Category Archives: Assisted Dying

Why is it a legitimate concern?

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Journalists writing about assisted dying continue to raise the spectre of abuse, and argue that those who oppose legalisation of assisted dying have a legitimate concern. Tasha Kheiriddin does it again in her latest opinion piece in the National Post. It reminds me of Victor Malarek’s misleading ending to his W5 documentary on assisted dying, where he got away with saying at the end, simply on the basis of a supposed expert’s opinion that ”It’s really scary what’s out there.” And Lloyd Robertson gave him the support that he wanted by saying something about ‘good arguments on both sides,’ which was as far from the truth revealed in the documentary itself as it could be. In the end, Dr. José Pereira was given the last word. He was the supposed expert, because he had written what must be one of the least well-documented articles on assisted dying in existence, one that was subsequently panned by real bioethicists. Indeed, in their paper,  Downie, Chambaere and Bernheim state:

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.

Pereira is a Roman Catholic hack, whatever his expertise in end-of-life care, and his paper is not only not worth reading, but a positive impediment to clear thinking on the issue. I said this in a response to Pereira which I wrote myself and sent to the programme’s producers, but they lent it no credence. I wonder if they are willing to change their mind now that Downie et al., and for similar reasons, have dismissed it so decisively.

However the trend continues. Tasha Kheiriddin, in what appears to be a perfectly innocuous piece (linked above), in which she describes, quite dispassionately, it seems, the assisted dying law that seems likely to pass into law in Quebec, and the provisions that would have protected her father from the abuse she imagines, goes on to say, without the slightest bit of evidence:

The fear of groups opposed to right-to-die laws, like that proposed in Quebec, is that people like my father might be euthanized against their will. This is a legitimate concern; there are always situations where unscrupulous relatives or caregivers could prey on vulnerable persons.

Why is it a legitimate concern? In jurisdictions where assisted dying is legal, there is no evidence of the kinds of abuse Kheiriddin imagines. Indeed, she fails to put assisted dying into contexts where there is an equal possibility of abuse, but which are completely legal. People can refuse treatment and have treatment withdrawn without any intervention by the law, even though such refusal, or such withdrawal will lead to their deaths, and yet in these cases the possibility of abuse is just as high as it is in cases of active assistance to die. Indeed, bioethicists have been unable to find morally relevant differences between supposedly passive acts of euthanasia, and more positive ones. Why do journalists like Kheiriddin feel the need to pander to the anti-assisted dying lobby every time they write something? Or do newspapers have a policy which requires that the whole issue be treated as a very difficult, serious issue, by giving voice to the “scary things” that are “out there”, whether there are such scary things or not? It’s a bit like teaching intelligent design in biology classes, whatever the evidence says. Each “side” must be given its due, even if there aren’t two sides to every story. Continue reading →

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The Epistemology of Evil

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Perhaps I should have commented over at Butterflies and Wheels, but the case of “Beatriz” (not her real name) in El Salvador (which means, of all things, The Saviour), where the Supreme Court of that benighted Catholic country has just said “No!” to her appeal for an abortion, seems to me worthy of more thorough examination. One more atrocity in the name of religion. The appropriate response is Ophelia’s: “Bastards. Fiends. Demons.” – though given my penchant for exclamations marks, I’d have said, “Bastards! Fiends! Demons!” So a tip of the hat in Ophelia’s direction.

There may seem very little to add to that succinct expression of anger and outrage, but I’d like to explore Beatriz’s situation in relation to something in the New York Times this morning. If you have a few of your free pages at the NYT left, perhaps you could take a look at it and see what you think. It’s an op-ed by a Stanford University anthropologist (T.H. Luhrmann) who has written a book about the American evangelical relationship with God – which clearly begs a number of questions – who thinks, as she says in her title, that “Belief is the Least Part of Faith.” It’s interesting how people seem to be jumping on the “faith isn’t really believing” bandwagon since Sam Harris opened the first salvo in the god wars, but it has become one of the commonest tropes amongst those who want so badly to say something nice about religion, but want us to understand that they are not so foolish as really to believe in such things. And neither, so the story goes, do the “believers,” who are more interested in – and these things do seem to trip so lightly off the tongue – “how to feel God’s love and how to be more aware of God’s presence.”

