Monday, September 05, 2005

The Right to Die

This article was something I wrote recently, and is somewhat of a longer piece. Apologies for any formatting issues resulting as I have cut and pasted from my word processing package.


I am sure that I am neither the first nor the most life-experienced writer to tackle the subject of the right to die, but after listening to a recent morning talkback show, I felt that I had a further contribution to make. Several points which really define the debate for me were missing, and it is hoped that the idea in this article might provide a different perspective, as they did for me in talking about this issue with others. We all have a life, so we are all qualified to have an opinion. My apologies in advance if I touch on any subjects which for you are sensitive.

The issue was brought to a head over two segments of John Fain's morning program on the 774 ABC Melbourne radio station. An elderly cancer sufferer, whose name I unfortunately did not take in, had phoned in on the topic of his right to die. He made an empassioned plea for the right to take his own life, his voice laden with an emotion which was too strong to be kept back entirely. This gentleman, while by no means representing my idol for truth, did put forward a very clear position. It was tragic to hear his story, but it was also touching to hear the values of personal liberty and atheism being put forward with emotion. So often, these philosophical positions are framed as being dry, unforgiving or counter-societal.

This gentleman had a debilitating cancer, was unable to eat or drink, and by his own estimation had weeks to live. This is not the place for a medical debate – I think we can take it as a given that his condition was terminal.

In the second interview, John Fain found a representative of the Catholic church to speak in defense of the opposite position – that there should be no right to die. Many other luminaries had been contacted, including members of both the Liberal and Family First parties. In the words of our cancer sufferer – at least someone had the guts to do it.

Unfortunately, he didn't have the chutzpah. He weakly advanced a philosophical argument based on the concept of democracy – that if you allowed some citizens to legally take a life, even their own, then fundamental principles were being compromised. It was, he implied, the thin end of the wedge – a Bennite solution.

The obvious retort was made, namely that one man's fundamental requirements were another man's fundamental objections. What was it that gave a person the right to enforce their value system either on society, or on some of its members? Especially in cases like this, which involve minimal direct harm to other individuals, why is it important, other than for faith-based theistically motivated reasons, to maintain the illegality of suicide? To paraphrase one caller, why shouldn't any citizen, even a young, fit twenty-year old be allowed to bid farewell to this mortal coil if a fit of melancholy or mescaline should so motivate him? The church advocate came up dry.

A choked board of calls dissuaded me from attempting to voice my own views at that stage, but let me put them here. Some people, obviously, do have a faith motivation. A relatively fewer number feel that they have the moral right to dictate that faith to others. After all, if God himself does not impose faith on his constituency, then what right have we? This aside, what other, rather more practical reasons might there be for placing our vote on one side or other of this particularly thorny fence?

Unlike the suicide booths of “Futurama”, which fulfill a the obvious function and may be utilized for a nominal fee, our society is not so blasé about the nature of suicide. There are a number of very well-grounded arguments for not allowing a carte blanche on suicide, even in difficult circumstances.

The first argument comes by way of a telling statistic – the number of failed suiciders who do not re-attempt. This is presumed to show that a large proportion of the untimely dead would not have a second go at it, if only they had failed the first time around. To put it another way – death is not really the true desire of those individuals; only death's finality prevents people from later regretting their decision.

The second comes from a faintly distasteful, yet almost certainly dead-accurate belief that the elderly or terminally ill might be pressured into such a course of action prematurely. It seems an unreasonable risk to trust the lives of some of society's most vulnerable members to those people who likely stand to profit financially from their death. Unarguably, the proposition that one might nudge a loved relative over the edge is a offensive to a loving son or daughter, but it is also the oldest trick in the book.
A third is related to the effects of suicide on those other than the victim. Paul Hester, former drummer of Crowded House?, committed suicide in a public place, leaving two young children behind who will be wondering why their father didn't love them enough to meet his responsibilities. With this as our example for the negative effects of suicide, is it possible to identify these cases? Could one reduce these impacts to a simple application form, to be processed by a particularly sombre-dressed man behind what, surely, would be an antique window-frame? While Paul Hester's case might be a particularly striking example of the impact upon others of suicide, there are surely more subtle ones also. At what point are those effects more the responsibility of the suicider than not?

These, then, are the risks we might sensibly wish to mitigate. But there are upsides, an d our ultimate position should consider both aspects.

