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Not So Slippery A Slope

Locked inCould the availability of assisted suicide actually prolong life in some cases?

The Economist notes:

The prospect of the loss of autonomy, of dignity and of the ability to enjoy life are the main reasons cited by those wanting assisted suicide. Having the option of assisted suicide means that terminally ill people can wait before choosing to end their lives. That may have been what happened to Gloria Taylor, a Canadian assisted-suicide campaigner with Lou Gehrig’s disease (a degenerative illness). After winning a landmark court case four months ago that gave her a “personal exemption” to seek a doctor’s help to commit suicide at the time of her choosing, she died earlier this month—from natural causes.

Intuitively this makes sense.

And as for that slippery slope that the scaremongers are always brandishing, protections can be built in that ought to fence it off:

[F]or the limited measures introduced so far, safeguards abound and evidence of abuse is scant. Oregon’s legislation, introduced in 1998, is widely admired. Under it, an eligible applicant must be a mentally competent adult, suffering from a terminal illness and with less than six months left to live. His decision must be “informed”, meaning he must have been told about alternatives such as hospice care and pain control, and he must have asked his doctor at least three times to be allowed to die. A second doctor must review the case both for the accuracy of the prognosis and to certify that no pressure (from inheritance-hungry relatives, say) has been exerted.

That is too restrictive in some respects (it wouldn’t help those with locked-in syndrome, who can live on for decades), but the other protections make good sense.

And how steep is that slope? Not very.

Almost all existing or proposed assisted-suicide laws contain similar safeguards. Some also require the applicant to be suffering “unbearable” physical or mental pain. Only in Belgium, the Netherlands and Switzerland, where assisted suicide has been permitted since 1942, are the non-terminally ill eligible. Yet even that liberality has not stoked the numbers. The annual total of assisted deaths among Swiss residents is still around 300, or 0.5% of all deaths. Dignitas, the only organisation in the world willing to help foreigners die, had 160 clients in 2011. In Oregon assisted suicides represent 0.2% of all deaths. In Belgium, where voluntary euthanasia is also legal, assisted dying accounts for less than 1% of the total. Even in the Netherlands, which takes a notably relaxed approach to both forms, it represents less than 3%.



Must Try Harder (2)

Writing in The Wall Street Journal, a Roman Catholic priest, Tadeusz Pacholczyk, tries to throw in (I think) a little irony in support of his church’s campaign against assisted suicide:

In the November elections, voters in Massachusetts will decide on “Question 2,” a ballot initiative to allow physicians to prescribe (but not administer) a lethal dose of a toxic drug to assist their patients in committing suicide. Advocates of physician-assisted suicide assure us that this can be a good choice for someone who is dying, or who wants to die.

If physician-assisted suicide really represents a good choice, we need to ask: Why should only physicians be able to participate? Why should only physicians be allowed to undermine public trust in their profession through these kinds of death-dealing activities?

Why not include police? If a sick person expresses a wish to die, the police could be notified, and an officer would arrive bearing a suitable firearm. He would load it with ammunition, cock the gun and place it on the bedside stand of the sick patient. After giving instruction on the best way to angle the barrel, the officer would depart, and the patient could then pick up the device and take it from there—police-assisted suicide.

Oh good grief. Please try harder, Father. You surely can do better than that. Mercifully, Pacholczyk then changes tack. He offers up a couple of true life stories that allegedly make the case against assisted suicide:

I remember reading a letter to the editor in the local paper of a small town many years ago. A woman wrote in about the death of her grandparents—well-educated, intelligent and seemingly in control of their faculties—who had tragically committed suicide together by drinking a deadly substance. They were elderly and struggling with various ailments.

Her firsthand perspective was unflinching: It took her years to forgive her grandparents. She was angry at what they had done to her and her family. She felt betrayed and nauseated. She could hardly believe it had really happened.

The woman was still upset that they hadn’t reached out to the rest of the family for assistance. She dismissed the idea that suicide could ever be a good thing as a “total crock and a lie…”

Because, you see, it was all about her. What her grandparents wanted for their own lives counted, apparently, for nothing. She cannot have loved them very much. Not really. Not truly.

And then we have this:

A friend of mine in Canada has struggled with multiple sclerosis for many years. He often speaks out against assisted suicide.