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Campaign for assisted dying gains ground, but is still widely misunderstood even by those who are campaigning for it

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The campaign for assisted dying gains ground around the world. In Australia, the legislature in New South Wales is debating assisted dying legislation; some British religious leaders (Christian and Jewish) have come out in opposition to the position of their leaders and their religions’ official stand on assisted dying; in Vermont the Governor has signed an assisted dying law into force that went through the normal legislative procedure. All these are good signs, and to be encouraged.

However, I am still troubled by the idea that assisted dying for the terminally ill is a satisfactory form of assisted dying legislation, and I am dismayed that organisations like Dignity in Dying in England, and Compassion and Choices in the United States, are content to consider, as sound, assisted dying legislation in which a terminal prognosis of 6 months to a year is required before someone is eligible for assistance in dying. (I wrote a note to Sarah Wootton regarding this, but have not received a response.)

There are two major problems with such legislation, and it is high time that people recognised them for what they are.

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Assisted dying and the failure of community — or how to be an idiot by following the rules

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I get so angry when people misrepresent assisted dying in the way that Giles Fraser does in his latest op-ed in the Guardian that I could scream! Why is it that something that is, for some people, a matter of urgent concern should be dismissed with lightweight and completely inapropos remarks from someone who simply misunderstands, and, from the look of things, will go on misunderstanding until the time comes for him to die. It’s a Christian (and generally religious) determination to look at irrelevant things and then suggest — for that is what he’s doing, after all — suggest that he’s been there, done that. He’s like a tourist who breezes through London in a day and then says he’s “done London,” as if you could do more than glance at one or two things of interest in the time allotted. But Giles Fraser is especially guilty, because, not only does he get it wrong; he hasn’t even begun to understand why people are asking for help to die. And he calls himself a loose canon! This is not loose. This is positively stupid.

He entitles his piece:

I want to be a burden on my family as I die, and for them to be a burden on me

Well, bully for him! That’s clear then, and his children will no doubt, when the time comes, appreciate the burden they have to bear. Of course, he may go out like a light, especially if he insists on flying so near the sun like this — or is it just the heat from his rhetoric simply melting the wax on his wings? But it’s all the usual stuff. Misdirection not to find directions out, but simply to mislead. The Anglican Church of Canada plays the same game, suggesting in its coy words that assisted dying represents a failure of community — which means, of course, abandonment, by those who can read between the lines. Here’s the key:

I do want to be a burden on my loved ones just as I want them to be a burden on me – it’s called looking after each other.

But it’s not called “looking after each other” if what the person who is suffering is asking for is help to die. It’s called coercion, then — which has a very different resonance — and if someone is being coerced into being a burden, then Fraser has simply has missed the point about what looking after each other is all about. Moreover — and this, coming from a priest, is inexcusable — it simply papers over the cracks with regard to how people die. Sometimes the burden, if Fraser really wants to know, is borne by those who are dying, and if those who are watching someone die in misery doesn’t notice this, then they are simply not watching closely enough!

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“The New New Atheism” my Foot!

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Theo – the vacillating, ‘not quite sure whether I’m cut out to be a priest’ – Hobson wrote an article for The Spectator recently, entitled “Richard Dawkins has lost: meet the new new atheists.” He begins by asseverating that

Richard Dawkins is now seen by many, even many non-believers, as a joke figure, shaking his fist at sky fairies. He’s the Mary Whitehouse of our day.

For those of you who were not around when Mary Whitehouse was a household name in practically the whole of the English-speaking world, Mary Whitehouse was a social activist prude, railing against what she saw as an increasingly permissive society. And of course it was an increasingly permissive society. The 1960s was undoubtedly a watershed decade in Western cultural history, when it seemed, especially to those who had been brought up in the 1950s, the world was being overthrown by sex, violence and rock and roll. She was, though, a stereotypical, comic figure, trying to command the tide of change, which washed over Western societies during the sixties, to cease, and people took considerable joy in poking fun at her. Search ‘Mary Whitehouse’ on YouTube, and you will find it hard to find anything besides parody.

It is simply ridiculous to suppose that Richard Dawkins is regarded in this way. What evidence does Theo Hobson provide for his opening claim that Richard Dawkins has turned into a parody of the Mary Whitehouse variety? None at all, really. He says, with considerable aplomb, about the new atheist “movement”:

So what was that about then?

