Category Archives: Legalisation
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.
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.
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.
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:
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.
One of the primary arguments against assisted dying is that legalising assisted dying would be to put ourselves at the top of a slippery slope that we would unavoidably begin sliding down, until, at the bottom, we’d have no control over the practice of assisted dying at all, and enormous numbers of people would die, who do not want to, and should not die, simply because we had established a context in which we would have no respect for life at all. No one has been able to show this yet, except that some people, with sublime disregard of the facts, take any evidence at all that someone, somewhere, was helped to die in the last few hours of a miserable death, without their express consent. Of course, no one has shown that this doesn’t happen in jurisdictions that don’t have legalised assisted dying. In fact, we have no idea at the moment how frequently patients in Canada (say) are being provided with assistance in dying, with or without consent, but, since doctors are not less compassionate than other members of the human race, the likelihood that some do assist the suffering to die when the pain and misery have become very great is not zero. The fact that there is more transparency in places like the Netherlands and Belgium is then used, without justification, as a sign that this problem of non-consensual assistance in dying is out of control, something that controlled studies have not demonstrated. Also to be borne in mind is that fact that, in places that do have legalised assisted dying, aside from fundamentalist Christians (and other religious) for the most part, people support assisted dying by a large margin, so the majority of people do not see the problems that the hysterical outpourings of Catholic and other religiously fundamentalist “pro-life” (death cult) organisations sate themselves with day after day with righteous anger and dire warnings.
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.
All I have to go on at the moment is the report in the National Post, but it seems that the government of Québec has found legal ways to work around the Canadian Criminal Code prohibitions of assisted suicide in order to provide for the legalisation of physician assisted dying, in the words of the National Post account, “in rare cases where a patient is close to death and unable to endure the physical or psychological pain.” Whether, in fact, the provisions will manage to skirt around the Criminal Code remains to be seen, but full marks to Québec for recognising, at least, that there is an issue of great importance here that demands attention. And far less than half marks to the spokesperson for the federal government who said:
This is a painful and divisive issue that has been thoroughly debated in Parliament. We respect Parliament’s decision.
To consider the “debate” in Parliament to have settled this issue once and for all is ridiculous myopic. the debate itself did not raise any points of importance. Most of those who commented in the debate did not seem to have considered the issue at any depth. And the refusal to pass the matter on to Parliamentary Committee was precisely a refusal to look at the matter in any depth, or to assess the general political will of Canadians on this issue. What is painful and divisive about the issue is that the church and the mosque is all wrapped up in making sure that the issue never gets an adequate airing in public debate. The position of the government on this issue is inadequate and evasive, and plays into the hands of religious opponents of assisted dying, who are the ones who make the most noise, and have the most money to spend in order to oppose it. It’s time for governments to recognise that the religious do not speak for the vast majority of people in this country, and that the refusal of government to conduct a widespread public discussion of the issues involved has left Canadian largely uninformed about current ethical thinking on the issue, as well as frustrated at the lack of action.
In a comment Michael Fugate referred us to a new article by Steve Lopez, the Los Angeles Times correspondent who has taken on assisted dying as an issue of pressing importance (thanks Michael). You can read the article, and watch an accompanying video, here. It is highly recommended. The title of the article is “Chorus of voices grows stronger for ‘death with dignity.’ The article brings out some important aspects of the discussion about assisted dying, and I will enumerate what I think are the important ones here.
First, there is a clear sign that even born again Christians, and ceteris paribus, other religious believers, may be able to see asking for and receiving assistance to die not as an act of unfaithfulness, but as a decision as reasonably and faithfully made as other life decisions. Generally speaking, religions have seen assisted dying as consisting in acts of suicide. This is a mistake. Suicide is an act of desperation taken in the midst of an otherwise normal life. It may or may not be justified by circumstances, but it is an act completely different from that of the person who seeks, because of suffering, to end life (themselves), or to have life brought to an end (by another), because there is no other way to meliorate the suffering involved either in a terminal illness, or in some other condition that leads to the degradation of a person’s quality of life to the point where, for that person, suffering has become intolerable.
(This is one reason, by the way, that I oppose laws which specify terminality as a necessary condition for assisted dying. For others may suffer as much or more than a terminally ill person, and may suffer for a much longer period of time. Another consideration is that, by specifying terminality, assisted dying laws implicitly state that terminality is a condition of life which may, almost by definition, include intolerable suffering. Since assistance in dying should be a choice, the issue of choice should be in the foreground of such laws, not specific conditions. It is for the individual alone to decide when life has become, for them, intolerable.)
The Principle of Double Effect, Abortion, Assisted Dying and the Religous idea of the Sanctity of Life. Putting Religion out to Grass
Under an earlier post, Scott McKenna, who wants, as many of you will know, to continue using the conception of the sanctity of life, though not, he says, in an absolute sense, remarked as follows:
The Church of Scotland states that there are circumstances in which it is permissible to have an abortion, such as when the life of the mother is at risk. No absolute sanctity here.
The claim, I think, that there is no absolute sanctity here, is questionable. It is possible, in various ways, to work around the notion of absolute sanctity so as to produce justifications for acts in which a death occurs. This is what the Principle of Double Effect (PDE) is all about. Its purpose is to preserve the idea of sanctity while at the same time preventing the sanctity of life from producing counterintuitive consequences.
