Assisted Suicide’s Moral Hostages

Bioethics-in-the-News-logoThis post is a part of our Bioethics in the News series

By Tom Tomlinson, PhD

This isn’t exactly news, but some of you may remember a ripple of controversy surrounding a proposal before the Dutch legislature to legalize assisted suicide (AS) for people over 75 who meet certain other conditions, as reported in October in The New York Times.

I was reminded of it in December, when I stumbled over an item in the UK’s Daily Mirror. (Yes, I’m an avid follower of British tabloids.) The item features a video interview with a 65-year-old man with multiple sclerosis who explains why he would want this option as he becomes more disabled by his MS. He complains he’s losing sight in both eyes, and has difficulty reading or writing. As he loses his independence, he finds it more difficult to be happy with his life. “Where are all the things that make life a pleasure, besides the people that I love?” he asks. “They’re all gone, one-by-one they’ve been stripped away…. I don’t see the point of waiting until one is a virtual corpse that simply breathes.”

Now of course assisted suicide for terminally ill patients is itself a controversial topic, although majorities support it in the U.S., Great Britain, and Western Europe. One can expect that a proposal to expand AS to those who have a collection of chronic and variously disabling conditions just by virtue of being old will be even more controversial, and indeed vigorous opposition is expected in the Netherlands, and the adoption of the proposed legislation is far from certain.

euthanasia-regulations-around-the-world

Image description: this map shows the legal status of Physician Assisted Suicide (PAS) and Voluntary Active Euthanasia (VAE) around the world. The map is a project of the Kennedy Institute of Ethics at Georgetown University. Visit the map on the web to explore its interactive features or to view a text version.

Speaking as a gradually disintegrating 71-year old, here’s a tentative defense. It starts with remembering what the Stoic Seneca taught. There is no need to fear death, since once you are dead there is no you to be afraid or to suffer. It’s the dying that we should fear—which is to say, the living we experience before we are finally released by death.

So if AS is justified for those who are dying from a terminal illness, it is because the quality of the life that remains has become intolerable for that person. But the terminally ill aren’t the only ones who struggle with losses to their capacities and their ability to find enjoyment and meaning in the life they are living. The old may well suffer the same kinds of losses as the terminally ill, as a host of chronic but not (yet) fatal conditions chip away at what before could be taken for granted, as friends and family die or move away and the social world shrinks, as the future begins to lose its allure, and there is nothing more in particular we want to achieve or do. “Dear World, I am leaving because I am bored. I feel I have lived long enough,” read George Sanders’ suicide note. A flamboyant actor, Sanders may have wanted his last lines to be good ones. But there was a lot more to the story. Sanders had suffered many losses before his death, which may happen to many of us in our later years. Under some perhaps narrow conditions, why shouldn’t we have the option of AS?

A common reply to this argument is that killing yourself is an awfully extreme solution to such problems, many of which could be ameliorated in other ways: better, more available primary and palliative care, assistive devices, meals on wheels, age-appropriate social activities and networks, visiting nurses and social workers, etc., etc. Once all this is provided, the need for AS will evaporate.

Now these are all fine options to be pursued in the individual case—when they are in fact available. But too often, these alternatives are used as reasons to not permit the option at all—as an argument against a policy allowing AS.

But when they are not readily available to all, or are not effective in the individual case, those who after due consideration believe that AS would serve their interests become moral hostages to an ideal world: a world where every deeply felt need motivating a desire for AS can be met in some other way. When we’re fixated on the ideal, the person in front of us is sacrificed to our vision of a better world. Paradoxically, the real world becomes a worse place as a result.

So I think this style of moral argument is deeply problematic. And assisted suicide is not the only context in which it’s found. For example, parents of children with familial short stature may want to use human growth hormone for children so their child may grow to something closer to the average height, and perhaps avoid the real social disadvantages short people face (men especially). Now there may be lots of good reasons to object to this treatment—e.g., it’s expensive, it is a crapshoot whether it will increase height by any significant amount, etc. But this use of growth hormone is also opposed on the grounds that what really needs to change are discriminatory social attitudes toward very short persons. By all means, let’s work on that. But in the meantime, what about this kid?

Another moral hostage, as we await the Millennium.

tomlinson-crop-2016Tom Tomlinson, PhD, is Director of the Center for Ethics and Humanities in the Life Sciences in the College of Human Medicine, and Professor in the Department of Philosophy at Michigan State University.