Recently, he sent me a picture of himself taken with his smiling grandchildren, one sitting on each arm of his wheelchair. Below the picture he wrote, “If I had opted for assisted suicide back in the mid-1980s when I first developed MS, and it seemed life as I knew it was over, look what I would have missed. I had no idea that one day I would be head over heels in love with grandchildren! Never give up on life.


In the early stages of his disease (and perhaps even now) this man could have opted for suicide by his own hand. He has chosen not to, and he continues to lead an apparently rich and fulfilled life. Good for him. He made the right choice, but what is right for him is not right for everyone, and is no argument at all for depriving (in particular) the helpless of their chance for release.

By the weakness of this almost insultingly feeble article, Father Pacholczyk reveals yet again how little intellectual force there is to the argument against assisted suicide once those who make it stray from the religious ideology on which their case is, in reality, based, a religious ideology that should not be enforced on those who disagree with it.

The answer to Massachusetts’s Question Two should be yes.




For Misery in Massachusetts

Cardinal O’Malley (The National Catholic Register reports):

Cardinal Sean O’Malley of Boston is leading a statewide fight to defeat the Death With Dignity Act, a November 2012 ballot measure that would legalize assisted suicide in Massachusetts.

He has outlined the Church’s underlying moral concerns regarding the threat to human dignity and patients’ rights posed by assisted suicide in a video homily broadcast at Boston-area Catholic churches. He’s also writing a series of columns critiquing the measure, and he has worked with the Massachusetts Catholic Conference to form the Committee Against Physician-Assisted Suicide, a coalition that includes religious, medical and disability groups across the state.

A Kennedy (Joseph Kennedy III) and The Republican (Sien Bielat) contesting Massachusetts’s Fourth Congressional District:

They found common ground on a couple of issues.

Both opposed the so-called “right to die” ballot question that would allow doctors to prescribe lethal drugs to terminally ill patients…

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Patronizing, Cruel & Misleading

Writing in The Daily Telegraph, Peter Mullen, a British parson, attempts to clothe his religiously-based objections to assisted suicide (“As a Christian, I do not believe we have the right to die at the moment and by the means of our own choosing. Suicide is a mortal sin.”) in what he pretends are “utilitarian” arguments:

First to be considered is the effect on the morals, the conscience and the psychology of the doctor who has allowed himself to conspire in the killing [suicide] of another human being.

Well, that rather presumes that the doctor believes that there is something wrong with acceding to his patient’s request, something that is unlikely given the right that would undoubtedly be given to doctors opposed to assisted suicide to hand this task over to someone else.

I note too that Mullen has nothing to say about “the effect on the morals, the conscience and the psychology of the doctor” who has allowed himself to conspire in the prolongation of the agony of a patient looking for release.

His argument limps on:

Every case of assisted killing [suicide] will be different from every other case. How, for example, in the case of a very sick person, do we assess the balance of his mind: is he capable of being certain that he wishes to end it? And who is to vouch for that certainty?

Who is this, “we”, Vicar? If the patient is sane, the decision is his. I don’t believe in there being a right to assisted suicide, or many other non-legislated rights for that matter, but I do think that a civilized society ought not to stand in the way of a patient to ask for the help he needs to bring his suffering to an end.

Then there’s this:

And it could even be that someone one day expresses the wish to die but that, days or weeks later, he changes his mind. Of course, if he is dead that possibility is no longer open to him.

Oh please. Most of those who support changes to the law also support waiting periods and other safeguards. That said, a society that attributes real value to individual self-determination will also recognize that individuals make mistakes and that sometimes those mistakes are irrevocable. That goes with the territory.

And, of course, there’s this old chestnut:

And then it is well-known that human beings are not perfect. Might some relatives of a very sick man try to persuade him to do away with himself – perhaps even to inherit his money?

Yes, that would be wicked, but how much more wicked is it really than denying a patient the right to end his agony in the name of a religious belief that he does not share?

Mullen, I’d hope, is not a cruel man, but the consequences of his absolute certainty can, at their worse, be monstrous. He should have the humility to remember the wisdom of Oliver Cromwell’s great request:

I beseech you, in the bowels of Christ, think it possible that you may be mistaken.




