Over at the Huffington Post there is a debate between Margaret Somerville, purported ethicist from McGill University in Montreal, and Wanda Morris, Executive Director of Dying with Dignity (Canada), the voice for choice at the end of life in Canada. Somerville, as is her wont, brings out all the usual suspects, none of which are really compelling, and all of which depend on two things, making you afraid of it, and claiming that it’s simply — it’s really that simple folks! — wrong to kill people. She forgets, of course, that people have been killing other people since the dawn of time, and will go on doing it. Certainly, many acts of killing are wrong and to be regretted and condemned, but merely saying that something is a matter of killing another human being is not enough all on its own to make it wrong.
Margaret’s biggest argument — the real big argument so far as Somerville is concerned — is that permitting the act of assisting someone in great suffering to die (she doesn’t like that euphemism, so we’ll come back to it) is changing something fundamental about the way in which we regard human life, and it will bring about untold changes in our society, and may — in fact she is sure that it will — change the way we regard killing others, so that legalising it in the case of those who choose to die in order to end their suffering will set society off on a slippery slope to disaster and depravity. She’s said this numerous times before, and she puts so much weight on it that it really constitutes her main argument against assisted dying (a ”sanitised” form of language that she deplores, but we will come back to that). Margaret’s problem, not to put too fine a point on it, is that she is left asking a vague question about the future: “What long term effects might result from that?” She doesn’t know, but she has this in common with the pope: she believes firmly that this will usher in a “culture of death,” if it hasn’t already arrived, and that there will be much weeping and gnashing of teeth because we didn’t listen to Jeremiahs like her.
Speaking of Jeremiah, Margaret Somerville’s special métier is the jeremiad, a mournful litany of everything that will go wrong if we go down the path that, in Somerville’s fevered imagination, is bound to lead us to the worst of all possible worlds. She brings up the old canard that if assisted dying is legalised vulnerable people, the elderly and the disabled, will be placed at risk, but not only is this not true, the legalisation of assisted dying would provide, even for people she considers vulnerable, a way to escape from a burden of suffering that even the so-called “vulnerable” may at some point feel is too great for them to bear. Vulnerable people would not be put at risk by legalised assisted dying, but it would open doors to them that are now closed. Would some vulnerable people be under pressure from uncaring family members to “do the right thing” and go? Possibly. But this goes for any number of situations, when we are under pressure to do things we do not want to do. Is Margaret Somerville saying that, by definition, people with disabilities, people with chronic medical or psychological problems, the old and the infirm, are children, and unable to stand up under pressure? Or that we have no way of distinguishing between someone who is being pressured to do something, and someone who is acting freely? Surely not. Some of the most forthright people I have known spend most of their time in wheelchairs. Being disabled very often makes people more able to deal with the slings and arrows of impatient sons and daughters, not less. Having a disability tends to make people fiercely independent. All Somerville is doing is using a supposedly “deprived” class of human beings to frighten us into acquiescence to a position which, for all her words, is lacking both depth and logic.
Let’s return to what Somerville calls the sanitised language of ‘assisted dying’ and its cognates. Margaret thinks that they take away the sting of the words ‘kill’ and ‘murder.’ Well, and so they do. But, of course, we have always made moral distinctions between acts, which may have salient characteristics in common, by separating them into separate moral categories, distinguishing acts which are morally licit from those which are not. Killing in war, for example, is not normally called murder. Even in self-defence a citizen has some latitude in the amount of force that may be used to protect life and property. But Margaret should be familiar with this, for she has Thomas Aquinas to guide her, and Aquinas claimed that if a legitimate act — say, self-defence — results in the death of a person whose actions threaten life and limb, this may be considered to be a secondary, and morally legitimate side-effect of an act which, in normal circumstances, would be considered murder. It’s the context in which the act is carried out that makes the difference. Somerville thinks that making distinctions like this leads to moral relativism, but there is no basis for this accusation, so often used by people like the pope to discredit contemporary morality. And that’s why supporters of assisted dying don’t use words which make it seem as though something shameful and illegal is taking place, which it’s not — or at least won’t be, once assisted dying is legalised. Whether legalised or not, it’s not shameful. What is shameful is refusing the right of people to take their dying, just as they have taken other aspects of their lives, into their own hands.
You can tell that Margaret is out of her depth when she starts saying things like this:
Pro euthanasia advocates argue that currently accepted end of life treatment decisions, such as refusals of life support treatment, result in shortening the patient’s life, but are ethical and legal, and euthanasia is no different from them and that it’s just another form of medical treatment. Therefore, to act consistently, euthanasia should be seen as ethical and legal.
