Voluntary euthanasia: Beware of the godly!

Sorrow by Martin Gommel.

In the United Kingdom, ongoing social and political controversy over voluntary euthanasia, or (physician) assisted suicide, has reached a new stage. Labour MP Rob Marris has put forward a private member’s bill, and it will be debated in the House of Commons this month. Thus, the UK now becomes a focus of attention for those of us with an interest in the issue of assisted suicide.

I won’t defend the specific legislative scheme proposed by Marris and his supporters, since much of the opposition to it comes from parties who are opposed to any such scheme. That style of opposition will be my focus in what follows. Can it be justified?

“Faith leaders” lobby parliament

Not unexpectedly, British “faith leaders” - that is, the leaders of various religious organisations - have united to lobby parliamentarians against the bill. One of these faith leaders is Justin Welby, the Archbishop of Canterbury, who has written a piece for The Guardian to set out his version of the case against assisted suicide. It appears under the melodramatic title: “Why I believe assisting people to die would dehumanise our society for ever.”

Welby claims that “We [faith leaders] have written, not in an attempt to push ‘the religious’ viewpoint on others but because we are concerned that a change in the current law on assisted suicide would have detrimental effects both on individuals and on our society.” But that is disingenuous.

Since they have acted in concert, presenting a united front, they are lobbying parliamentarians with what can reasonably be called, in this particular context, “the religious viewpoint”. Furthermore, they want their viewpoint to be reflected in public policy and, in that sense, to be imposed on others. They are not merely attempting to persuade individuals against seeking assisted suicide when the time comes. For better or worse, Welby and the other religious lobbyists are attempting to impose their shared viewpoint on others through government policy and power.

There remains an important question as to whether, nonetheless, their position obtains independent support from compelling secular arguments. In his Guardian article, Welby offers an argument with three prongs. It does not make direct reference to any supernatural concepts, but nor (I suggest) is it entirely independent of religious assumptions. He alleges that enacting any regulatory code such as the one sponsored by Rob Marris would:

  1. cross a “legal and ethical Rubicon”;

  2. place large numbers of vulnerable people at risk; and

  3. lead to a society where it is no longer the case that “each life is … seen as worth protecting, worth honouring, worth fighting for”.

Since each of these is supposed to be undesirable, Welby is arguing, we should not go ahead with the Marris bill. So, is any of this convincing? Not at all, I submit.

Crossing the Rubicon

The more detailed claim about crossing a normative Rubicon is that “respect for the lives of others goes to the heart of both our criminal and human rights laws and ought not to be abandoned.” But this is little more than sophistry. A carefully regulated process allowing a place for assisted suicide does not require, or even somehow insinuate, that we should no longer respect the lives of others. It does not, that is, require or insinuate that we should no longer see the lives of others as demanding our consideration.

If such a process were introduced, the law would still ban the deliberate or reckless taking of human life (murder). It would still ban the negligent (or otherwise blameworthy, but less than murderous) taking of human life (manslaughter). The law would continue to give effect to important values relating to respect for the lives of other people. Indeed, careful delineation of the circumstances under which assisted suicide would be permitted would demonstrate that the lives of the individuals concerned are very much being given consideration by the law itself.

That noted, we should acknowledge that a point can be reached when someone’s continuing life has become a burden to him or her - possibly because of uncontrolled and extreme pain, but possibly even if their physical pain is controlled. Many severely and terminally ill people find themselves feeling (among other things) helpless, humiliated and unable to take part in any activities that once brought them joy. In those circumstances, they may feel that their active lives are effectively over and that they are now merely lingering.

In such narrowed and unhappy circumstances, our ordinary fear of death - whether through murder or manslaughter, or otherwise - can become entirely beside the point. Rather than fearing a premature death, and demanding the state’s protection from harm, we might quite reasonably fear going on with no ability to bring our burdensome existence to an end. If, in those dire circumstances, the criminal law prevents others from helping us to die, it is no longer protecting us from something that we fear. It is, instead, operating perversely. It’s operating to remove any remaining control of our own fates. It’s operating to add to the things that we reasonably fear.

The criminal law exists chiefly, and least controversially, to protect us from harmful actions by others. In some situations, of course, it does operate paternalistically to protect us from the results of our own choices, but I suggest we not be sanguine about the existence of paternalistic laws. Generally speaking, they insult us, infantilise us, and infringe our autonomy. We should subject them to the glare of sceptical scrutiny.

Sometimes, I accept, we have reasons to welcome specific paternalistic legislation. However, paternalistic laws should be exceptional, rather than routine, and any government interference with our self-regarding choices had better be as limited as the practicalities allow. In fact, some special features of a situation had better be adduced to justify the restriction on our choices, especially where the interference turns out to be significant in reducing our sphere of autonomy.

When state power compels us to live on well past a point where life became burdensome - perhaps humiliating and joyless, perhaps also agonisingly painful - that is a radical denial of our autonomy. Such laws are disrespectful to us. We have every reason to chafe against this kind of “protection” from our own choices.

In short, no Rubicon is crossed if, in extreme circumstances, we are allowed to make an effective choice to die. The law shows abundant respect for our lives if it offers us protections from institutional or family pressures while also leaving us genuine scope to end our lives with capable assistance.

Protecting vulnerable people

What about the need to protect vulnerable people from undue pressure? Here, Welby is on somewhat stronger ground. His claim is that a law permitting assisted suicide would place very large numbers of vulnerable people in danger. Once such a law is in place, he says, “there can be no effective safeguard against this worry, never mind the much more insidious pressure that could come from a very small minority of unsupportive relatives who wish not to be burdened.”

Really? Can there really can be no effective safeguards against undue pressure to choose death?