The Independent:

The debate about assisted suicide has been reignited after the [English] High Court ruled that two men with locked-in-syndrome cannot be legally helped to die. Tony Nicklinson, 58, and a second man known as Martin, 47, mounted legal challenges in attempt to secure immunity from prosecution for any professional who helped them to die. The men are completely physically dependent and can only move their eyes and eye lids yet remain cognitively sharp. Both want to die but neither is capable of taking their own life.

Lawyers acting for Mr Nicklinson, who suffered a catastrophic stroke in 2005, argued for an extension to the common law defence of ‘necessity’ for murder because the alternative – forcing him to stay alive – is worse. They also argued that the government is in breach of his Article 8 right to ‘privacy, dignity and autonomy’, a right he cannot exercise independently because of severe disability. The court rejected the “bold” submission, stating that there was no precedent anywhere in the world and such socially controversial changes were only for Parliament.

The decision was condemned by Mr Nicklinson and his family but welcomed by medical leaders and religious groups.

Both men are likely to appeal and will most likely end up in the Supreme Court.

Martin, who also suffered a stroke, bid to have the Director of Public Prosecutions (DPP) amend current guidance regarding assisted suicide. The clarification he sought would have meant that if a doctor or lawyer were to help Martin to end his life by taking him to the Swiss clinic Dignitas, they would not face criminal and/or disciplinary action. Martin cannot currently fulfil his wish to end his life as his wife, a nurse and carer, is not willing to actively assist in any steps leading to his death.

The three judges, who said the court had been “deeply moved” by both men’s circumstances, ruled that such matters were for Parliament to decide…

Sadly, the judges were correct. There is no innate “right” to assisted suicide, and it’s not for the courts to discover one. It’s up to Parliament to decide.

And so Parliament should: by changing the law to allow those two men, and others like them, to end their suffering if they so choose.

Get on with it.

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Against Self-Government

The Council of Europe is, in theory, meant to be some sort of bulwark for the citizens of its member countries against the power of the overreaching state.

That’s the theory. But here’s how it really works. The Daily Mail reports:

The Council of Europe has ruled that euthanasia and assisted suicide should be banned in every country across the Continent. In a declaration that will have huge implications on human rights laws in its 47 member countries, the Strasbourg-based organisation announced that such practices ‘must always be prohibited’.

The move will represent a major setback to assisted dying campaigners in the UK who want Britain to follow Holland, Belgium and Switzerland in allowing doctors to help to end the lives of their patients. The explicit condemnation of euthanasia was inserted into a non-binding resolution entitled ‘Protecting Human Rights and Dignity by Taking Into Account Previously Expressed Wishes of Patients’.

The resolution had originally simply focused on the human rights questions of ‘advance directives’, or ‘living wills’, in which people set out how they wish to be treated if they became mentally incapacitated.

But members of the Parliamentary Assembly of the Council of Europe argued that living wills, which became legal in the UK under the 2005 Mental Capacity Act, were inextricably connected to euthanasia. They successfully moved an amendment forbidding euthanasia by 34 votes to 16 with six abstentions.

The amendment said that ‘euthanasia, in the sense of the intentional killing by act or omission of a dependent human being for his or her alleged benefit must always be prohibited’.

Among those fighting for the amendment was British member Edward Leigh, the Tory MP for Gainsborough.

It’s that “always” that sticks in the craw. What it means (thankfully the resolution is not binding) is that Leigh, and those like him, are insisting that their prejudices should prevail over an individual’s power to decide his or her own fate. The consequences of such absolutism can, of course, be grotesque suffering. A patient with locked-in syndrome, for example, who wishes to end it all has no need to worry about some “slippery slope”. He is already a prisoner, imprisoned in a body that has become its own dungeon, guarded by doctors who have thrown away the key.

And quite why Leigh, a Tory supposedly, a euroskeptic allegedly, believes that a transnationalist body should have the power to police Britons in this way escapes me. He is, it appears, an opponent of the right of Britons to govern themselves — and in more ways than one.


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Shut in by the State

Count me amongst those who are profoundly skeptical about the notion that it is “self-evident” that we come into this world endowed with a large collection of supposedly inalienable “rights”. I do not, for example, believe that there is such thing as a built-in right to die. That said, it ought to be beyond dispute that any society that wishes to call itself civilized should bestow such a right (with appropriate safeguards) on those who live within it.

The tragic fate of Martin, a British victim of the stuff of nightmares that is locked-in syndrome is a case in point.

