Euthanasia, Assisted Dying and Various Distinctions

As I’ve researched and read up on scholarly work and various opinion pieces addressing euthanasia or assisted dying or assisted suicide, I’ve come to recognize that one cannot navigate these waters without identifying various distinctions. Euthanasia, I suppose in the minds of some, can be viewed as an all-encompassing issue that umbrellas all the other sub-categories of what’s called mercy killing. (Of course, ‘mercy killing’ is an unacceptable term for many.) What distinctions should be made when discussing euthanasia?

The Basics

Well, we recognize that there are passive and active forms of euthanasia. For example, passive euthanasia is merely the deprival of necessary, life-sustaining things from the person attempted to be terminated. Active euthanasia is a direct action to terminate the life like “pulling the plug” or suffocation.

We further recognize the different degrees of voluntariness. There is voluntary euthanasia where one kills another person to end their suffering consensually. There is involuntary euthanasia where one terminates the life of a person despite their explicitly stated desire not to be killed. And then there’s non-voluntary euthanasia, where the one being euthanized gives no indication, either way, whether or not they want to be euthanized. For example, where a person is in a permanent, or indefinitely long, coma and the family make the executive decision to end the person’s life to reduce their suffering.

It’s important and useful to think in these terms when discussing euthanasia. Evidently, euthanasia can look quite different from one case to another. You can have cases similar to where Robert Latimer, quite disturbingly, killed his disabled daughter when she was nearly 13, by connecting his car’s exhaust via hose to the inside of his car with his daughter inside. And then you can have other cases where people flock to the likes of Jack Kevorkian or John Hofsess to die on their own terms. There’s involuntariness. And there’s voluntariness.

Do these distinctions affect the ethics of euthanasia? How does recognizing these definitions change the discussion?

Worldview Assumptions

Let’s clarify a few assumptions. In my worldview, life is sacred. The sanctity of life, in other words, translates to basic value, worth, and dignity found in human existence. Killing is wrong and in all circumstances.

From a human rights perspective, it is always necessarily wrong to kill an innocent human being. All people have and deserve basic human rights and justice demands that when rights are violated, the violator relinquishes their own. (Note my anticipation of the capital punishment counter-argument.)

I’d like to submit a few more distinctions critical to the debate on the morality of euthanasia. Human value is tied directly to the humanity of the person and their simple existence as a human being. Yet, for others, human value is like currency. It fluctuates. It depreciates. It all depends on the circumstances. So, which one is it? Suppose it’s the latter case where our value corresponds to our quality of life. How do we make the judgment objectively? What metric do we use? Who draws the line? Who does the judging? If it’s up to the individual person themselves, and no other, and if it’s up to their estimation, how they feel, and if there’s no external, transcending law or standard for the person to meet and uphold, then I think it safely follows that all forms of voluntary euthanasia are justified. Assisted dying would be near-universally permitted. And it logically follows that assisted suicide, and any form of suicide for that matter, would then be morally justified. Because it is based upon the assumption that we, autonomous agents, are the judges of our own life’s worth according to how we read, interpret and respond to our circumstances, to our pain.

The argument may be stated thusly:

  1. Immense suffering removes our lives of value and meaning.
  2. In the absence of meaning and value, suicide is morally justifiable.
  3. Therefore, if you suffer and suffer immensely, suicide is morally justifiable.

Problem #1: How immense is ‘immense’?

Problem #2: Premise 1.

Problem #3: Premise 2 sounds too much like Camus.

This is why, I’m assuming, many who would be in favor of legalized assisted dying (or assisted suicide, alternatively) would also support the notion of rational suicide. Because this argument leaves room not just for the terminally ill cancer patient or the ALS patient to end their lives, but also for those who suffer other kinds of non-terminal illnesses, other non-physical pain.

The dilemma here is for the person who supports medical assistance in dying. Wait, what dilemma? Well, suicide prevention day, this year, is September 10. It’s a day where we’re supposed to meet people in their suffering and urge them to fight another day. The concept of “suicide prevention” is one that takes direct aim at meaningless suffering. It presupposes a simple value in living. To support the right to die, in any case, or elective suicide, is to necessarily contradict this assumption. There’s no third horn. The right to die campaign asserts that you decide how much your life is worth for yourself because it’s your life. Under the proclamation of “choice” is that underlying assumption. That’s the fundamental assertion from a worldview magnifying individual autonomy.

