So euthanasia is back in the news, with the Commission for Assisted Dying’s report on 5 Jan claiming that there is a ‘strong case for legalisation’ in England and Wales. Of course, opponents including the Church of England have been quick to point out that the Commission was far from independent, being set up by the pro-euthanasia group Dignity in Dying and funded by Assisted Dying campaigner Sir Terry Pratchett.
In terms of arguing for or against assisted dying I can’t really add a lot to the comprehensive set of resources on the BBC Ethics pages: www.bbc.co.uk/ethics/euthanasia – particularly the sections on pro- and anti-euthanasia arguments. But you know me too well to imagine I’d turn down the chance to put in my tuppence-worth.
As always, we need to be careful to define terms at the outset. With AD we’re not talking about people being allowed to make the decision to take their own – or someone else’s – life merely on whim, simply because they’re having a bad day or are fed up with looking after a sick relative. As I understand it, we’re broadly talking about:
- A person (generally but not necessarily a terminally ill person) being allowed, under certain circumstances, to choose to end their illness or other suffering by ending their life. If (as is generally the case) this requires medical assistance, this is assisted suicide/dying.
- Doctors and/or relatives being allowed to make the decision to switch off life support in the case of permanent vegetative state of a terminally ill person who has no probable chance of recovery (this is euthanasia but isn’t technically assisted suicide/dying).
Whereas I’m fairly strongly emotionally opposed to abortion, I’m oddly agnostic on assisted dying. I think the reasons I feel less strongly opposed to euthanasia are:
- That (when done properly) it is carried out at the wishes of the person involved and with their full consent, which is of course not the case for the foetus in abortion.
- It generally comes at the end of a life not the beginning, when the person has had a chance to live their life and take their opportunities. (NB this is not always true; sometimes it’s children or teenagers, which makes it far more difficult.)
- The person is (generally) already terminally ill and it’s usually a matter of bringing forward the inevitable, or of not prolonging suffering. Where this is not the case, I would be more strongly opposed.
- It allows the patient the chance to die with dignity in the manner and at the time of their own choosing rather than at the mercy of disease and degeneration.
However, I’m well aware that there are some strong and important objections to AD. I won’t try to re-hash all the arguments but these are the ones that seem most persuasive to me:
- Objectors argue that euthanasia is too open to abuse – can we really be certain that an elderly person has actually willingly consented to it, or in some cases are their families or doctors not acting with their best interests at heart? Where there is any genuine uncertainty over the patient’s ability to decide for him/herself, I believe that AD should not be allowed (unless there are overwhelming medical grounds).
- Sometimes people wish to die simply because they are depressed or don’t wish to be a burden –it would be wrong to allow euthanasia under these circumstances.
- In a small % of cases, apparently terminally ill people do get better, at least for a time. Particularly in the case with younger people – children and teenagers – I therefore feel that euthanasia should not be considered until the point at which any reasonable chance of recovery is past. It would be terrible and tragic to help someone die while there was still a chance – however small – that they might live.
- Objectors argue that legalising euthanasia ‘sends out the wrong message’ – that it gives out the signal that it’s fine to take your life, or that life doesn’t matter. They also use the phrases ‘thin end of the wedge’ and ‘slippery slope’, meaning that once voluntary euthanasia for terminally-ill patients is legal then it’s only a matter of time before involuntary euthanasia will be legal too, and finally it will be okay to kill pretty much anyone for no particular reason. This has never struck me as an overwhelming argument; however, it’s certainly possible that once legalised, restrictions will gradually get laxer and goalposts will shift over time, as they arguably have in the parallel case of abortion.
- Some see euthanasia as a consumerist attempt to commodify life and medicalise death, to avoid or deny the undignified but important reality of old age and dying. By bypassing natural processes of dying we deny ourselves (and our relatives) the chance for spiritual and psychological growth, for coming to terms with our mortality, for realising that our own worth and others’ doesn’t depend on our usefulness or beauty but simply on our personhood, our being human. The suffering of dying can therefore be redemptive and transformative.
- Religious objectors consider euthanasia to be usurping God’s place. In this view, it is simply not our right or role to take human life, which is made in God’s image and infinitely precious to God; it violates the command not to kill, and taking a life dehumanises both us and society. (Some might also argue that assisted dying prevents the chance of deathbed conversion, though that’s a more dubious one.)
There is of course a marked difference between actively taking a life and merely withdrawing life support that’s keeping someone alive past what their own body or brain can naturally sustain. However, assisted suicide – actively ending a life rather than just allowing it to end of its own accord – is clearly far more problematic.
