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.
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.
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.
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.
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.
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.
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.