– as though the new atheism were past and finished with, and we can now see it in historical perspective – when, of course, it is as lively as ever, and producing such phenomenal results as A.C. Grayling’s soundly philosophical The God Argument. Hobson wants us to think that the new atheism was just a flash in the pan, instead of a real shot, prompted mainly by the 9/11 attack on New York and the Pentagon, and the 7/7 attacks on London, which, now that we see them as fairly limited and not all that frightening, can be dismissed with a casual wave of the hand and a reference to vicarage tea parties, as though all religion were quite anodyne and harmless.

But, quite aside from the horrific impact of those religious atrocities on the Western consciousness, let’s not forget Christopher Hitchens’ classic remark:

Many religions now come before us with ingratiating smirks and outspread hands, like an unctuous merchant in a bazaar. They offer consolation and solidarity and uplift, competing as they do in a marketplace. But we have a right to remember how barbarically they behaved when they were strong and were making an offer that people could not refuse. [god is not Great, 67] 

Of course, he might have said:

But we have a right to remember how barbarically religions behave where they are strong and making an offer that people cannot refuse.

For there are, after all, many places in the world where people have no choice at all about religion. Muslims will still quote the Qur’an to the effect that there should be no compulsion in religion. But we have a right to remember where people are still imprisoned (and often murdered) for blasphemy and executed for apostasy, where any perceived insult to the “prophet” Muhammad touches off social paroxysms of frenzied crowds baying for blood. How blind, really, is Theo Hobson? Can he not see?

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New England Journal of Medicine Debate – Poll on Assisted Dying

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The New England Journal of Medicine has just published, on its website, a debate on “physician assisted suicide.” There is a “case vignette”, and then two short articles pro and con physician assisted suicide. Included is a poll in which you can vote, and you may also post a comment in response to the articles. I commend this to your attention. You can access it here. Following are my own comments on the arguments presented against assisted dying, though I commend the article that favours assisted dying to your careful consideration. Also included is an audio file with interviews with the primary authors of the articles. I will include a link to the debate and poll at the end as well.

I will only pick out a few points for consideration. The brief pro and con articles are, of course, inadequate to do justice to the arguments, but it is noticeable that the arguments provided against the practice of physician assisted suicide are particularly “thin.” For example, Boudreau and Somerville begin by saying that they “recognize that a patient in Mr. Wallace’s position [in the case study of the man with metastasizing pancreatic cancer] is in a state of grief.” There is certainly no evidence in the case study as presented that this is the case. This is consistent with the view, often expressed by opponents of assisted dying, that one must be, in some sense of the word, “depressed,” in order to request aid in dying. Not only is the evidence for such a claim lacking, there is ample reason for someone in Mr. Wallace’s position not to think of the future in terms of hope. In other words, if he were depressed, there would be ample reason for his unhopeful state of mind. Opponents of assisted dying often speak about depression as though it were always pathological. It is not pathological, where there are sufficient reasons for a depressed state of mind. Nor does depression necessarily impair judgement, as Boudreau and Somerville imply.

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Canadian woman goes to Dignitas in Zurich for an assisted death and is interviewed by CBC’s “The Current” before her departure

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Susan Griffiths is a woman with MSA, Multiple System Atrophy, a neurological disorder which, according to Wikipedia, is “associated with the degeneration of nerve cells in specific areas of the brain. This cell degeneration causes problems with movement, balance, and other autonomic functions of the body such as bladder control or blood-pressure regulation.” While she is not yet completely immobile or incapable of some enjoyment of life, she feared not being able to lift her hand in order to drink the barbiturates used by Dignitas for what they call an “accompanied death.” She was interviewed by Anna Maria Tremonti of CBC’s “The Current,” which was aired yesterday morning. Here is the interview:

You can also see a video of Susan Griffiths in The Winnipeg Free Press, explaining her reasons and reading a letter which she sent to every Member of Parliament asking them to change Canadian laws respecting assisted dying. She is a wonderfully eloquent person, and makes her points clearly and forcefully. As she says, for her.

[t]he future’s too grim. This is the right direction. It’s my life.

Dying, as I have said before, is the final act of our lives. We can either be passive towards it, or we can be active. We can simply die of the diseases which are destroying us, or we can take up arms, and make dying the final, decisive act of our lives.