The argument from human dignity and being made in God’s image can of course cut both ways. If we’re made in God’s image it could be argued that we should have the dignity to choose to end our sufferings on our own terms rather than succumbing to the awful forces of chaos and entropy. I’m reminded of Hamlet’s famous speech weighing the pros and cons of suicide: ‘Whether ‘tis nobler in the mind to suffer the slings and arrows of outrageous fortune, or to take arms against a sea of troubles and by opposing, end them’. I’m not saying I take this view.
What then of non-terminal cases, where the patient’s quality of life is low with little or no prospect of improvement, but where with medical help and care they may be able to go on living for several more years, perhaps indefinitely? The person in this state may feel that life is simply no longer worth living, but should they be allowed to make this decision? Anyone who has experienced serious depression will also probably have felt that life is not worth living, that there is no hope of things ever getting better. I certainly wouldn’t consider someone in this state to be in a position to decide whether they should live or die. But the long-term terminally ill sufferer may be in a similar position, depressed or despairing about future prospects. We should never write someone off as no longer having any meaningful or viable life or worth; neither arguably should we let someone do that to themselves.
And can someone else ever decide that another person should no longer live? From the point of view of the state or the family, someone may just be an inconvenient burden, but that doesn’t justify having them put down like a sick pet. I would say that only in cases where it’s certain (as far as that’s possible to determine) that the person will not recover, where their quality of life is so poor that to die would be genuinely better for them, and where they are mentally or physically unable to make a decision for themselves, can someone else potentially make the decision to end that person’s life. These are muddy waters though.
The right to die?
Most people would probably say that everyone has a right to live (and of course this belief is central to the pro-life argument in the abortion debate). But do we also have a right to die, to choose the time and manner of our own death; or else to put ourselves in situations where our death is either inevitable or at least extremely likely? Some argue that the right to live also implies the right to death; I’m not sure.
Of course, rights always have to be balanced with responsibilities. Rather than demanding the right to live or die, to be kept alive or not, perhaps we need to see the issue in terms of the duty to care for others.
Nonetheless, even if the right to die is not an innate human right like the right to life, are there any circumstances under which taking one’s own life does become a legitimate moral option? There is certainly a long tradition of what might be termed ‘honour suicides’ – soldiers or leaders committing suicide rather than allowing themselves to be taken captive (and probably killed) by enemies. Defeated Roman centurions would often fall on their own swords; Boudicca swallowed poison rather than be captured. In the Bible we have the rather dubious example of King Saul.
The Warrior Tradition, martyrdom and self-sacrifice
In a blog comment last year, David Holland spoke of the Warrior Tradition, expressed in the phrase ‘today is a good day to die’. In many cultures those who go out to fight to defend and protect their land, their homes, their families are seen as heroic, noble and brave, the very ideal of manly courage – even when they are overwhelmingly likely to be going to their graves. They are facing death – sometimes certain death – not selfishly but self-sacrificingly, for the good of others (at least, that’s the ideal). Therein I think lies the difference with suicide.
A friend once argued that Jesus effectively committed suicide because he could easily have saved himself from the cross but he himself chose to die. This is where choice language becomes interesting – you could technically call such a choice to die suicide, but we have another word for such a manner of death: martyrdom (or self-sacrifice).
As an aside, the terms we choose in these kinds of debates are instructive, because words are inherently value-laden; so for example with abortion (itself a highly connotated word), pro-lifers talk of killing or murdering a baby while pro-choicers talk of terminating a pregnancy.
Either way, the point again here is that Jesus voluntarily laid down his life on behalf of others, not because he wanted to die but because only by his death could their true freedom, healing and restoration be attained.
So I would argue that we do have a right – perhaps even a Christian duty – to die on others’ behalf when the situation calls for it; but I’m not sure we ever have the right to kill ourselves for our own sake.
Criteria for AD
In short, I’m not convinced that it’s ever morally right for someone to be able to choose to die with medical help and with the support of the law. However, I can imagine that there could possibly be cases in which AD is the least worst option. If that is indeed ever the case, I think that certain stringent conditions would need to be met:
- The person must be judged to be of sound mind, capable of making such a decision (and acting independently, not under pressure)
- Their medical condition should be assessed as incurable and overwhelmingly likely to deteriorate, leading to an unsustainably or unbearably poor quality of life
- The process of decision-making should be reasonably long (say at least 1 year), with many opportunities to review the situation and to pull out.
It does strike me as slightly inconsistent or illogical that it should be legal to end what arguably amounts to another’s life or potential life in abortion, especially when that life is healthy, yet illegal to be helped to end one’s own when suffering a debilitating terminal illness. If it is indeed right for abortion to be legal, surely euthanasia ought to be; however, if it’s right for euthanasia to be illegal, surely abortion ought to be even more so.