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References

  1. Bagot M. Suicide law could give healthy over-75s the right to end their lives. Daily Mirror. http://www.mirror.co.uk/news/world-news/suicide-law-could-give-healthy-9491792. Published December 20, 2016. Accessed January 26, 2017.
  2. Bilefsky D, Schuetze CF. Dutch Law Would Allow Assisted Suicide for Healthy Older People. The New York Times. https://nyti.ms/2k4Gvon. Published October 13, 2016. Accessed January 26, 2017.
  3. Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA. 2016;316(1):79-90. doi:10.1001/jama.2016.8499.
  4. George Sanders. Wikipedia. https://en.wikipedia.org/wiki/George_Sanders#Later_years_and_suicide. Accessed January 26, 2017.
  5. Golden M. Too Many Flaws in Assisted-Suicide Laws. The New York Times. http://www.nytimes.com/roomfordebate/2012/04/10/why-do-americans-balk-at-euthanasia-laws/too-many-flaws-in-assisted-suicide-laws. Published April 10, 2012. Accessed January 26, 2017.
  6. Hawthorne F. Fact or Fiction?: It’s No Tall Tale, Height Matters. Scientific American. https://www.scientificamerican.com/article/no-tall-tale-height-matters/. Published November 14, 2008. Accessed January 26, 2017.
  7. Largest ever poll on assisted dying shows 82% of public support Lord Falconer’s proposed change in the law. Campaign for Dignity in Dying. https://www.dignityindying.org.uk/news/poll-assisted-dying/. Published April 4, 2015. Accessed January 26, 2017.
  8. Of Consolation: To Marcia. Wikisource. https://en.wikisource.org/wiki/Of_Consolation:_To_Marcia#XIX. Accessed January 26, 2017.
  9. Span P. Physician Aid in Dying Gains Acceptance in the U.S. The New York Times. https://nyti.ms/2k1fO3R. Published January 16, 2017. Accessed January 26, 2017.

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7 Responses to Assisted Suicide’s Moral Hostages

  1. If Life is a gift, apparently it Is non-returnable, as our society has deemed all sales final. Even among those who are sympathetic to the plight of the suffering, slippery slope arguments keep resurrecting the specter of death panels and “Logan’s Run”-like carousels. In my opinion, miserable involuntary existence devalues Life by making it less of a gift and more of a prison sentence.

  2. Joel says:

    The concerns about a slippery slope are not unfounded – example: AS for psychiatric illness. See this interesting article in NY Times, referencing a recent study published in JAMA Psychiatry: https://www.nytimes.com/2016/02/11/health/assisted-suicide-mental-disorders.html?_r=0

    In my experience life is both bitter and sweet, and one cannot know ahead of time the length a season of either will last – or even how long a terminal illness will linger. We should humbly admit that some situations defy our understanding, and some decisions are beyond our authority to render.

    • Tom Tomlinson says:

      My concern is not with slippery slope arguments, Joel, which purport to predict what will happen if AS is legally allowed (although those have notorious problems of their own). It’s with the argument that says, in effect, there are better ways to handle the concerns that prompt the desire for AS, when in fact those better ways are not yet available, or not available to all– when the likelihood of those being available lies somewhere off in an ideal future. Your counsel to those who would like the AS option is that they can’t really know what awaits them– it might be better than they think. But of course, you suffer from the same limitation– it might be worse than you think. Then the question becomes who gets to roll that dice.

  3. Richard Hesse says:

    Several times, when I was in the hospital I was interviewed by staff about if I was being abused etc., The last question has been; “Have you considered suicide”. My response was always immediate.
    “Anyone that has not, has not experienced all that life offers.”

    • Tom Tomlinson says:

      Yes, indeed. I have, back in the darker days of my youth. For most of us, experience tells us that life, or our perspective on it, will change. For some of us, there may be little prospect that it will.

  4. Martin Benjamin says:

    Here is a passage from my “Philosophy & This Actual World” (Rowman & Littlefield, 2003), p. 145:

    “If . . . the nation fails to provide access to high-quality palliative care to all who could benefit from it, how can it, in good conscience, oppose assistance in suicide to terminally ill patients who are denied such care and for whom the prospect of continuous pain and suffering renders death preferable to continued life? Granted, under more favorable conditions they might not elect PAS. But those conditions do not exist; and this, the life they are living, is the only one they have. ‘It is on earth that we live,’ Berlin has said, ‘and it is here [and now] that we must believe and act.'” (“The Pursuit of the Ideal,” in Isaiah Berlin, “The Crooked Timber of Humanity” (Princeton University Press, 1990). p. 13).

  5. Tom says:

    Right on, Martin. I should note, by the way, that there is little evidence that the availability of AS reduces the use of hospice or inhibits the development of hospice services. E.g., according to the most recent report regarding patients who sought assisted death in Oregon, 92% were also enrolled in hospice. (http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf)

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