And then she says, predictably:
They also argue the right to refuse treatment establishes a right to die. But that is wrong. Rights to refuse treatment are founded in respect for the right to inviolability, the right not to be touched, including by medical treatment, without one’s informed consent. They do not recognize a right to die, let alone a right to be killed. At the very most, they establish a right to be allowed to die naturally.
There is so much wrong with this that it’s hard to sort out, not only what she’s trying to say, but why she says it, and what she thinks it means. Let’s be patient with her. She has trouble getting her ideas across, because they go clean contrary to what reasonable people nowadays tend to think. As she has come to realise in trying to get her points across to law students, her prejudices don’t wear very well in plain English. At a conference of Catholic priests, or in an audience with the pope, she would no doubt feel right at home, but most of us can see through the smoke screen that she so carefully lays down.
The problem is that, for all her bluster, there are certainly common features between a patient’s refusing treatment, or having it withdrawn, so that they can die, on the one hand, and apparently more positive acts whereby the patient is helped to die, on the other — whether this is done by being provided with a drug which will enable them to slip gently out of life by their own hand, or by receiving an injection by a doctor or nurse which, as the saying goes, helps to “put them out of their misery.” Somerville wants us to believe that these things are very different and should not be unceremoniously shoved together. Withdrawing life-sustaining treatment and providing assistance in suicide are different, aren’t they? Well, not really. Turning off a respirator, stopping nutrition and hydration, not performing life-saving surgery, putting someone into a medically induced coma until they die “naturally,” as the euphemism has it: all these things are as positive as acts of assisting someone, at their own request, to die; and pretending that they are not is just as euphemistic as the supposedly sanitised language used by supporters of assisted dying.
If Margaret Somerville really is a bioethicist, she will have familiarity with these arguments, and won’t need to be told by me. But if she knows them, then she has a duty to inform us why they do not work for her. Instead, she falls back on what is basically religious dogma, that life is invi0lable from conception to natural death. She uses the latter term a number of times as though it were a talisman. But natural death is something that human beings, as a rule, do not have. They are surrounded by medicines, life support machinery, saline and antibiotic drips, and all the other paraphernalia of modern medicine. Not a natural death in sight. And in this situation, withdrawing treatment is just as positive an act as providing the means whereby someone may end their life, and it is simple prevarication to suggest otherwise. She makes the argument that
in respecting refusals of treatment the physician does not have a primary intention to kill the patient as is true in euthanasia
Notice the word ‘primary’ here. This is the so-called doctrine of double effect. If an act can be interpreted in two ways, as in the case of withdrawing treatment, the doctor is free to interpret this in terms of the requirements of the law, protecting the patient’s right not to be touched or treated against their will. So the doctor’s primary intention is to fulfil this obligation, not to kill the patient. This keeps everything morally neat and tidy, but this only holds where there is a clear distinction between the act of withdrawing treatment and the cause of death. This is generally not the case, as, for example, when a patient is being kept alive on a ventilator. The point still is that it is an act (or an act of omission) that brings about the death of the patient, and Somerville can’t hide behind double effect in this convenient way, as though the fact that an act can be interpreted in different ways means that we have radically different acts. It doesn’t work this way, and Aquinas himself was fully aware of this. In any event, what is really at issue is the patient’s quality of life. The patient makes a decision regarding quality of life, and then has those responsible for her care to make sure that she dies. The doctor may not “intend” this as a “primary” intention, but is still responsible for the outcome. This is very clear in the case where withdrawing the treatment doesn’t lead quickly to the death the patient thought would come soon. It just won’t do to pretend that the doctor bears no responsibility for hastening death in such a case, or for whatever outcome ensues upon his or her decision. A good book for Somerville to read here would be Helga Kuhse’s The Sanctity of Life Doctrine in Medicine: A Critique.
Somerville’s most scathing remarks she saves for individualism and autonomy, though she doesn’t really call it that. It’s worth quoting her at length:
Unbridled “radical autonomy” is the cornerstone for many of the so-called “progressive values” stances, including euthanasia.
But can dying people really can make free and informed (autonomous) decisions that they want “assistance to die” — which is not the same as “wanting to die,” which many terminally ill people do want. New concepts such as “relational autonomy” — the idea that a person is not an isolated being, but exists in a context that influences their decisions, and that this must be taken into account when judging the validity of those decisions — can restrain individual autonomy gone wild.
