tag:theconversation.com,2011:/fr/topics/philip-nitschke-11664/articlesPhilip Nitschke – The Conversation2014-11-14T04:13:05Ztag:theconversation.com,2011:article/342332014-11-14T04:13:05Z2014-11-14T04:13:05ZShould people with acute mental suffering be allowed to die?<figure><img src="https://images.theconversation.com/files/64547/original/9n5vcvjd-1415935282.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Too stringent an approach to assisted dying risks locking people with mental illness out of the right to make decisions about the end of their lives.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/thomashawk/8129311815">Thomas Hawk/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Euthanasia advocates often assert a distinction between dying with dignity (good) and suicide (bad), drawing on the community’s twin commitment to both <a href="http://www.theaustralian.com.au/news/latest-news/per-cent-support-voluntary-euthanasia-poll/story-fn3dxiwe-1225791455181?nk=017d5a37b677dfec62c82635d3f7b9b6">permitting euthanasia in some circumstances</a>, and <a href="http://suicidepreventionaust.org/about/">preventing suicide</a>. But rather than being distinct, euthanasia and suicide are points on a continuum of death decisions, that overlap uncomfortably where intractable mental suffering is asserted as grounds for assisted dying.</p>
<p>The tension between the two was played out this week in the Northern Territory, where the local Civil and Administrative Tribunal is considering whether to uphold the <a href="http://www.abc.net.au/news/2014-11-13/philip-nitschke-says-he-wishes-he-had-never-met-nigel-brayley/5887572">Medical Board of Australia’s suspension</a> of Philip Nitschke’s medical licence after a three-day hearing.</p>
<p>The suspension came after Nitschke <a href="http://www.abc.net.au/news/2014-07-03/nitschke-criticised-over-45yo-mans-suicide/5570162">discussed assisted suicide with 45-year-old Perth man Nigel Brayley</a> even though he knew Brayley did not have a terminal illness. Brayley reportedly told Nitschke in an email that he was “suffering” in the sense that he was deeply unhappy in his life. Nitschke did not refer to him to a psychiatrist or offer any other help.</p>
<h2>More complex than it appears</h2>
<p>Nitschke’s actions have been roundly criticised, particularly <a href="http://www.theguardian.com/commentisfree/2014/jul/24/philip-nitschke-should-not-be-the-sole-face-of-the-euthanasia-movement">by other euthanasia advocates</a>, who seek to distance themselves from existential justifications for assisted suicide. However the idea that euthanasia should not be offered for mental suffering is not universally agreed, and requires some further consideration. </p>
<p>In the Netherlands and Belgium where euthanasia is legal, assisted dying for emotional suffering is permitted. Approval will only be granted where where applicants are of age, mentally competent and their suffering constitutes an “incurable condition” that causes continuous and unbearable anguish.</p>
<p>Of the <a href="http://www.bbc.com/news/world-europe-24373107">1,432 recorded cases of euthanasia</a> in Belgium in 2012, 52 were on psychological grounds. <a href="http://www.euthanasiecommissie.nl/overdetoetsingscommissies/jaarverslag/">In the Netherlands</a>, the figure was 42 out of a total of 4,829 cases in 2013.</p>
<p>Still, the idea – and practice – remains deeply controversial. Concern often focuses on a lack of confidence in the notion that mental illness or emotional pain should ever be regarded as “incurable”. A troubling question then arsies as to whether we might be too carelessly priviliging the right to autonomy, and undermining our <a href="http://www.salon.com/2013/10/07/euthanasia_for_emotional_pain_mercy_or_a_culture_of_death/">responsibility to protect vulnerable people</a> from harm. </p>