The PDE has its origin in Thomas Aquinas’ defence of killing in self-defence, which is worthwhile quoting in some detail. You can find it in his Summa Theologica, II-II, Question 64, Article 7: “Whether it is Lawful to Kill a Man in Self-defence?” In response to the objections to the claim that it is, Aquinas answers as follows:
I answer that Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention. Now moral acts take their species according to what is intended, and not according to what is beside the intention, since this is accidental as explained above. Accordingly the act of self-defence may have two effects, one is the saving of one’s life, the other is the slaying of the aggressor. Therefore this act, since one’s intention is to save one’s own life, is not unlawful, seeing it is natural to everything to keep itself in being, as far as possible. And yet, though proceeding from a good intention, an act may be rendered unlawful, if it be out of proportion to the end. Wherefore if a man, in self-defence, uses more than necessary violence, it will be unlawful: whereas if he repel force with moderation his defence will be lawful, because according to the jurists, “it is lawful to repel force by force, provided one does not exceed the limits of a blameless defence.”
Now, it is clear, I think, that the PDE as thus understood can easily serve its turn in justifying abortion where the woman’s life is in danger. The Roman Catholic Church seems to be under the misapprehension that, if saving the mother involves the “direct” killing of the foetus, the PDE does not apply, as was argued in the case of the woman in Phoenix, when a nun was excommunicated on the strength of this misunderstanding of Aquinas’ argument.
A lot of things have been happening lately in the right-to-die movement, and they are worth recording here. Perhaps the most powerful statement so far made was made by Tony Nicklinson, who, after losing his High Court case for the right to die, lost hear, refused to eat, and died a few days later, finally free of the burden of a life which was becoming increasingly intolerable for him. That the courts would not set a precedent — and there is no obvious reason why they could not — because this is a matter for a Parliament which has shown scant interest in the issue for years, was a great disappointment, not only to Tony, but to many other people who are seeking relief from intolerable conditions of life.
A lot of commentators have remarked that the court could not have acted, for to have acceded to Tony Nicklinson’s request would have been, effectively, to legalise euthanasia, and there seem to be a lot of people who are unwilling to take that extra step, including many in the right-to-die movement. That they are completely wrong about this doesn’t seem to dawn on them. It may be that the preferred way is to provide the means for assisted suicide, so that the person who is suffering is the one who actually has to do the deed, but this excludes, by definition, all those who cannot do the deed, like Tony Nicklinson, and others who have lost the use of their bodies. Many people with MS and ALS end up in this state, and the limitation of assisted dying to assisted suicide means that these people will be forced to make the decision to die earlier than they otherwise might have done, because they would know that, once trapped in their bodies, they are trapped forever, unless they wish to starve themselves to death. But what people who was assistance in dying want is to be in full possession of their faculties when they die, and those who starve themselves to death eventually pass into a comatose state, and then they die. Why they cannot be helped simply makes no sense. It is significant that those who have fought this in court are those who are or who were likely to be in a state where assisted suicide would have been of no use to them. Tony Nicklinson, Diane Purdy, and Diane Pretty: all except Ms. Purdy were unable, at the time of their court challenges, were unable to die by receiving assistance in suicide. And still, unfortunately, the right-to-die organisation in Britain, Dignity in Dying, has not got the point.
Andrew Brown gets it wrong again?! What do you call someone who gets it wrong more often than he gets it right?
I was thinking of writing something this morning on assisted dying and changing values — because a new British poll has come up with some surprising results — and then I came upon Andrew Brown’s take on assisted dying, and my decision was made for me (which will please Sam Harris and Jerry Coyne immensely!). Everytime Andrew Brown takes aim at something he’s almost sure to get it wrong — though once in awhile, as if by accident, he seems to make sense – but this time the goes so far over the edge that one has to wonder whether he wasn’t under the influence of some mind-altering drug. Perhaps it was just his usual hubris, but, if so, he was feeling particularly expansive when he wrote this piece in the Guardian: Assisted dying: who’s to decide when a life is not worth living? I could give him the answer to his question in a few words, but experience shows that people like Brown just won’t listen. They’ve already made up their minds. They know the score. And we should only listen to them, apparently, because they certainly don’t listen to anyone else.
That’s what’s so galling about this issue. People are not listening. Brown didn’t listen to Tony Nicklinson, who he thinks was “relatively healthy.” Listen:
In conjunction with other recent surveys, it shows that more people are in favour of the law allowing the killing of relatively healthy patients like Tony Nicklinson than of those who are terminally ill.
What does “relatively healthy” mean, I wonder? If this man was relatively healthy, then what does one have to do to be counted sick? This is the picture accompanying Brown’s article:
I don’t ask the question in a way that suggests that there is an obvious answer to the question whether Tony Nicklinson is sick enough to be permitted to receive help in dying. Because that decision belonged to none other than Tony Nicklinson himself. And he made it!! I’m asking the question in such a way as to put the question to Brown: How miserable does someone have to be before they should be allowed to ask for such help? We know Tony Nicklinson’s answer. Why doesn’t Brown see that Tony Nicklinson was not only making a perfectly reasonable decision; but that it is an intolerably cruel thing to force someone like Tony Nicklinson to go on living when life has become for them a burden to great to bear? Why doesn’t Brown’s humanity kick in?