Broadly speaking, the Right to Die is considered to cover two issues in legislative terms – voluntary euthanasia and assisted suicide. The first of these relates to the right of the individual to say that doctors may intervene – or at least withhold treatment – if they enter a state where they are incapable of living without medical support. Assisted suicide, in legal terms, primarily concerns the issue of whether someone who has a degenerative illness and has reached the point where they are incapable of killing themselves may legally involve another person – usually a loved one or doctor - without that second person facing criminal charges. Both of these are set in a wider ethical question of whether our lives are our own to conclude as we see fit[i], [ii].
Several recent, high-profile, instances of individuals seeking assisted suicide in response to incurable diseases – such as the author Terry Pratchett - has raised the issue of the extent to which dying, in and of itself, is a matter for the individual or the state. Death is, of course, an emotive issue and framing legislation relating to the end of life is notoriously difficult. Suicide – assisted or otherwise – has been seen as a crime in many countries and still is in some. However, advances in medicine meaning that it is possible to keep individuals alive long after would have been the case a few generations ago have raised a key question – just because it’s possible to keep someone alive, is it necessary a good idea?
Even starting at the extreme of murder, it’s surprisingly difficult to demonstrate why it is immoral without coming to the conclusion that it’s mainly a crime because it denies the victim choice. So where a person chooses to die is there even a moral issue at all, let alone a legal one?
Both philosophers and medics make a distinction between a passive approach – withdrawing medication and allowing nature to take its course – and an active intervention which directly brings about the death of the individual. There is anecdotal evidence[iii] that the first type is surprisingly common and the latter is more common than one might imagine. The first group falls mostly under the general term of ‘euthanasia’ and the second would, generally, be thought of as ‘assisted suicide’ but drawing a meaningful line between the two is quite difficult.
At one extreme, there’s the issue of turning off the life-support machine of a patient in a permanent vegetative state, at the other giving assistance to an otherwise healthy individual who simply no longer wants to live. Of course there’s then a step beyond that where no assistance is required and the individual commits suicide themselves, what should their family’s and wider society’s response to that be?
In many countries, especially those where religious organisations are dominant, for suicide to be covered up as it is seen as a sin. Despite this, families of suicides have been known to ask coroners to change their findings to suggest death by natural or unexplained causes as a result of shame, religious or social in origin[iv].
The issue of the right to life is one that exercises many commentators and furious legislative debate. The right to die – and our wider relationship to death – is one that has tended to receive less attention and, when it has done so, the debate has tended to be conducted in muted tones with very few hard and fast moral principles to cling onto. In part, this is, perhaps, inevitable. As a species the desire to live is hard wired into our DNA and it is difficult to conceive that, for some, they may have reached an entirely rational and reasonable decision that they have finished with life. It is much easier to conjure the image of a baby and make the case that it should not be denied its potential than it is to face a grown adult who is in obvious pain and tell them that they just have to put up with it.
Realistically, in legislative terms, the debate on assisted suicide relates to how it impacts on the ‘supporting characters’; the relative or medic required to help someone who may have to give assistance – is that person open to prosecution. There is also a practical question, in the case of the medic, is it fair to ask an individual who has dedicated their life to saving life to assist in ending it? This debate is however broader than that, there is already a debatabase debate on assisted suicide[v], and one on suicide,[vi] instead this debate focuses on the issue of choice and rights.
Clearly this debate covers an enormous number of topics; political, legal, philosophical, ethical, medical and others. From the point of view of proposition, it is important to nail down a tight definition. It’s important to give the parameters in which the right to die would apply otherwise opposition can easily portray the situation of people wandering into emergency rooms and asking to end it all because they’ve had a bad day. Does the right to die exist only in the case of a terminal medical condition? Is old age a sufficient justification? Are psychological and medical examinations of the individual required? What protection is there from relatives killing off their relations and then insisting that it was suicide? If ever there was a debate in which prop needs to give a clear overview of how the process would work, then this is it. They should aim to set out a process in which it has been demonstrated that the potential suicide is in full control of her own mental faculties and has not been placed under pressure by others to end her life. Even with these secured opposition may argue, as some ethicists have, that the decision to commit suicide is, itself, prima fasciae evidence of a disturbed mind. Prop would also do well to place the debate over assisted suicide in countries where regular suicide is already legal – it’s simply an easier case to argue.