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<img alt="" src="https://images.theconversation.com/files/64546/original/f6pvxmjh-1415935090.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/64546/original/f6pvxmjh-1415935090.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/64546/original/f6pvxmjh-1415935090.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/64546/original/f6pvxmjh-1415935090.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/64546/original/f6pvxmjh-1415935090.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/64546/original/f6pvxmjh-1415935090.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/64546/original/f6pvxmjh-1415935090.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There’s concern about the confidence with which we can say that mental illness or emotional pain should be regarded as ‘incurable’.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/porsche-linn/5561412422">Porsche Brosseau/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Others have suggested that if we extend the right to die beyond those who are actually already dying, we risk setting off down a “<a href="http://www.nbcnews.com/news/other/painless-death-or-precipitous-cliff-transsexual-chooses-euthanasia-after-failed-f8C11339134">very dangerous path and one that’s extremely slippery</a>”. This worry seems to be that we slide into a situation in which marginalised and vulnerable people’s right to life will not be sufficiently protected. </p>
<h2>A fine line</h2>
<p>But too stringent an approach risks locking people with mental illnesses out of the right to make decisions about the end of their lives – and this might be discriminatory.</p>
<p>In a troubling <a href="http://www.bailii.org/ew/cases/EWHC/COP/2012/1639.html">2012 UK case</a>, for instance, a hospital was ordered to cease a palliative care program consented to by a 32-year-old woman with anorexia nervosa and to forcibly re-feed her despite her deep distress at the prospect. The woman had consistently refused re-feeding over the past several years, experiencing it as a violent assault. </p>
<p>The court decided the fact that she had an eating disorder made her <a href="https://theconversation.com/force-feeding-anorexic-patient-curbs-freedom-of-choice-7815">incompetent to make a legally enforceable decision to refuse treatment</a>. The implication of the decision was that, by definition, people with anorexia cannot make an end-of-life decision, no matter how harrowing and intractable their illness becomes. </p>
<p>It was a conclusion that bitterly disappointed the woman’s parents, who said:</p>
<blockquote>
<p>It seems strange to us that the only people who don’t seem to have the right to die when there is no further appropriate treatment available are those with an eating disorder. </p>
</blockquote>
<p>Nitschke may well have made errors in his assessment of Brayley. These will be considered by the tribunal. But he had a reasonable point when he said that he had suffered a “political deregistration” because “a government board … doesn’t agree with the beliefs of its citizens”. Certainly there are a range of defensible views on what is a good life and when assisted dying is acceptable. In any case, the fact remains that assisted dying for mental suffering is a long way from achieving broad acceptance in Australia. </p>
<hr>
<p><em>If you have depression or feel very low, please seek support immediately. For support in a crisis, contact <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14. For information about depression and suicide prevention, visit <a href="http://www.beyondblue.org.au/">beyondblue</a>, <a href="http://www.sane.org/">Sane</a> or <a href="http://www.samaritans.org/">The Samaritans</a>.</em></p><img src="https://counter.theconversation.com/content/34233/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sascha Callaghan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Euthanasia advocates often assert a distinction between dying with dignity (good) and suicide (bad), drawing on the community’s twin commitment to both permitting euthanasia in some circumstances, and…Sascha Callaghan, Lecturer in Health Law & Bioethics, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/296582014-07-27T20:24:13Z2014-07-27T20:24:13ZDo people really have the right to a rational suicide?<figure><img src="https://images.theconversation.com/files/54955/original/pq6rk2j5-1406454340.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Historical evidence of suicide rates varying with the philosophy of the times urges caution about adopting an unqualified libertarian stance that privileges autonomy above all else.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/biomedical_scraps/7006377871/in/photolist-2rFKa8-eZ388S-eZ39dU-7L3zbR-bV9HU3-58CXej-5EJgg-gtPUSx-eZ38YU-eYQMaF-eZ38AL-8cKTd3-bqm1VD-aDuQPe-eYQP6r-8DmFmy-5xUKe-7pzST8-bF8w3t-87XHHK-cQay4s-4Utxu8-7znPm-7M3Yhy-u1kYc-8RCTFY-8RzKyn-9gvRuw-fNwZAD-uPTdz-4RB4Gr-4RB1eM-eYQMHt-bqkBRn-bqm1Vx-5nsPvk-VQZuK-beKSDM-eYQNrx-eUqiWX-4RB4Gt-4xeUZ-dwtG7f-9heqYS-hVAorq-3cu8tX-7HHQJ-bRNq96-bRNqeH-6gHsgX">Arallyn!/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Seven Australians will <a href="https://www.lifeline.org.au/About-Lifeline/Media-Centre/Suicide-Statistics-in-Australia/Suicide-Statistics">die today</a> as a result of suicide, the leading cause of death in young Australian men. So the media interest surrounding one in particular, that of <a href="http://www.abc.net.au/news/2014-07-03/nitschke-criticised-over-45yo-mans-suicide/5570162">45-year-old Nigel Brayley’s suicide</a>, needs some explanation. </p>
