This 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.

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.

Tom 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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