When confronted with chronic pain or with diseases that steadily remove our sense of self – or at least the self of whom we are aware – death has proven to be a sensible option taken by sensible people[i]. It is a simple fact that we all die, our objections to it tend to be based on the idea that it can happen at the hands of others or at a time, or in a manner, not of our choosing.
Neither of these issues arise with either assisted suicide or voluntary euthanasia. Proposition has no difficulty at all with the suggestion that both procedures should be regulated and take place in safe, medically supported, environments.
However, if an individual accepts that death is their preferred option in such a scenario, it is difficult to comprehend of reasons why they should not be allowed to proceed. Our social rejection of murder does not, ultimately relate to death itself but to the denial of choice. With murder someone is denying that person all their future potential so denying their freedom of choice, and this remains the case even if the murder was completely painless. Here, reason tells us, the virtuous act is death and the reservation of that choice.
The determining element of humanity is that we are rational beings; a blanket ban – legal and social – on choosing the time and manner of our deaths reflects our primeval fear of a death that comes, unwanted, in the dark of the night, not the mature judgement of modern, thinking (and long-lived) humans.
It is the mark of a civilised society that we accept the inconvenience of laws in some circumstances because we also require their protection in others. To take a trivial example we take away the choice for people to drive on the other side of the road to everyone else. Here the protection offered by a full moratorium on killing requires that we accept all of its implications. The challenge is to use medical science to make it a moot point. Proposition has therefore made a powerful argument in favour of better painkillers and more research into mentally debilitating illnesses. Many of those developments have come about as a result of the very human attributes prop is so keen to cite. Realising that they have an opportunity of future free of pain and illness, humans have found ways of delivering it. It is precisely because death can now be managed that the process of self-imposed triage prop suggests is increasingly unnecessary; a fact to be applauded, not discarded
We now live longer than at any time in the 100,000 years or so of human evolution and longer than the other primates[i]. In many nations we have successfully increased the quantity of life without improving the quality. More to the point, too little thought has been given to the quality of our deaths.
Let us consider the example of the cancer patient who opts not to put herself through the agony and uncertainty of chemotherapy. In such a circumstance, we accept that a person may accept the certainty of death with grace and reason rather than chasing after a slim probability of living longer but in pain.
All proposition is arguing is that this approach can also apply to other conditions, which may not be terminal in the strict sense of the world but certainly lead to the death of that person in any meaningful sense. The application of medical science to extend a life, long after life is ‘worth living’ or would be possible to live without these interventions cannot be considered a moral good for its own sake. Many find that they are facing the prospect of living out the rest of their days in physical pain or are losing their memory. As a result, some may see ‘going out at the top of their game’ as the better, and more natural, option.
[i] Caleb E Finch. Evolution of Human Lifespan and the Diseases of Aging: Roles of Infection, Inflammation, and Nutrition. Proceding of the National Academy of Sciences of the united States of America. 12 October 2009.
This conveniently ignores that patients in a permanent vegetative state (PVS) do recover. It also ignore that Alzheimer’s patients enjoy moments of lucidity that bring pleasure to both themselves and their friends and relatives. It also discounts the possibilities offered by advances in medical science. The one point in any of the processes that is irreversible is the point of death – in the event of a misdiagnosis or the creation of a new drug, it’s too late if the person is already dead.
Ultimately, the decision to die is a personal one, it may affect others but, clearly it has the greatest impact on the person who decides to die.
Clearly those who remain behind will have to deal with the consequences of that death and the end of their relationship with that person but, one would hope, that would be the case if she had died of natural causes at a later date. Furthermore the experience of watching someone die can by as traumatic, or more so, for the carer or loved one than it is for the individual concerned.