<p>The <a href="http://www.theguardian.com/world/2014/jul/24/euthanasia-campaigner-dr-philip-nitschke-suspended-by-medical-board">sensational midnight meeting</a> that led to the suspension of euthanasia campaigner Dr Philip Nitschke’s medical registration for his role in that suicide was certainly newsworthy, though Nitschke’s activities do not wholly depend on his license to practice medicine.</p>
<p>Most likely interest is driven by the linked ideas of a “right to die” and “<a href="http://www.abc.net.au/7.30/content/2014/s4053344.htm">rational suicide</a>”, terms that have been used repeatedly by Nitschke in explaining his support for Brayley’s actions. Neither idea is new (both stem from libertarian ideas of individual autonomy), nor is the drug Nembutal, which Brayley used, a new or unique means to achieve death through suicide. </p>
<p>But there’s a back-story here that’s essential to making sense of the theatre surrounding Brayley and Nitschke.</p>
<h2>The right to die and rational suicide</h2>
<p>First “the right to die”. This right is not listed in the <a href="http://www.un.org/en/documents/udhr/">Universal Declaration of Human Rights</a>. <a href="http://www.un.org/en/documents/udhr/index.shtml#a5">Article 5</a>, which prohibits torture and inhuman treatment, certainly implies a right to relief of suffering at end of life, and it finds legal support in many jurisdictions (including Victoria). </p>
<p>But the language of rights is any case bewildering, as it imposes an obligation on others (your right to die becomes my obligation to kill) and invariably engages with opposing rights. Consider the role of a doctor in a botched suicide attempt, for instance.</p>
<p>While it has served as useful shorthand for supporters of the evolving idea of providing exceptions to the Crimes Act in certain cases of deliberate killing by commission or omission, the “right to die” is ethics reduced to a bumper sticker and does little to further our understanding. </p>
<p>And as a statement of the bleeding obvious – we all are born with a right to die that cannot be infringed. Only the suffering associated with our dying can be changed.</p>
<p>Rational suicide, on the other hand, has been with us for millennia. Acceptance that there are some circumstances where you should kill yourself or knowingly allow yourself to be killed is widespread in most cultures, including western Christian ones. </p>
<p>Few advocates of suicide could have been more cogent than a former dean of St Paul’s Cathedral, <a href="http://www.luminarium.org/sevenlit/donne/meditation16.htm">the poet John Donne</a>:</p>
<blockquote>
<p>If man knew the gaine of death, the ease of death, he would solicite, he would provoke death to assist him by any hand which he might use.</p>
</blockquote>
<p>Arguments against rational suicide based on a revealed truth that our bodies and lives do not belong to us do not convince philosophers or the broad public that suicide could never be a rational choice. And a scientific assumption that all suicide is due to mental illness is unproven and unprovable. </p>
<p>So rational suicide exists, but does that make it right? Suicide may be rational (that is, it may have clear and understandable reasons) but Nitschke’s conclusion, that we should accept it and educate people on how to carry it out painlessly, is deeply flawed. </p>
<p>For all the millennia that rational suicide has found supporters, it has encountered systematic opposition based broadly on the idea of public interest.</p>
<h2>Your life and the public interest</h2>
<p>This “public interest” led to the <a href="http://www.bbc.com/news/magazine-14374296">criminalisation of rational suicide</a> in England in the 13th century (you had to be considered sane to be prosecuted; about one in eight were).</p>
<p>Punishment was also meted out to surviving family members, who were <a href="http://www.bbc.com/news/magazine-14374296">stripped by the Crown of all their belongings</a>, an early function of the coroner.</p>
