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.
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!
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.
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
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.
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:
This video doesn’t exist
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.
Almost a year ago Justice Lynn Smith, of the British Columbia Supreme Court, found in favour of the plaintiffs in a landmark ruling which struck down the assisted suicide provisions of the Canadian Criminal Code, and gave permission to Gloria Taylor, one of the plaintiffs, to receive help in dying, should she choose to receive it. (You can read the judgment here.) Part of this judgment was subsequently challenged by the government immediately, namely, the part of the decision in which the provisions of Section 241 of the Criminal Code of Canada were suspended in the case of Gloria Taylor, a woman suffering from ALS who died without assistance shortly after the government lost its appeal. The section in question reads as follows:
241. Every one who
(a)counsels a person to commit suicide, or
(b) aids or abets a person to commit suicide,
whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.
Madam Justice Smith gave the government a year to correct the inconsistency between Section 241 and the Charter of Rights and Freedoms, but the government has, not surprisingly, since everyone is of the opinion that the matter will eventually wend its way to the Supreme Court of Canada, chosen to challenge the judgment itself. This challenge is now proceeding before the British Columbia Supreme Court, and the lead counsel for the government, Donnaree Nygard, has opened the government’s case by claiming a number of things which are arguably not true. I want to consider aspects of those arguments, which, rather curiously, includes a claim seldom made in arguments against assisted dying. (A summary of Nygard’s argument can be read in a number of newspapers. This link will take you to the Globe and Mail iteration of a Canadian Press article that blanketed the country two days ago.)
Nygard claims that the reason people seek assisted dying is simply “that people who contemplate assisted suicide are simply scared of suffering, even though they might be able to cope.” It is hard to know what to make of this argument. Call it the “scaredy-cat argument.” First of all, the “scaredy-cat argument” – and some people, despite Nygard’s contemptible accusation of cowardice, are justly afraid — shows a lack of understanding of the many and various forms of suffering that people are forced to undergo in the course of dying, or living in intolerable circumstances. But second, and more important, what business is it of the government to make claims about people’s courage or lack of courage in dying? So, some people are afraid. Sure, if they are forced to do so, they not only will cope, but they must. There being no other option, if that is what they are forced to do, as Nygard argues that they should be, they will have no choice but to “cope,” whatever that means. If it means they must endure, well, yes, they will endure their sufferings if that is what they are forced to do. This is tautologous. The question is whether they should be forced to do so, and arguing that “many of these people find that in fact they are able to cope and they are able to find enjoyment in life,” as Nygard does, adding that “[t]hey are acting out of a fear of the future,” is simply to restate the problem in place of giving a reason why they must be forced to live through that future.
The University of Edinburgh’s Humanist Society and Edinburgh University’s presumptuously named “Life Society” will host a debate on the motion: “This House would legalise Assisted Suicide.” The debate will be held on Thursday, 21st March 2013 at Appleton Tower LT5. Interested persons should go to the web announcement at the University of Edinburgh Students Association.
It is worth adding that our friend, the Rev’d Scott McKenna, of the Church of Scotland, is one of the debaters, in favour of the motion. We wish him well.
I add that I have been asked to advertise this event by the Humanist Association, and I am happy to do so. I cannot, however, forbear, nor do I, to remark on the name of the “Life Society.” The suggestion behind such names is that those who favour assisted dying legislation are in favour of death and do not support life. This is, in itself, a slander on those who support assisted dying, for they do not do so because they favour death; instead, they favour compassion for the suffering and uphold their right to autonomy in dying. Such a slander should not, in my view, be allowed to stand without criticism. In response to the presumption of so-called ”pro-life” groups and movements, I call those who speak of themselves as “pro-life” as being, in effect, a “death cult,” for they celebrate the misery and suffering of the dying as itself being of infinite value. Such people deserve our distrust and contempt.
This post is now available in Polish translation over at Racjonalista. Thanks again go to Malgorzata.
The Ottawa Citizen has an advice column which puts questions to so-called “religion experts,” who give answers on crucial issues facing individuals and society. There is a big problem with this, because religion experts are, almost by definition, not religion experts at all. What is there to be expert about? They might be experts in their own religion, but there is no such thing as a religion expert who is qualified to give religion’s answer to any question. A recent column in the Citizen’s “Ask the Religion Experts” column, for 31 January 2012 — thanks to Veronica Abbass for the link – asks the two questions: “Is euthanasia right? Would God want us to suffer?” And then the religion experts weigh in on the side of their favourite god. The nonsense that this makes of the questions should be clear right from the outset. We ask the experts their opinion, and all they can do is refer to the “experts” of their religion. According to Z, this is the way it is; according to Y, the truth is such-and-such, and so on. And, around the edges, a little lie or two will take you over the hump when reason fails.
The first one is perhaps the funniest. It’s by a Bahá’í scholar, Jack McLean. Seeing him described as a scholar reminds me of the day I took my M.Div. degree diploma and cut it to shreds. I no longer consider that to be a degree at all. It qualified me as an Anglican priest, but it no longer seems to me that there was anything to know, except, of course, historically, for the church does have a history (or perhaps I should say the churches have a history, for there is no point, during the whole history of Christianity, where there was an unquestioned unity within Christianity), but it is impossible to be a scholar of religion itself, for religion has no subject matter. The “theo” part of theology (the word ‘theology’ meaning, roughly, the logos of theos, or the reason, knowledge of god) is simply UA (on unauthorised absence), having departed his post, or, rather, never having been there in the first place, for all the confident pretence of religious believers, especially its officer class, to which, largely, the Ottawa Citizen has appealed for enlightenment upon a subject which has no object.