There’s certainly an apparent inconsistency of supporting suicide prevention efforts while maintaining the pro-right to die position.

We can think about this in other ways. For example, if life is rendered valueless, or meaningless, by extreme pain, this assumes there is meaning out there to be had. There is value elsewhere. Where do we derive meaning and value in the absence of pain? One might say, well, happiness or a half-decent quality of living makes our life worth living. I might ask, then, does that apply across the board, to anyone experience happiness or a decent quality of life, universally and absolutely, or is it still up to the individual to decide for themselves? Could we theoretically have a person living a healthy, normal life, and they can decide for themselves for reason xyz that their life is absolutely worthless and they would be justified? If no, why?

If people under ordinary circumstances can’t justifiably decide for themselves their lives are worthless, then mustn’t it be because life’s value is in fact absolute and is not determined by personal feeling or individual approximation?

Assisted Dying, Assisted Suicide, and Suicide

This happens to pose a problem for those insisting that assisted dying is not the same as assisted suicide, or suicide. Indeed, they have a point.

Now this is an area needing defining, as well. What is assisted dying and what is assisted suicide? Are they the same or are they different? Well, as it turns out, they’re not exactly the same. Dying With Dignity, in the UK, puts it this way, “Assisted dying allows the terminally ill person to have a choice over the manner and timing of their imminent death… Assisted suicide enables someone who is not dying to choose death over life.” In one case, it’s a physician administering the lethal cocktail to an already-dying person (the patient might also self-administer). In the other case, the patient serves themselves the dosage though they’re not terminal.

Death With Dignity (US) argues this way, “Physician-assisted suicide, or PAS, is an inaccurate, inappropriate, and biased phrase which opponents often use to scare people about Death with Dignity laws. Because the person is in the process of dying and seeking the option to hasten an already inevitable and imminent death, the request to hasten a death isn’t equated with suicide. The patient’s primary objective is not to end an otherwise open-ended span of life, but to find dignity in an already impending exit from this world.” One must wonder, isn’t everybody’s lifespan closed-ended?

Worth considering, then, is that some suggest that assisted dying can’t be viewed as synonymous with suicide or assisted suicide because “suicide” means the true desire to die while “assisted dying” means controlling how one dies when death is imminent. Again, I recognize that there are certain differences (assistedness, legality, circumstances, and so on). Here, on a moral level, a final distinction to be added is that there’s a crucial difference between dying to natural causes and dying by intention. Assisted dying is still intentional, though circumstances tend to be arguably more critical than those typically surrounding suicide. Intentional, nevertheless. Just different logistics. All things considered, morally speaking, the underlying assumptions are the same and the result, functionally, is the same. It’s the act of ending one’s own life.

Final Thoughts

So, while knowing of the various degrees of passivity, assistedness, legality and voluntariness is useful for clarifying positioning and creating logical distinctions between different kinds of acts, they are not the kinds of distinctions that determine the ethics of such acts. By my estimation, assisted dying is wrong because it’s grounded in an assumption about life, suffering and human value that, in my worldview, is untenable. Moreover, from a human rights perspective, I firmly believe that it is wrong to kill any innocent human being regardless of circumstances. Therefore, whether we are talking about assisted dying or assisted suicide, it is always wrong to terminate one’s self. And whether we are euthanizing a person voluntarily, or involuntarily, it is always wrong.

I’m aware that I’ve concentrated on the ethics of killing and haven’t spent much discussion-time on suffering as a motivating factor. I recognize that I haven’t yet attempted to identify with the hurt that’s out there. I haven’t yet scratched the surface of what it can be like to watch a person suffer so greatly, to virtually live at hospitals and clinics, to know that attempts to sustain a life might just be futile. (I’ve written on the issue of suffering a couple of times on this blog addressing my incompetencies as well as the hope that I have in times of real pain.)

What I’d like to say, at the end of an article like this, is to express what my deepest desire is. Human life, be it your own or that of others, is not to be messed with. I don’t deny that those who disagree with me view this as a serious, serious issue. Upholding the immense value of living and protecting life is of chief importance, and in a world that cheapens what was previously viewed as sacred (life, sex, nature), this is no small feat. It requires more than philosophizing. It requires faith.

Photo retrieved from https://ctviewpoints.org/2015/12/04/assisted-suicide-oct15/.

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