<p>In his <a href="http://www.lonang.com/exlibris/blackstone/bla-414.htm">1825 Commentaries on the Laws of England</a>, Sir William Blackstone called suicide a:</p>
<blockquote>
<p>crime against God and nature, as well as a crime of depriving the King of a subject. </p>
</blockquote>
<p>Though suicide was decriminalised in England in 1950 (and 17 years later in Australia), we still use the word “commit” with suicide, a term otherwise reserved for murder and sin. </p>
<p>Nowadays, the law prohibits suicide in more specific settings, <a href="http://www.ncbi.nlm.nih.gov/pubmed/507056">guided by a US case</a> that suggested, among other things, that “protection of the interests of innocent third parties” and “maintaining the integrity of the medical profession” could weigh against self-determination. </p>
<p>Philosophers vigorously disagree, but most continue to see contemporary reasons to question rational suicide, <a href="http://jme.bmj.com/content/25/6/457.full.pdf">some arguing that the idea is nonsensical</a>, while others argue that <a href="http://plato.stanford.edu/entries/suicide/#AutRatRes">intervention to prevent suicide is warranted</a> in any case, as an assessment of rationality is difficult to make.</p>
<p>The pragmatic findings that suicide commonly has an impulsive element, and that failed suicide may be associated with good quality survival, lend weight to the view that attempting to prevent suicide is a greater good than making it safer and more accessible.</p>
<p>The historical evidence that suicide rates vary with the philosophy (zeitgeist) of the times, with surges during the <a href="http://en.wikipedia.org/wiki/Age_of_Enlightenment">Age of Enlightenment</a> and more recently with <a href="http://en.wikipedia.org/wiki/Romanticism">the Romantics</a>, urges some caution in adopting an unqualified libertarian stance that <a href="https://theconversation.com/strange-bedfellows-euthanasia-same-sex-marriage-and-libertarianism-29651">privileges autonomy over all else</a>.</p>
<p>At a time when extreme libertarian philosophers still find free will “unintelligible”, there are grounds for caution in embracing libertarianism as a the principle upon which we judge acts of terminal self harm.</p>
<p>Rational suicide may exist, but is as sad as that driven by mental illness. It deserves our attention and our compassion, but not our complicity.</p>
<p><em>Anyone seeking support and information about suicide can contact <a href="https://www.lifeline.org.au/">Lifeline</a> on 131 114 or <a href="http://www.beyondblue.org.au/">beyondblue</a> 1300 22 46 36</em></p><img src="https://counter.theconversation.com/content/29658/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Saul does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Seven Australians will die today as a result of suicide, the leading cause of death in young Australian men. So the media interest surrounding one in particular, that of 45-year-old Nigel Brayley’s suicide…Peter Saul, Senior Specialist in Intensive Care and Head of Clinical Unit in Ethics and Health Law, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/296512014-07-25T04:39:25Z2014-07-25T04:39:25ZStrange bedfellows: euthanasia, same-sex marriage, and libertarianism<p>The <a href="http://www.abc.net.au/news/2014-07-24/euthanasia-advocate-philip-nitschke-suspended-by-medical-board/5615268">suspension of Philip Nitschke’s medical registration</a>, and the events leading up to it, has sparked one of the most heated discussions about euthanasia in Australia for some time.</p>
<p>What’s surprising, however, is that the debate hasn’t split along the usual pro-euthanasia versus “pro-life” lines. Instead, <a href="http://www.nhs.uk/conditions/euthanasiaandassistedsuicide/pages/introduction.aspx">advocates of both euthanasia and doctor-assisted suicide</a> themselves have been condemning Nitschke for <a href="http://www.abc.net.au/news/2014-07-03/nitschke-criticised-over-45yo-mans-suicide/5570162">failing to urge a 45-year-old man</a>, who had no terminal illness but who expressed a wish to take his own life, to seek psychiatric help.</p>
<p>Nitschke <a href="http://www.abc.net.au/7.30/content/2014/s4038913.htm">has insisted</a> that it wasn’t his role to try to dissuade someone from “rational suicide”:</p>
<blockquote>
<p>If a 45-year-old comes to a rational decision to end his life, researches it in the way he does, meticulously, and decides that … now is the time I wish to end my life, they should be supported. And we did support him in that.</p>