Note first the loaded language: “unbridled ‘radical autonomy’,” “individual autonomy gone wild.” There is no basis for supposing that autonomy has gone wild or that what people are asking for is unbridled radical autonomy (whatever that means), though one might wonder whether the ordinary person would consent to be “bridled,” and why Somerville thinks that they ought to be. Somerville talks as if we were horses in need of restraint. But who is going to do the restraining? Somerville? The pope? The cardinals, priests, bishops, papal nuncios, MPs or Prime Ministers, or other authorities? And by what right do they assert their authority over the individual who is suffering intolerably?
The new concept of “relational autonomy” is just the old authoritarianism writ small. No, we are not isolated beings. And that is precisely why assisted dying should be available, so that suffering people do not have to crawl away by themselves and die in some desperate attempt to rid themselves of their lives when they have become a burden. We expect that the family and the society will rally around the suffering person, to help relieve their suffering where this is possible, but to help them die when, in the opinion of the person who suffers, it is the right time to die. Somerville is right in one thing. Even people who ask for assistance in dying don’t want to die. Of course not. My wife Elizabeth did not want to die. She loved life, and was full of life to the end. But she judged that dying was the only way to escape the pain and the indignity imposed by her MS, a condition that would only worsen until she was trapped inescapably in her body. And when someone comes to the point of making that judgement — and why can they not, despite Somerville’s paltry efforts at making such autonomous decision making deeply questionable? — they should have the assistance of society to bring their lives gently to an end, with their families around them, as they make the last journey in their loving company. Instead, Elizabeth died before she otherwise would have done, because once trapped, Canadian law would have provided no other alternative than either a long-drawn out life of paralysis or starving to death, and she was unwilling to be trapped in her body. How many years did she lose, because of people like Margaret Somerville? I don’t know, but they were not few.
I find Margaret Somerville so offensive that sometimes I find it hard to write without animus about her. She is shoring up the ruins of an old authoritarianism, when society made crucial decisions for citizens, who were thought incapable of making these choices on their own. But that day is waning fast, and Margaret keeps finding different half plausible accounts that make it seem more humane and life-affirming, but what she is really celebrating is death in all its misery. Dying is a miserable thing to do. Very few people die with dignity; some die in great misery and intolerable pain, simply because of the nature of their diseases. Does society have a right to force people to die in the way that is prescribed by the particular illnesses which afflict them? I say not. Margaret thinks she has the right to determine how others will die; but I will say now, what I have said before, that for that period of life in which I, or any other person, is being forced to suffer against their will, they are no more than slaves of a system that holds their lives hostage until the magic of a suppositious “natural death” has borne them away. By what right do societies enslave their suffering members in this way?
Margaret Somerville is Canada’s most unqualified ethicist, and because she is almost unstoppable once she begins to talk, she is the darling of the CBC, who like to fill the unforgiving minute with 60 or more words rattled off at top speed from someone who claims to be qualified to speak on moral issues. She’s no more qualified than the pope, and he is hopelessly outclassed by experts in bioethics. She keeps repeating the same old mantra, looking for clouds where there are silver linings, supposing that the people of the Netherlands, Belgium, Luxemburg, Oregon, and elsewhere, are being carried off by careless and thoughtless health professionals. She brings up the case of the deaf twins in Belgium who were recently helped to die — “euthanized” as Somerville puts it — because they were going blind. But there was much else that was wrong, as John Walker, over at The Limping Chicken (independent deaf news for the UK), tells us in some detail (thanks to Wanda Morris for the link). Margaret hears what she wants to hear. She has no compassion for the suffering. Her dogma is always more important than the suffering of those who are the victims of her crusade against assisted dying. Suffering people who seek help in dying are the most vulnerable of the vulnerable, but Somerville has no heart for them, only for those who are in no danger, but who, in Margaret’s addled religious mind, are thought to lie at the top of a slippery slope which, once set in motion, will lead us inevitably to perdition. She is not an ethicist at all. She’s a religious busy-body who can’t shut up, because her religious beliefs insist on intruding themselves in others’ lives. They have no place there. Put a sock in it, Margaret!
By the way, Wanda Morris does a great job defending assisted dying. Go read the debate and vote. So far the religious Margaret has changed more minds. I can scarcely hope to “Pharyngulate” an online poll, but spread it around. Take the woman and her empty arguments down!