What it clearly is not, is an issue for legislators and other strangers who have no connection to the person involved. There are deeply personal issues such as love, death, sex, and reproduction where we accept the state may have a role in the formal sense of preventing their abuse but otherwise should not have an opinion either way. With the right to die the state has maintained not only an opinion but a criminal sanction. This is a clear example of where the role of the state is to respect the individual and step back; legislation is far too cumbersome a tool with be used in circumstances as varied and complex as these.
Dealing with the loss of a loved one, particularly in a situation such as assisted suicide, is painful and traumatic enough for all concerned without adding to that the additional stress of a threat of criminal sanction.
Society routinely accepts that the state has a role in balancing the desires of some with the threats those pose to others. For every reasoned, unpressured decision that can be presented by prop, we can offer a situation in which the decision to die was coerced, or at least was not devoid of financial of self-serving interests on the part of others. The only way to prevent those negative outcomes is to deny the palatable ones through a complete moratorium. Such actions may not become routine yet even one death through compulsion is too many. However it is equally likely that once a right to die becomes established it comes to be seen as normal that someone who is particularly ill or frail will exercise the right to die. Once this is normalised then it becomes easier and easier for the boundary to slowly slip as it is an arbitrary line, either those exercising the right slowly become less and less ill or frail. Alternatively there is a slide into coercion as it becomes normal it begins to be seen as expected that the right will be exercised.[i]
In terms of moral absolutes, killing people is wrong sets the bar fairly low. Pretty much all societies have accepted this as a line that cannot be crossed without the explicit and specific agreement of the state which only happens in very rare circumstances such as in times of war.
There is a simple reason for a blanket ban. It allows for no caveats, no misunderstandings, no fudging of the issue, and no shades of grey. Again, the reason for this approach is equally simple; anything other than such a clear cut approach will inevitably be abused[i]. As things stand guilt in the case of murder is determined entirely on the basis that it is proven that someone took another life. Their reasons for doing so may be reflected in sentencing but the court is not required to consider whether someone was justified in killing another.
It is in the nature of a court case that it happens after the event and nobody other than the murderer and the deceased know what actually took place between them. If we take shaken baby syndrome cases as an example the parent still loves the child, they have acted in the madness of a moment out of frustration. It’s still murder. Supporting a dying relative can be no less frustrating but killing them would still be murder, even where that comes after a prolonged period of coercion to fill in forms and achieve the appearance of consent. It would, however, be very hard to prove. At least with a baby we can assume consent was not given, that would not be the case here.
The issue that Op highlights is the matter of intention, that the courts should not be interested in why someone took the decision to kill another person. However, that does not apply here as the intention is that of the person who has chosen to die. In a majority of nations suicide is already legal – the most spectacular exception to this being North Korea, a country with, otherwise, a fairly relaxed approach to the deaths of its citizens. Accepting the right to die simply extends the ability to do so to those who currently are incapable of performing the necessary procedure themselves[i].
It is easy to say that this social move would not lead to healthy thirty year olds walking into emergency rooms and asking to end it all because they had just broken up with their partner or been sacked. However, it’s rather difficult to see why it should not. Proposition says that all this would do is extend the right to commit suicide to those currently incapable of performing the act themselves but that isn’t so. It also extends the surety of success and of a medically painless procedure that is not available to the teenager with a razorblade or the bankrupt with a bottle of pills and another of vodka. For the sake of exactly the equality of approach, it seems only fair to do so. Proposition are attempting to pick the easy bits of the case but, by doing so, they leave contradictions in their case, why shouldn’t the right to die be universal? They know the reason; society would reject the idea out of hand, regardless of its merits. As a result they draw an arbitrary line simply because it is difficult to argue this right as a response to poverty or grief or addiction. They could argue that all of those things “might” get better. Well similarly a cure for cancer “might” be invented. The only consistent argument is either a universal ban or a universal acceptance. Anything else is an argument about where to draw the line; such approaches tend to lead to a gradual, slippery descent away from the original intentions of legislators. Whatever the initial legislation, it would likely be a matter of days before the court cases started.