Barbara Kay, mother of Jonathan Kay, also a columnist for the National Post — official paper, it sometimes seems, of the Tory Party – has said a lot of stupid things in her time, but perhaps the following is one of the stupidest:
I have always found it odd that the same people who feel the death penalty is barbaric often look benignly on euthanasia. And it does show that words matter. One person’s stark “state killing” is to another, as in Quebec’s pitch to legalize euthanasia, “dying with dignity.”
This comes from an article in the National Post yesterday (23 January 2013), and the attempt to assimilate assisted dying to the execution of criminals is perhaps the most hyperbolic claim that has yet been made about assisted dying. No one that I know of has tried this before, and it just shows that Barbara Kay simply does not understand.
Assisted dying is not, contrary to Kay’s opinion, “state killing,” as though the state qua state would be involved as the agent in every act of assisted dying, and that assisted dying, were it to be legalised, would be directed and intentional killing by the state, as it would be were it an act of judicial killing mandated by legislature and courts. Making the suggestion is offensive, but it is also just stupid. Kay seems to think that an assisted dying law would turn every hospital into a Lubyanka Prison, and every doctor into a KGB agent, looking for inoffensive citizens to kill. Has she no control over her mind at all, or does she come out with these kinds of idiocies simply because she has a form of intellectual Tourette’s Syndrome? Instead of thinking things through she just lets her mind spew out the latest idiocy that arises from her unconscious without exercising any rational censorship over what ends up on the page or screen. The entire article, without exception, is evidence for this.
Al H has been regaling us in the comments on several recent posts with his Christian convictions, with every confidence that he has proposed sufficient reasons not only to believe in God and his Christ, but to live our lives according to a Christian understanding of what is right and good. He applies this especially to assisted dying. So, for instance, he says, in response to a recent post:
To Eric MacDonald #12: In my view, personal autonomy is not a sufficient warrant to grant such an exception to the sixth commandment. Sure, suicides, murders, etc. happen and no law can prevent them. That does not imply that they should be legalized. The sense of obligation to request a physician-assisted suicide that I mentioned in my #9 post (in cases where physician-assisted suicide has been legalized) is an internal psychological sense of obligation on the part of the elderly, chronically infirm or disabled who wish not to be a burden on others, especially when that option is recommended to them by their care-givers — as I understand has happened repeatedly in the Netherlands. E.g., I don’t want my dear wife to sense that obligation in addition to her severe 24/7 physical pain. I do not regard as in the common good a segment in the training of health-care professionals devoted to most efficient and effective means of killing their patients, if requested to do so by anyone, including the patient. I believe there is merit in the Hyppocratic [sic] oath to do no harm. At least in ancient Greece it helped to restore some measure of confidence in health-care professionals.
I will now respond directly to Al H. There is simply no basis for the claims that you make here. They are prompted by your Christian beliefs, and cannot be seen as independent of them. Your reference to your dear wife in this connexion is irrelevant to the point at issue, for there is no reason to suppose that people will feel under this obligation, or, if they do, that the obligation would be based on the legalisation of assisted dying. People do sometimes feel under an obligation not to be a burden on their family. It is often a justified feeling arising from a sense of helplessness and hopelessness, and is a perfectly legitimate feeling to have. And some people, feeling such an obligation, do not take “heroic” measures in order to prolong their lives or their dying.
I have to admit that, before Scott McKenna proposed it, it seemed to me that you could not pry the sanctity and inviolability of life apart. As he says, quite clearly:
For me, sanctity of life does not necessarily equate with inviolability. My argument is that God has given us moral responsibility. We cannot ever say that God desires intolerable suffering of us and, in ending our life in such circumstances, we, as co-creators with God, are exercising compassion and God-given choice. There are no ‘disastrous consequences’: God is bigger than that. It is precisely because God is compassionate that we have nothing to fear. We have real moral choice: we are not ‘sheep’.
This is, it needs to be said, contrary to what is normally meant by the sanctity of life, and, as for moral responsibility, religions have normally seen morality as a function of their belief in and loyalty to God, not something which can be separated from that belief or that commitment.
It is necessary to state firmly once more that nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly. nor can any authority legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity. [my italics]
Of course, there is a qualification, bringing the principle of double effect into play, namely, that one may not intentionally bring about the death of an innocent human being. This expedient, however, is simply a band aid where a battle dressing is required. In her book The Sanctity of Life Doctrine in Medicine: A Critique, the Australian philosopher Helga Kuhse defines sanctity of life as follows:
It is absolutely prohibited either intentionally to kill a patient or intentionally to let a patient die, and to base decisions relating to the prolongation or shortening of human life on considerations of its quality or kind. [11; italics in original]
In the light of these considerations, how can Scott McKenna claim that he supports the principle of the sanctity of life, and yet does not consider this principle absolute?