The Daily Telegraph takes up the story here:

The man, known for legal reasons only as Martin, suffered a severe stroke three years ago, which left him unable to move. His only method of communication is by using his eyes. In a highly unusual case, he wants to clarify the law so that medical staff or solicitors who help him to end his life will not be prosecuted. Assisting a suicide carries a potential 14-year jail sentence. By staring at letters on a computer screen, from his hospital bed in the converted garage at his home, Martin can slowly form words, and has written a statement to the court asking the judges to help him. In his court statement, extracts of which have been seen by The Daily Telegraph, Martin said his life was “undignified, distressing and intolerable”.

“It is extremely important to me that I feel able to control when and how I die,” he said. “As is no doubt appreciated, almost every other aspect of my life is now out of my control and I want, at least, to be able to control my death.
I am clear that I no longer wish to continue to live and hope that people can respect this wish and now allow me to die. I want it over with without delay.”

Martin wants support from professionals to die either by refusing his food and drink, or by helping him to travel to the Dignitas suicide clinic in Switzerland. Previous legal battles in assisted dying cases have involved close family members who were willing to help their loved ones to die. However, Martin’s wife, known as Felicity, respects her husband’s wishes but does not want to play any part in hastening his death. She said she did not want her husband to die…

Last year, the director of public prosecutions issued new guidelines on assisted suicide, which stated that family members who are clearly motivated by compassion to help a loved one to die would be less likely to face a criminal trial. Martin’s lawyers, Leigh Day & Co, will ask the High Court to afford the same protection to doctors and legal staff, who would potentially also face disciplinary action from their professional bodies.

The case is expected to begin next month.

That Martin is forced to beg for his release is a disgrace. That the form of that release (if it is granted) can only come from either an arduous trip abroad or death by starvation is revolting. But if British law (or, if necessary its lawmakers) cannot find room to permit even painfully modest requests of the type that Martin is making, it will prove nothing other than a willingness to permit terrible suffering in the name of abstract and dubious principle. That’s not a distinction that Britain, or any other country, should want.




Whose Life is it Anyway?

There’s been plenty to read on Andrew Sullivan’s blog this week on the question of assisted suicide. Amongst the posts and pieces to which Andrew has linked is this one by the New York Times’s Ross Douthat to which Mother Jones’s Kevin Drum had this fine retort:

So what’s the objection to assisted suicide? This is where it gets weird. Douthat argues that it’s a slippery slope: if terminally ill patients are allowed to kill themselves, what’s to stop anyone else who wants to do it? Nothing, he says, as the example of Dignitas, a Swiss assisted suicide clinic, shows. And technically that’s true: about a fifth of Dignitas’s clients aren’t terminally ill, but merely weary of life. But think about that number: it means that perhaps 200 weary people have used Dignitas’s services over the past decade or so. That’s something like 20 per year.

In other words, even after a decade in business, Dignitas almost certainly isn’t doing anything to spur suicides and it hasn’t created a tidal wave of people wanting to die. Like so many other things, it merely provides an additional option for the well off (Dignitas charges about $6,000 to perform an assisted suicide). The less well off simply continue to swallow bottles of aspirin or jump off bridges.

So, again: what’s the problem? More than anything else, I think this column illustrates the perils of taking a religiously motivated belief and trying to justify it on secular grounds. It just doesn’t work. The slippery slope here pretty obviously doesn’t amount to much, so you’re left with a simple disapproval of people deciding to take their own lives. And what’s the argument for that? Douthat doesn’t provide one. He simply declares it murder and calls it a day. Without recourse to his underlying religious objections, that’s really his only choice.

But of course, that’s the real slippery slope. If the state is allowed to prohibit me from killing myself, what else is the state allowed to do? Can it force me to accept medical treatment that will save my life? Can it force me to accept medical treatment that might save my life? If not, why?


Douthat responds here:

The slippery slope that I discussed in the column doesn’t amount to much if you don’t disapprove at all of people deciding to take their own lives.

To which one must point out that it is possible to disapprove of something without believing that it should be made illegal.