</blockquote>
<p>The pushback against Nitschke <a href="http://www.abc.net.au/news/2014-07-07/nitschke-a-maverick-suicide-campaigner-rodney-syme-says/5579802">from euthanasia campaigners such as Rodney Syme</a> (as well as mental health advocates such as <a href="http://www.skynews.com.au/news/politics/national/2014/07/24/kennett-says-nitschke-has-damaged-the-cause.html">beyondblue’s Jeff Kennett</a>) provides a valuable lesson about what can happen when two very different ethical approaches converge on the same policy prescription; it becomes important to discuss the principles, not just the policy.</p>
<h2>The importance of liberty</h2>
<p>This problem isn’t unique to the euthanasia debate. Last week, newly-minted Liberal Democrats senator David Leyonhjelm announced plans to introduce <a href="http://www.smh.com.au/federal-politics/political-news/new-senator-david-leyonhjelm-urges-libertarian-mps-to-come-out-of-the-closet-and-support-samesex-marriage-20140714-3bw6w.html">a bill to legalise same-sex marriage</a>. </p>
<p>As a libertarian, Leyonhjelm has called for <a href="http://www.theaustralian.com.au/national-affairs/new-senator-david-leyonhjelm-calls-for-lower-taxes-greater-freedom/story-fn59niix-1226983323454">lower taxes and a massively reduced role for government</a>. Yet his position on marriage equality aligns him with a policy more closely associated with the political left.</p>
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<img alt="" src="https://images.theconversation.com/files/54839/original/rchbfhn8-1406250559.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/54839/original/rchbfhn8-1406250559.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/54839/original/rchbfhn8-1406250559.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/54839/original/rchbfhn8-1406250559.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/54839/original/rchbfhn8-1406250559.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/54839/original/rchbfhn8-1406250559.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/54839/original/rchbfhn8-1406250559.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some political conservatives support same-sex marriage.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dunechaser/129583202">Andrew Becraft/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>He’s not the only right-wing supporter of same-sex marriage of course. But when someone like <a href="http://www.theguardian.com/politics/2011/oct/05/david-cameron-conservative-party-speech">British Prime Minister David Cameron declares</a> “I don’t support gay marriage despite being a Conservative, I support gay marriage because I’m a Conservative,” he is doing something very different: he’s saying that marriage is a substantive good, and committed same-sex couples can and should be able to participate in that good. </p>
<p>Philosophers such as <a href="http://www.amazon.com/The-Long-Arc-Justice-Marriage/dp/0231135211">Richard Mohr have argued</a> that committed same-sex relationships already <em>are</em> marriages in a substantive sense, and the law should simply recognise that.</p>
<p>For libertarians (for the most part), the only real substantive good is individual autonomy. Leyonhjelm doesn’t argue, as far as I can see, that certain types of relationship have a special, substantive value; he simply thinks “<a href="http://www.theaustralian.com.au/national-affairs/new-senator-david-leyonhjelm-says-samesex-marriage-is-a-liberty-issue/story-fn59niix-1226988123380?nk=595f42bdd767655aa8e6f44776b7eb39">It is not the job of the government to define relationships</a>.” (In which case, we might ask, why should governments get involved in certifying marriage at all?)</p>
<p>Those of us who support same-sex marriage can probably live with that tension, if it delivers the outcome we want. But the philosophical tension between approaches is still there. </p>
<p>And the very moral thinness of libertarianism, its refusal to trade in any ethical currency other than liberty, sits uneasily with issues of life and death, where all sorts of other moral considerations are in play.</p>
<h2>The limits of autonomy</h2>
<p>That’s precisely why Nitschke’s comments about suicide are so shocking. Most arguments for euthanasia come down to a concern to alleviate needless suffering. </p>