Man is a mortal being. While the “age barrier” is somewhat of a slowly moving target, we continue to hit it hard. Given that all men must die, why then should we assign particular importance to a person's length of life? Why is it that someone who has lived a good life, and wishes to die, invokes in their relatives not only pride and sympathy, but also fear and avoidance? None of us wish to lose our loved ones, but there seems to me an additional desperation to those people considering the last moments of a dying relative.
Greek philosophers – well, some of them anyway – would agree with the principle of valuing quality over quantity. “Death …, the most awful of evils, is nothing to us, seeing that, when we are, death is not come, and, when death is come, we are not.” 1 What is important is the quality of the life lived. The extension of a life for a matter of weeks, or months, if those weeks or months are not well-lived, are not worth living. Plato himself lived and died by this controversial philosophy, committing suicide with a studied calmness, almost indifference, while those around him wept and wailed. Often, it seems to me, this is indeed the way of it. An elderly relative, ready to go, surrounded by others who are weeping and wailing.

Does personal liberty really extend to taking ones own life? Do we really own our own lives, or are they rather lent to us by others? This question represents a fundamental religious difference between many people. If our lives are truly our own, and none of the specific objections of harming others, being mentally unstable and so forth apply, then surely it is only our own morality and our own beliefs which give us the right to end our own lives? Whereas, if our lives are merely lent, then others truly have the right to dictate terms, at least to some extent.

It is my position that all sides have some truth to contribute. I accept that, religious beliefs aside, we owe a genuine responsibility to our society, and if taking our own lives should cause us to fail in that responsibility, then we have done something which is wrong. In all areas of consideration, I believe that neither extreme represents a fully justified position.

So, now that at least my principles have been identified, can any solution be found. Better yet, can the problem be fixed, managed or otherwise solved such that the concerns of all parties might be addressed?

I would argue yes. Moreover, I would argue that we already have such a system in place. What now follows is a substantiation of those two points.

Let us consider briefly the ideal properties of a system for voluntary death. This is not entirely distinct from euthanasia, where the power of choice rests instead with a third party. It is not entirely clear to me that choice can be properly delegated in all situations in which euthanasia might appear a moral option, so let us take into account only those cases where the beliefs of the sufferer are known. This simplifies things somewhat, and in a way which does not harm the argument later, should we wish to consider it again.

One would like to allow people the right to choose, if that choice can be said to be made with an entirely free will. This here means that no other person's will is being imposed upon the situation, moreover that the person is of sound mind, and even yet that the person is free from any wider responsibilities which their death might prevent the fulfillment of.

In order to ascertain that such criteria are met, some checks and balances should be built into the system.

1.It should be difficult for others to impose their desires on the decision of the sufferer, such that the decision is in no sense made for them.
2.The person should have medical certification that they are of sound mind. This is not meant in a legal sense, but rather in the sense that a judgement is made by an expert, rather than by an amateur, in assessing the person's mental state. Those people who are not so judged should be prevented from undertaking self-harm, for they are not in need of death but in need of mental health.
3.The decision should be shown not to be frivolous or harmful to others

How might these three principles be codified in law? If not in law, then how at least can we establish guidelines or a framework for assessment? Using such a guideline, can we be comfortable that we have managed to protect people from abuse, including abuse of the liberty to die?

To my mind, the answers are clear enough. Place the power in the hands of medical experts, whose job and life experience gives them the best knowledge of what is best for a suffering person. Have in place a judicial system, such that people might seek rectification for abuse. Discourage the impression of assisted suicide as “the right thing to do” for the elderly and sick – using the strongest means available.

This, I would suggest, is the situation we already have. While assisted suicide is technically illegal, it is practically achievable in most cases. Anecdotally, I am told this is true, and it is unsurprising. For someone already on the edge of death, it takes only minor mis-medication to kill instead of heal. The number of aged deaths through overdoses of morphine, or other treatments, is higher than statistics might say is likely.

Clear abuses of this system, where patients in relatively good health are killed, are capable of being pursued both through the various medical review tribunals, and also through the court system. Once again, only the most clearly proven cases should result in a guilty verdict.

The official illegality of the act gives people good recourse to justice where there is a clear failure in the duty of care of the relevant medical officer. The decision to assist a suicide is, every time, a moral and practical choice that both parties are forced to take seriously due to the gravity of the risk involved. Each person involved in the assisted suicide is required to risk something in the action.

The seriousness of the potential for abuse should recommend to us a system which errs on the side of caution, and which does not openly encourage the choice of death. As a practical matter, death is seldom unavailable to those who sincerely wish it. As nice as it might be to have legal recourse to both assisted suicide and euthanasia, the practicalities seem to put such a possibility out of reach.

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