Category Archives: Bioethics

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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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.

The Harper government argues against assisted dying, says Parliament has already dealt with “all sides” of this question ….

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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.

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A Debate at the University of Edinburgh: “This House would legalise Assisted Suicide.”

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Humanist Society

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.

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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.

Margaret Somerville/Wanda Morris Debate Assisted Dying on HuffPo. So far, Margaret is Winning!

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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.

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