Screen Capture of Susan Griffiths speaking about her letter to MPs about assisted dying

Screen Capture of Susan Griffiths speaking about her letter to MPs about assisted dying

One thing that people do not seem to recognise is that forcing a person to die in the way prescribed by their disease, and refusing them the right to make the decision themselves, and receive help from competent professionals, not only denies us what is reasonably thought to be a liberty right, it is also, effectively to turn us into slaves, living under compulsion. No other decision in our lives is so hedged around with restrictions such as this. Indeed, if we are being kept alive on machines, we can ask to have treatment withdrawn, thus effectively taking our own lives. This is no different, ethically, than receiving the kind of help to die that Susan Griffiths sought – and could not find in Canada. Thus she is forced to die in exile, as Elizabeth did.

Yesterday evening I was contacted by a radio station in Halifax, and asked if I would comment on this, and I was happy to do so. And once again the old chestnuts were pulled out of the fire, still apparently steaming hot, but in truth the same old unreliable prejudices hawked as arguments. Every time the question of the legalisation of assisted dying is raised the question of risk to the vulnerable is raised along with it. But no one seems to think that the vulnerable are at risk when withdrawal or refusal of treatment is in question. Why not? Perhaps because that is already legal. Indeed, more than that, treating a person against their will is accepted in the common law as common assault! You have to ask yourself: If this is so, then why is the compulsion to live through misery not an offence in law? And when you consider that people can be in as great a risk with DNR orders, and the right to withdraw treatment, as they would be were assisted dying legalised, this question is even more pressing. The truth is that we need to make sure that those who are asking for the withdrawal of treatment are competent, well informed, capable of understanding the information provided, and are making the request of their own volition. These are exactly the same conditions that would govern assisted dying. Decision would have to be durable (that is, held steadily over time), based on full information of the options and consequences, competent and voluntary. In addition to this, we know that assisted dying is happening now; we just don’t know how often, by whom, and for what reasons. People make the claim that people would die who should not die were assisted dying to be legalised, but since making assisting someone to die is a criminal offence, and doctors are not heartless, assistance takes place, but is unreported. We don’t know where we are on the so-called “slippery slope.” The arguments against assisted dying, just like against abortion, drives such activities underground. Alternatively, they force people to take matters into their own hands, very inexpert hands, and besides making suicide more desperate, makes it a lonely journey that a person is forced to make in desperation. Accepting that we die, and that some people need assistance to die to escape intolerable suffering, is healthier for society than making it furtive and secretive.

Susan Griffith can afford to go to Switzerland. Many people cannot. It is time that the government took this matter seriously, instead of having discussions in Parliament which do not reflect, at any level, what is now known about end of life decision making, and the bioethical imperatives that are involved. Assisted dying is still looked upon in religious ways. Suicide at the end of life is inappropriately being thought of in the same terms as suicide in the midst of life, like the desperate suicides of broken-hearted teenagers, or those who despair of success. It is time that people put their religious convictions aside and spoke about this in terms that are not slanted by religious prejudices.

Colin and Isobel Mclachlan on Assisted Dying

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Thanks to Haggis for this. I think the video can stand on its own. Both Colin and his wife Isobel (who, as you know, died recently) have been active in the movement to legalise assisted dying in Scotland. Once again Scottish MPs voted down the bill, Scottish MPs voted down the bill in 2010. Whether Margo Macdonald’s next attempt (still in preparation) will be more successful, time will tell. Why politicians are so reluctant is a mystery, since a majority of Scots, as well as Canadians, Australians, and others, support assisted dying. The injustice involved in forcing people to die in ways prescribed by their diseases, giving them no choice in the manner of their dying, should be obvious to thinking, caring people. As the last act of life, dying is very important in retrospectively shaping the whole of one’s life. To be denied the right to die in ways of our own choosing, people are effectively enslaving people for the period during which they are forced to remain alive against their will. If we are opposed to slavery we should oppose these primitive ideas which simply do not seem to understand the horrors they are imposing on people against their will.

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Readers might also like to read the tribute to Isobel McLachlan, here. Once again, our sympathies are with Colin, who, I am sure, will remain stalwart in his fight for the last right.

Old Age Rational Suicide?