Kevorkian and All That

Jack Kevorkian’s death has generated a flurry of commentary on the issues with which he was associated, and, indeed, on his ‘meaning’. To Wesley Smith, writing on the Corner, he was a “dark mirror on society.” I replied here:

Wesley, you write that Kevorkian’s more important place in contemporary history was “as a dark mirror that reflected how powerful the avoidance of suffering has become as a driving force in society…” I’ll give you the “dark mirror”. Kevorkian was a very odd bird indeed, but count me less convinced than you about the importance that “society” (at least the politicians that presume to represent it) really attaches to the avoidance (more accurately, alleviation) of suffering. From the excesses of the government’s war against painkillers to the almost insurmountable obstacles that the state places in the way of a terminally ill individual who wishes to end it all but (due to physical impairment) is unable to do so, at least some of the evidence would appear to suggest something rather different.

A couple of commenters assumed my reference to the “war against painkillers” referred to medical marijuana. As I explained in response, it in fact concerned the heavy-handed policing of the prescription certain categories of legal painkiller in this country. This debate should not be seen as a subset of the controversy over narcotics prohibition, rather it is an extension of a far wider discussion: the extent to which the state should involve itself in matters that an individual is able to decide about himself and for himself.

There was a story in the Daily Telegraph recently about a British doctor who had to confront just that:

Police who investigated the death of a young rugby player at the Dignitas clinic in Switzerland have called for clearer guidelines for doctors after revealing that his GP had known of his wish to kill himself six months before he died. Detectives who investigated the case of Daniel James said that his GP witnessed a formal declaration of his intentions two weeks before he died at the Dignitas centre in Zurich. But police were only alerted on the day that Daniel flew to Switzerland with his parents, too late to attempt to convince him to change his plans, because the doctor wanted to preserve “patient confidentiality”. Detective Inspector Adrian Todd, of West Mercia Police, called for clearer guidelines for medical professionals and an overhaul of the way assisted suicide cases are handled.

Assisting someone to kill themselves is illegal but revised guidelines, drawn up after Daniel’s case, state that a family member is unlikely to be prosecuted for helping a loved one to die if they were motivated by “compassion”.

Prosecutors eventually decided not to charge Mr and Mrs James with assisting their son’s suicide, despite securing enough evidence for a conviction, Mr Todd said. Daniel, who had represented England at schoolboy and university level, was paralysed from the chest down after suffering a severe neck injury when a rugby scrum collapsed during training in March 2007. Before he died aged 23 on September 12, 2008, he had attempted suicide several times at home. Speaking to an inquiry into the subject of assisted dying, organised by the think-tank Demos, Mr Todd said: “A number of people were aware what was going on before that but we weren’t told until that day.” Mr Todd said he was not criticising any individual agencies, but called for health service staff to be involved at an earlier stage in cases of suspected suicide. Daniel’s GP, who was not named, referred him to a psychiatrist on February 22, 2008, almost seven months before his death, after he told her he intended to go to Dignitas, Mr Todd said. Daniel was later assessed as having the capacity to make decisions for himself.

After seeing Daniel, who lived near Worcester, on several further occasions, the doctor witnessed his signature on a declaration on August 28, 12 days before he flew to Zurich. The document stated: “I Daniel James of the above address intend to travel to Switzerland on 9th September 2008 for an assisted suicide.

“I am aware that in the event of my death my family wish for my body to be returned to England for a funeral service and cremation. In order to minimise their distress I am happy to give my consent for my GP to provide my details to the local coroner to reduce any complications that may occur.”

Writing in Crisis magazine, Barbara Nicolisi’s response to what she sees as a ”frightening cultural trend” of pro-euthanasia advocacy in the media is to argue that “the latest human-killing bandwagon” might be overturned by a “shrewd and all-encompassing cultural strategy” that includes developing “emotionally winning language”, including, she suggests, using terms such as “elder abortionists”.

Elder abortionists?

Most interesting, however, are her references to “the infinite blessings that come through suffering…If we lose the fight on euthanasia, we lose our souls. By removing suffering and the meaning of suffering from our culture, we make the final step in denying and defying our creature-hood.”

I’m all for stoicism and the stiff upper lip, but as for “the meaning of suffering”, well…

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Attitudes toward assisted suicide

Previous post prompted me to look to the General Social Survey in regards to attitudes to assisted suicide broken down by demographic variables. The variable I used was DOCSUI, which asks:

How much do you agree of disagree with the following options for this person? This person should ask for physician-assisted suicide

The N was a little more than 1200, and the question was asked in 1998. I put the extreme and moderate views together (strongly and not strongly). Below a chart and the raw data in a table.

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