It is not uncommon for legislation to apply in extreme circumstances and not in more routine ones – the right to use violence in defence of the home or self being just one example. If the legislation states that this relates to certain, terminal conditions and those patients shown to be of sound mind, then that’s how the legislation works. Society gives the universal right to free education but not if you’re 46 and decide that you should have done something different at school, the right is confined. That applies here and in most universal rights. Its aim is to solve one particular legal problem, not all of them.
By far the biggest worry is that a right to die will create a silent form of coercion that cannot be detected. In the West’s increasingly elderly society the role of older people in that society, their value and their continuing contribution is all too likely to be masked by the issue of the cost placed on those of working age. Even where older people do not face pressure from their families, society needs to be aware of this wider narrative. Such a narrative will slowly create a norm where the elderly feel that they are a burden and it is expected that they will exercise their right to die. The ‘choice’ will remain and they will even think it a choice free of coercion but will exercise their right not because they really want to die but because they feel it is what they ought to do, once the right to die is completely normalised those exercising it may not even consider that what they are doing is not really of their free will. Perceiving oneself as a burden is already a common cause of suicide[i] and would certainly increase if it were to no longer be considered taboo. Not having a right to die will not stop arguments about the burden placed on the working members of society by the elderly but it will stop this going any further towards the creation of a culture where individuals consider it normal that they should die when they feel they are a burden.
This risk can be mitigated by making it clear that the elderly, disabled, and others who may feel a burden are genuinely wanted as a part of society but that the right to die is there if they feel it is too much. Any right to die being allowed is not going to be as simple as going to the doctors and getting an injection. In any system there would be checks and balances put in place. There would probably be some form of application process, checks to see if there is any coercion and that it is what the individual really wants as well as probably some form of cooling off period after which the checks would probably be redone before they finally have their chance to exercise their right to die.
Even setting aside the religious concerns of many in this situation[i], there are solid secular reasons for accepting the sanctity of life. First among them is the impact it has on the survivors. The relative who does not want a loved one to take their own life, or to die in the case of euthanasia. It is simply untrue that others are not affect by the death of the individual – someone needs to support that person emotionally and someone has to administer the injection. Because of the ties of love involved for relatives, they are, in effect, left with no choice but to agree regardless of their own views, the law should respect their position as well.
It further gives protection to doctors and others who would be involved in the procedure. Campaigners are keen to stress that doctors should be involved in the process whilst ignoring that, pretty much whenever they’re asked doctors say they have no desire to have any part of it[ii]. Indeed it would be against the Hippocratic oath which while it is no longer always taken still sums up the duties of a doctor which includes doing no harm and includes "And I will not give a drug that is deadly to anyone if asked, nor will I suggest the way to such a counsel." So ruling out euthanasia.[iii] Presumably, the very case that is so keen on the voluntary principle would also observe this compelling rejection by a group critical to the plan.
[i] Joint letter to the Telegraph. The terminally ill need care and protection – not help in committing suicide. The Most Rev Rowan Williams, Archbishop of Canterbury. The Most Rev Vincent Nichols, Archbishop of Westminster. Sir Jonathan Sacks, Chief Rabbi.
Obviously nobody is going to compel doctors or others in the medical profession to undertake a procedure of which they do not approve. Indeed doctors are routinely required to give independent advice - so that a patient is aware of the available options - without being required to perform a procedure themselves. The same is true with relatives or friends. There are many issues in life, where we may disagree with someone’s decision but we respect their right to make that decision just as they respect ours to check that they have considered all the implications. In the case of the doctors this is simple professionalism, in the case of loved ones, respect.
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Sokol, Dr Daniel, ‘A guide to the Hippocratic Oath’, BBC News, 26 October 2008, http://news.bbc.co.uk/1/hi/7654432.stm
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