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I’m not altogether sure what is meant by “old age rational sucicide,” but here is an example where, it seems to me, ordinary provisions for assisted dying would have provided all that is needed. There is a video and an article. I will upload the video here, and link to the articles in the Australian newspaper, The Age, here and here. So, first, the video, then a short comment:

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Michael Cook, the Editor of BioEdge, a conservative bioethics blog from Australia, is tied up in knots about this, partly because he thinks of Beverley Broadbent as relatively healthy, and partly because he questions the ethics of the journalist who reported Ms. Broadbent’s point of view without even trying to dissuade her from taking her life. As he says:

In the first place, a journalist is first of all a human being. Didn’t Medew [Julia Medew, the reporter] have a moral obligation to dissuade a relatively healthy woman from committing suicide?

Of course, the answer to that is: it all depends. If Ms. Broadbent had been a young person in the prime of life, who was suffering from a episodic bout of depression with a specific physical or social cause (like the loss of a loved one, a love affair gone wrong, or whatever), it would seem that this would be the appropriate thing to do. However, Ms. Broadbent’s reasoning is hard to fault. She is afraid of being caught up into the medical system in such a way that there is no escape, and rather than proceed with all the ramifications of starting the process she thinks it best to leave when she is still able to enjoy life, but may not be able to enjoy it much longer.

Of course, if Australia had provision for someone like Beverley, and could promise her that, if she started the process, she could exit the process at any time with medical help to die, if the process looked to be a long and arduous and ultimately pointless exercise in trying to stretch her life out another few months or years, that would require surgery or chemotherapy or radiotherapy, etc. The point here is that, facing an uncertain future, and having no legal way out of the complex of procedures that a biopsy might set in motion, she chose instead to stop the process before it began, because she did not feel confident of being able to stop it later with the sort of consummation that she had prepared for herself.

But the fault is neither with Ms. Broadbent, nor with Julia Medew, but with governments which continue to refuse people alternative measures at the end of life. My wife Elizabeth, for instance, might have lived some months longer. She would have had to suffer the continuing indignity involved, as she experienced it, of her nursing care, but she might have opted to stay longer, but only if she had an alternative ending of her own choosing at a time chosen by her. Failing that, she decided to go to Switzerland, and received help in dying from Dignitas, because the alternative would not have been available here. Michael Cooke is simply out of his depth.

He wants to add to Medew’s file blame for not following World Health Organisation guidelines regarding the reporting of a suicide, which warns of the copycat suicides that sometimes follow the reporting of a suicide. But Ms. Broadbent’s suicide was of a very different sort, and not likely to influence those who are liable to die by suicide for other reasons that would be invoked by the self-chosen death of a older person facing possibly difficult medical circumstances. A promise of assisted dying when her outlook became even bleaker, if that occurred, would likely have kept Ms. Broadbent alive. If governments refuse to legalise assisted dying because some people might die before their time, they must take into account the deaths of people like Ms. Broadbent, who might still be enjoying her declining years, had assisted dying been legal.

On the Difficulty of Criticising the Public Face of a Religion

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My last post spoke of Islam as “a bossy domineering sexually warped abusive misogynist sack of shit,” with thanks to Ophelia Benson for this comprehensive put-down of a religion. I am then accused by one commenter (using the name Rahman) of conflating peaceful Muslims with the more extreme variety, thus, it is claimed, aiming my criticism at the wrong people entirely. Most Muslims, I am told, are peaceful, and do not intend to subvert governments or to overturn existing cultures in which Muslims have come to dwell. I am guilty of conflating extremist Muslims and perfectly harmless Muslims who simply want to get on with their lives and practice their religion in peace. It was always thus, of course, and it is a perfect excuse to do nothing at all about the problem of radical Islam.

However, here is the criticism, so that you know what I am addressing here:

 [I]n your article you subtly conflate the views of ‘Islamic fundamentalists’ and extremest muslims with muslims as a whole. I sometimes think all billion muslims are viewed by westerners as pretty much the same, all live in the desert, depraved, primitive, chopping of peoples hands and stopping their women driving. In a way I think this view has been promoted by western powers who profit from wars against muslim countries.

There are all sorts of things wrong with this, and the rest of the comment to which it belongs carries these mistakes further and further than this opening gambit seems to suggest, going, almost at once, to list a number of completely irrelevant supposed facts. I find this kind of thing tiresome, so I thought perhaps I should make another stab at this. It is almost impossible to escape the accusation of “Islamophobia,” and doubtless the following will be no exception to this, but the Islamophilia that is proposed in response to any of my attempts to criticise Islam is, if anything, less discriminating than the Islamophobia that Western critics of Islam are, almost by a reflex, accused of.

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