There are various motives that can lead to such abuse, and none of them should be dismissed as merely fanciful. It’s unlikely, however, that the existing culture of medical care in countries such as the UK and Australia could easily be changed to such an extent that assisted suicide would be embraced by institutions and medical practitioners other than as a last resort. New laws can be designed to reflect and reinforce, rather than subvert, that established culture of care.

Familial abuse might be more a realistic concern, however, given the wide range of relationships and emotions within families. Might this be a reason to resist the legalisation of a form of assisted suicide?

No, since it is possible to introduce procedures to mitigate any undue emotional pressure when patients consult with their families. Family members' views can be somewhat buffered by other influences, such as mandatory discussion and advice from professional counsellors. The purpose here is not to divert a patient from choosing death, but to help ensure that any decision to die is not a response to emotional pressure.

It is also true, as Welby points out, that one consideration when patients choose to die is that they may feel, during their last period of life, that they are a burden to others. I see no way around this, but nor do I find it shocking. If I were in a situation of terrible helplessness, humiliation and pain, and if the time and other resources of my loved ones were largely devoted to me as I lingered near death, of course one consideration in my mind would be the effect on them. Why imagine or pretend that there is something sinister about this?

It is almost inevitable that the effect on others of my lingering would be one element in my thoughts. It would be a perfectly relevant consideration, and its presence in my thinking would not take away the fact that I might also, and more importantly, find my life too joyless, painful, frustrating, and humiliating for me to want it to continue. Thus, it is unfair to appeal, as Welby does, to a large percentage of people who report their sense of being a burden as one factor in their decision to die with medical assistance. That should be expected.

A more legitimate worry might be the prospect that adequately protective procedures would be ineffective because they would be too demanding and complex to be workable. Thus, they could frustrate patient decisions to choose death, actually increase suffering and cause unintentional breaches. Those would be highly perverse outcomes.

Although this argument might have some force - more than the line actually taken by Welby - it seems unnecessarily pessimistic. It should be possible to design procedures that are workable, yet minimise the possibility of abuse.

For cases that do not fall neatly within any detailed procedures, it might also be possible to develop a relatively broad defence along the lines of “mercy” killing. In any event, there are currently prosecutorial guidelines in England and Wales that make it less likely that prosecution will be undertaken when the “victim” had made a settled, clear, informed decision to commit suicide and/or the assistance given was entirely motivated by compassion.

In fairness, we should note that Welby is not opposed to these. Nothing prevents similar guidelines being retained as an additional protection against harsh prosecutions, even after legislative reforms are enacted.

Down a slippery slope?

Welby’s third prong of argument has no evident merit. It is somewhat along the lines of a slippery slope approach. If we legalise assisted suicide, so it suggests, we will become a society in which we no longer “show love, care and compassion to those who at all ages and stages of life are contemplating suicide” and we no longer view each life “as worth protecting, worth honouring, worth fighting for”.

This adds little to the first prong of the argument, and it has much the same problem. The existence of a statutory scheme to legalise and regulate assisted suicide does not in any way make a society one that lacks “love, care and compassion” to those who are contemplating suicide. By allowing people who fall in a defined class of desperate situations, and for whom ongoing life is experienced as a burden, to end their lives, the society shows more compassion. More, that is, than if it required those people to linger against their will.

However, there’s a further suggestion here, that we must view each life as “worth fighting for” even past the point when the person actually living it finds it of value.

Doubtless there are many situations where individuals no longer want to live because of temporary, though deeply upsetting, circumstances. When that happens, we will, indeed, do what we can to help and comfort the individuals concerned and dissuade them from acting rashly. But it does not follow that we should do all in our power to keep alive an individual who is terminally ill and enduring a conscious existence that she experiences as agonising or miserable.

I know of no secular reason for a compassionate person to want such a life to go on even against the will of the person who is living it. A point can come where insistence on not helping to end life is arrogant and appears cruel.

The insistence would have some rationale if we accepted the supernatural hypothesis that God (or the gods or Fate) decides each person’s time of death, and that any killing, including an assisted suicide, usurp’s God’s prerogative. As it seems to me, some thought such as this must lie behind the view of the British faith leaders. It is not, however, a thought that should influence public officials charged with developing and administering the secular law.

Beware of the godly

Religious leaders such as Archbishop Welby have no particular authority - intellectual, moral, or otherwise - in respect of issues that relate to decisions at the beginning and end of life. Religious leaders are experts on the doctrines of their respective organisations, but that sort of expertise should cut no ice with the rest of us.

They are, of course, entitled to present their arguments in the public square - they have freedom of speech like everyone else in a liberal democracy - but those arguments have no additional credibility because they come from religious leaders. To the extent that they depend on otherworldly assumptions, the arguments provide a poor basis for government policy. To the extent that they are translated into secular (or this-worldly) terms of some kind, we can certainly consider them on their merits, but they will often be found unconvincing.

As I mentioned in a short post on my personal blog, there is something tiring, annoying, and self-serving about the rhetoric of “profound compassion” employed by religious advocates such as Welby. Let’s take note that you can use the word “compassion” or “compassionate” without actually being compassionate or advocating policies that will actually reduce suffering. Likewise, you can use the word “profound” without being in any way profound - though it may give your prose a certain appearance of saintliness and solemnity if you dress it up in such words. This is an old but effective rhetorical tactic.

The forthright atheist blogger Ophelia Benson goes further, seeing much of Welby’s rhetoric as a kind of emotional bullying. Although she and I have sometimes clashed over other issues, I think she’s right on this occasion. Much of the language in the Archbishop’s Guardian article is manipulative, intended to shame and impress us into agreement. Benson uses some harsh and colourful terms for this: “eyewash”, “flapdoodle”, “bullshit”.

I call it propaganda.