"Doctor, you've got to help me. I'm in terrible pain and I know I'm dying. Put me out of my misery. Kill me swiftly and painlessly now. I can't go on any longer."
"Let me get this straight," replied Dr. Hyde. "Are you suggesting that I should, say, give you a very high dose of painkillers—20mg of morphine sulphate perhaps—a dose so high that you would soon lose consciousness and shortly afterwards die?"
"Yes! Please be merciful," said the patient.
"I'm afraid that's something I cannot do," replied Dr. Hyde. "However, I can see that you are in pain, so here's something I can do. In order to relieve your pain, I would need to give you a very high dose of painkillers, say 20mg of morphine sulphate, a dose so high, however, that you would soon lose consciousness and shortly afterwards die. How does that sound?"
"Just like your first suggestion," replied the puzzled patient.
"Oh, but there's every difference in the world!" replied the doctor. "My first suggestion was that I killed you, the second that I relieved your pain. I'm no murderer and euthanasia is illegal in our country."
"But either way I'm out of my misery," protested the patient.
"Yes," said the doctor. "But only one way spares mine."
Baggini, J., The Pig That Wants to Be Eaten, 2005, p. 157.
In the title of this post—Double Trouble—we see a good indication that this particular framing of the euthanasia issue by Baggini was meant to bring up the doctrine of double effect, an idea which can be tackled easily, so let's do that first. That doctrine argues that: "sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end." This idea originally came from Thomas Aquinas who used it to justify killing in self-defense, which Saint Augustine had earlier stated was wrong. (Ah, the battles those ancient theologian thinkers got into.) Supporters of this doctrine use it to claim there is a moral difference between intending to do something and merely foreseeing what your actions will bring. I, however, stand with the critics who see this as ludicrous. Any appeal to good intentions as an excuse for behaviour that brings about a morally bad outcome is only acceptable where the future result was unknown. The law makes this quite clear by also including definitions for reckless endangerment where "the accused person isn't required to intend the resulting or potential harm, but must have acted in a way that showed a disregard for the foreseeable consequences of the actions." Therefore, it is patently clear that if you foresee the consequences of your actions, and you perform them anyway, then you intended the consequences. In this thought experiment, Dr. Hyde foresees what his action will bring, verbally admits as much, and should be held accountable for it.
Now, with that little wrinkle of nuance smoothed out of the way, we are left with the larger issue of whether Dr. Hyde actually has anything to be held accountable for. Is there anything wrong with voluntary euthanasia? Why, in most countries, do we make the Dr. Hydes of the world try to invent twisted philosophical hoops for themselves to jump through?
As I mentioned above, this has been a thoroughly investigated topic with many practical details discussed on both sides of the issue. In the comments to my post on Monday, reader Lucy (a newly minted doctor of health psychology) shared an excellent article from the National Health Service (NHS) of Britain that summarised the arguments for and against euthanasia and assisted suicide. Assisted suicide is currently illegal in the UK, but organisations like the Voluntary Euthanasia Society of Scotland (VESS) are pressing hard to get this changed. They provide an excellent FAQ page about the issue. And philosopher Elizabeth Telfer did a nice job summing up the Philosophical approaches to the dilemma of death with dignity in a paper based on a talk she gave to VESS. If this is a pressing issue in your life, or the life of a loved one, I highly recommend reading those three links in their entirety. For the purposes of this short and general audience blog post, however, let me now try and distill the debate into a few sets of bullet points. First, to understand exactly what we are talking about here, note the rules that are in place for euthanasia where it has already been legalised. Then, the arguments for and against the case can be considered more clearly.
Conditions Required for Voluntary Euthanasia to be Allowed
- The patient is suffering from a terminal illness
- The discovery of a cure for that illness is unlikely during what time remains of the patient's life
- Because of the illness, the patient is either suffering intolerable pain or only has a life that is unacceptably dependent on others or on technological life support
- The patient has an enduring, voluntary, and competent wish to die
- The patient is unable to end their own life without assistance
Arguments Against Allowing Voluntary Euthanasia
- Only God has the right to end a human life
- Assisting suicide would be a violation of fundamental medical ethics
- Legalising voluntary euthanasia could lead down a slippery slope to non-voluntary euthanasia, which is tantamount to sanctioned murder
- Alternative palliative treatments for the end of life are available
- Individuals can be in error about whether their lives continue to be worth living
- We can never be certain that a person's request to be helped to die is competent, enduring, and genuinely voluntary
Arguments For Allowing Voluntary Euthanasia
- People should have the right to control their own body and life
- Any categorical "Respect for Persons" should also respect that these persons not be reduced to something less - animal, vegetable, or even machine
- Suffering through intolerable pain or becoming unacceptably burdensome can reduce the well-being of an individual to the point that their life will no longer be worth living
- Medical personnel have a duty to relieve suffering when they can
- There are clear logical stops between voluntary and non-voluntary euthanasia, and in practice, national studies carried out in the Netherlands from 1995 to 2010 have shown no evidence of a slippery slope arising while voluntary euthanasia has been legalised in that country.