<p>One reason death is viewed as normally being a harm to the person who dies is that it <a href="http://plato.stanford.edu/entries/death/#3">deprives us of goods we would have enjoyed</a> had we lived. In a situation where there is nothing left in the patient’s future but pain and loss of dignity, there are no more goods to lose.</p>
<p>Compassionate regard for someone whose fate is in our hands may mean helping them achieve a quicker, more dignified death is the <a href="http://virtualphilosopher.com/2006/11/least_worst_opt.html">least-worst option</a>. </p>
<p>Autonomy plays a crucial role in that, of course: we need to respect the patient’s decisions regarding their treatment, including their <a href="http://books.google.com.au/books?id=dcK6-h1ngtcC&pg=PA159&lpg=PA159&dq=bonnie+steinbock+the+intentional+termination+of+life">refusal of further interventions</a>. Compassionate concern for others may mean allowing them a degree of control over their impending death.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/54838/original/bcsjdtyn-1406250341.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/54838/original/bcsjdtyn-1406250341.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/54838/original/bcsjdtyn-1406250341.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/54838/original/bcsjdtyn-1406250341.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/54838/original/bcsjdtyn-1406250341.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/54838/original/bcsjdtyn-1406250341.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/54838/original/bcsjdtyn-1406250341.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Having only one source of light, the libertarian landscape is dimly lit.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/grahammhodgson/1323051683">Graham Hodgson/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>What Nitschke’s libertarian position does, however, is strip out everything <em>but</em> autonomy and reduce the whole issue to one of individual choice.</p>
<h2>Libertarianism’s moral moonscape</h2>
<p>If you think, as Nitschke apparently does, that the question here is simply about exercising a right to suicide, why should it matter whether someone is terminally ill or not? If someone wants to die, and they’re clear-headed enough to make competent decisions, who are we to interfere with their personal liberty in order to stop them?</p>
<p>And yet most of us <em>do</em> have fairly clear moral intuitions that the suicide of an otherwise physically healthy person, possibly with treatable mental health issues, is a terrible thing. </p>
<p>Libertarianism either can’t make sense of that intuition, or treats it as irrelevant.</p>
<p>When teaching classes on the ethical debate over euthanasia, I’ve found that students often seem to struggle with explaining why it should matter whether the patient is dying (or at least permanently debilitated) or not. Yet from a mercy perspective, it matters very much that there are, in fact, no truly good options left open. </p>
<p>In part, this is because mercy is <a href="https://theconversation.com/drowning-mercy-why-we-fear-the-boats-16394">a particular kind of response towards another</a>, a response that acknowledges their distinctive value – and understanding that value is essential to understanding the full tragedy of death, of what is lost when a person dies. </p>
<p>Acknowledging that value means <a href="https://theconversation.com/fuming-with-outrage-nazis-nannies-and-smoking-16682">accepting some limits on autonomy</a> where avoidable death is involved.</p>
<p>Respect for patient autonomy needn’t involve the sort of wilful blindness Nitschke has shown. If we want to make the case for progressive reforms, such as euthanasia and marriage equality – as we should, vigourously and doggedly – we should resist doing so in terms that leave us unable to make sense of our moral environment.</p>
<p><em>Anyone seeking support and information about suicide can contact <a href="https://www.lifeline.org.au/">Lifeline</a> on 131 114 or <a href="http://www.beyondblue.org.au/">beyondblue</a> 1300 22 46 36</em></p><img src="https://counter.theconversation.com/content/29651/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Stokes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The suspension of Philip Nitschke’s medical registration, and the events leading up to it, has sparked one of the most heated discussions about euthanasia in Australia for some time. What’s surprising…Patrick Stokes, Lecturer in Philosophy, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.