Canada’s most famous quack bioethicist,” (my emphasis) and so she is. Whenever CBC radio or TV wants an expert on assisted dying they phone Margaret Somerville, because they know they’ll get from her all the most reactionary stuff that will please a certain demographic. Basically, Somerville is a Roman Catholic fanatic (or at least gives the appearance of being one) who pretends to speak as an expert ethicist, but aside from creating the McGill “Centre for Medicine, Ethics and Law,” of which she is the founding director, where she can ride her Catholic hobbyhorses and pretend that she speaks with authority on matters of bioethics, she has no particular expertise beyond a conservative moral position which owes both its content and its lack of flexibility to the Roman Catholic Church. She opposes same-sex marriage, assisted dying, and, of course, abortion. Her agenda looks very much like that of Pope Ratzinger, but she affects the pose of a secular academic.

Basically, to get to the point of this post, Somerville’s argument against assisted dying is that it’s a matter of killing. Period. End of Argument. She says, with a kind of wide-eyed innocence, as if this were all we needed to ask:

We must face the basic question that euthanasia raises: Is it inherently wrong for one person intentionally to kill another?

If you simply pare back all the other considerations that enter into the question of assisted dying, and look at only one aspect of it, assisted dying, especially when it is not assisting someone to suicide, is one person killing another. But why should one pare away all those other considerations? Somerville knows, as well as anyone, that a simple act of killing can be qualified in such a way that it becomes an act of compassion, an act of kindness. For her, though, it’s an act of killing, tout court, no qualifications or contextual detail allowed. But when she complains about the difficulty of justifying the argument against assisted dying, she says that it is the thick description of the social context that is so hard to get people to attend to. As she says, people just look at it from the standpoint of an intense individualism; but she fails to notice that that supposedly intense individualism has a thick context and description as well, a context that has been developing now for two or three centuries, in which individual rights and autonomy are of central importance. That doesn’t mean that other things are not of importance, but the same rights that women have justly claimed, and that enable Somerville to occupy the position that she does, are the rights that suffering people can also appeal to when they say that they do not think it is right that they should be forced to die in the way that their disease prescribes, something that is entirely contingent and happenstance. Had hurdles been placed in Margaret Somerville’s way because of the morally quite irrelevant consideration that she happens to be a woman, she would doubtless be the first to complain about the injustice. Yet when someone says that they do not want to die of their disease, because that is causing intolerable suffering, she thinks they should simply ignore the fact that the obstacle to being assisted to die in a way that preserves their own sense of who they are, and what their life has been about, is completely arbitrary in relation to the things that they consider important in their own lives. She seems unable to see the thick social circumstances in which people are beginning to say that it is unacceptable for society to prescribe how people must die, that this is not society’s business, but should be left to individuals to decide.

Of course, society has a duty to protect people as well, but Somerville has not demonstrated that people’s lives will be put at risk if we legalise assisted dying. In fact, in this latest contribution she dispenses with that argument altogether, apparently sensing that she is in an unwinnable situation with regard to it. Instead she says this:

As writer Peter Stockland says, the central question in the euthanasia debate is not whether the system will work as designed to prevent abuses, as pro-euthanasia activists argue it will, but what the system is designed to do.

(Peter Stockland is Director of the Cardus Centre for Cultural Renewal in Montréal, a Roman Catholic think tank, which, like so many other things Roman Catholic, does not advertise itself as such. He believes, and has stated that, “[i]f assisted suicide is legalised in Canada, we cross the barrier from civilisation to savagery.”) What the system is designed to do is not just to kill people, as Somerville suggests; it is to assist people to die when their condition is such as to cause irremediable suffering, suffering that is judged by the individual to be intolerable and in conflict with their own sense of what makes life valuable. It is not just bare killing, without moral qualification, as Somerville claims, committing the same mistake that she attributes to her students. It is responding to the intolerable suffering of people who will never recover, and this, clearly, being what the system is designed to do, cannot simply be dismissed as an act of killing simpliciter — like murder or manslaughter. It is precisely because we value life that we acknowledge the justice of helping someone to die when, in the opinion of that person, suitably qualified so that abuse of such assistance is prevented, life in their state of health, and the limited further prospects of their life, are such as to make continuing to live a net loss, considering their life as a whole. Margaret Somerville does not provide a single reason why assistance to die should not be provided to those who qualify for such assistance, and request it in accordance with laws that would provide for such assistance. She simply thinks saying that it’s wrong to kill people is enough. That is a measure of her lack of ethical understanding. She is, as Larry Moran (who, by the way, it was my privilege to meet at Eschaton 2012 in Ottawa) so helpfully says, a quack bioethicist.