- In Oregon, where assisted suicide has been legal since 1997, an independent study from the Journal of Medical Ethics reported there was "no evidence of heightened risk [of being pressured into euthanasia] for the elderly, women, the uninsured, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations."
- Euthanasia is already happening (particularly passive euthanasia where people are allowed to die by withholding further treatment), so it would be better to regulate the issue properly
- There is no clear or morally helpful distinction between passive euthanasia (acts of omission which are accepted) and active euthanasia (acts of commission which are not)
- Palliative care involves trial and error; even the best care may fail to relieve all pain and suffering
- At least some patients can demonstrate competent, enduring, and voluntary requests for euthanasia—either during their illness or prior to it in the case of a "living will"
- In March 2015, the largest ever poll on assisted dying showed that 82% of the public in the UK support giving terminally ill, mentally competent people the legal option of assistance to die with dignity
So how do we judge from among these arguments? Well, I'll dismiss the religious objection with the same respect that it gives for logic and reason and evidence. Does God ever do anything for us? Is he really the only thing that can kill us? Does that mean God=cancer? As for the rest of the objections, I believe they have already been expertly rebutted on a point by point basis. And yet, voluntary euthanasia is mostly illegal in the world. Why is that?
Obviously, religious fervour drives much of the rejection of logic from this issue. Even in the face of a strong, logical case for voluntary euthanasia, too many people will still say, "it's just wrong!" The best way to hasten the death of these faith-filled worldviews is to replace their unsupported ethical rules with a clear definition of what is actually wrong and right. This is where evolutionary ethics can help. Current secular justifications for voluntary euthanasia have come from the current camps of morality: utilitarianism and deontological rule-based systems. Each has its failures.
Utilitarianism easily finds instances where acting for "the greatest good" allows for voluntary euthanasia. But the problem is that the same utilitarian mathematics can find examples where involuntary euthanasia is allowed. We find this repugnant, and thus utilitarianism alone cannot be the guide.
So, we turn to deontological moral systems in search of a means to justify voluntary euthanasia while excluding non-voluntary euthanasia. But no single rule or set of rules about actions has ever been accepted as the basis for a system of ethics. The reason why is that every rule has its exception, which undermines any authority such rules would claim. Rules for actions look like: thou shalt not do so and so (the Commandments), or treat others as you would like to be treated (the Golden Rule), or treat others as they would like to be treated (the Platinum Rule), or act such that your action can be applied universally (Kant's Categorical Imperative). Philosophers have tried to make lists of rules using duties, rights, or negative rights for their basis, but all have been found wanting under certain imagined scenarios. Of course it would be nice if people had a list of simple moral rules to obediently follow; life would be so much easier. But unfortunately, life just isn't that easy.
In the system of evolutionary ethics I am trying to build, morality isn't based on rules for actions; morality is based on a universally necessary and sufficient consequence. Good is that which leads to the long-term survival of life. This outcome provides a universal principle to guide our actions. The exact specific actions are dependent upon the best available information for every specific situation.
How, then, might voluntary euthanasia be good for the long-term survival of life? By giving us control over our own death, it could help us avoid personal pain and suffering. Voluntary euthanasia, can take away worry from loved ones, and it can free resources for better use. It also allows us to lose some of the fear of death, which means death becomes less a topic we need to repress, and more one that can be looked at plainly in order to motivate better living. There are no slippery slopes in these considerations. With the proper safeguards in place, as listed above, there can be room for good people to make good decisions for the individuals being affected. Wouldn't it be better to live in a society that allows such good people to do that hard work, rather than treat everyone like children and imprison them within a restrictive set of laws that have no justification and lead to widespread suffering? I hope that situation changes before I need it, and I wish the same for you and yours.