Wednesday, July 25, 2007

When living is a fate worse than death; the case for voluntary euthanasia

Too many people I cared for have died before their time, killed by cars or cancer. Too many others have lived well beyond their time. With the progress of medicine and the widespread increase in longevity, the second category is likely to increase relative to the first. The issue is not, however, a new one. Job 42:17 reads: “So Job died, being old and full of days”. The Dutch version is rather more direct: Job dies oud en der dagen zat.”, which is best translated as ‘old and over-filled with days’. The word ‘zat’ - related to ‘sated’ and ‘satisfied’ - has a strong connotation of too much of a good thing. In Afrikaans, the characterisation is ”old and ’lived out’” (‘afgeleefd’).

The three grandparents I got to know well all went through an absolutely dreadful final two years of life – all three were in their eighties when they died. When I say dreadful, I mean dreadful for them, and not just for those who loved them and witnessed their humiliating and undignified decline into pain, incontinence and incoherence laced with flashes of understanding, despair and horror at what was happening to them. The problem of living too long has now reached my parents’ generation. Some day (if I am lucky enough to live that long) it will be my problem too. Unlike my grandparents and my parents, I intend to be ready when that day arrives. Unfortunately, my proposed course of action would be illegal under the laws of most countries (the enlightened Netherlands are an exception), including the UK and the USA. Were I to require assistance to carry out my plan, the person(s) assisting me could be tried for manslaughter or murder.

Here is my position:

Suicide is a fundamental human right. Assisting someone to commit suicide should, subject to proper safeguards and oversight, be legal.

It is clear to me that the right to commit suicide must be restricted to adults who are of sound mind and who are not suffering from treatable but untreated forms of clinical depression. Assisted suicide should, as it is in the Netherlands, be supervised and accompanied by qualified medical personnel, and be subject to clear guidelines and judicial oversight and accountability.

There are risks associated with assisted suicide and voluntary euthanasia. The main risk is that voluntary euthanasia becomes euthanasia (‘good death’) in the eyes of the just the party or parties administering it rather than in the eyes of the person seeking to end his life. From that point, it is but a small step to involuntary euthanasia or murder. Getting the doctor to quadruple granny’s morphine dose to get at the inheritance in time for the summer holidays, is not part of the package. It is therefore essential that full, informed consent be given by the person wishing to end his life, without any external pressure. Only an adult of sound mind, not blighted by treatable but untreated clinical depression, can make the determination to end his life. This means that those in a coma should be kept on life support, unless they have left clear instructions, say in the form of a notarised living will, that they are not to be kept alive under such circumstances. It may be sensible to make it mandatory for all adults to have living wills covering these contingencies.

I believe that these views on suicide and assisted voluntary euthanasia are fully compatible not just with enlightened humanist ethics, but also with the fundamental tenets of the Christian faith I grew up in and confess to this day. I can see no conflict or tension between my views and the moral imperatives emanating from the two great commandments, quoted by Christ from the Books of Moses: “First, you shall love the Lord your God with all your heart, all your soul and all your mind; and, second, you shall love your neighbour as yourself”.

We have no say in how and when we enter this world. We can have a say in how and when we leave it. That freedom - the right to choose and, if necessary, the right to die, and to choose the time and manner of our dying - is a gift of God – a precious gift.


Lesley said...

How I agree with everything you have written, and how refreshing to have someone express support for assisted dying whilst holding their Christian values so highly. I agree with you because my brother, John Close, was amongst the first people to travel to Dignitas to die. It saddens me that we still face such intense opposition to even discussing the idea in this country, as was shown by the undemocratic manner in which Lord Joffe's bill was rejected by the Bishops in the House of Lords in May 2006. Your eloquent words are marvellous: thank you for sharing your views with strangers.

Anonymous said...

I am a US social worker that works with senior citizens and people with disabilities and I believe that your ideas in this post are dangerous if put into practice. People with disabilities (and or terminal illness) who want to commit suicide are going to fit the criteria for clinical depression. It’s going to be left up to some poor psychologist to make the value judgment of why it’s ok to participate in killing some depressed people but prohibiting suicide for other depressed people. The bias (even discrimination) is going to be against the person with the disability and or terminal illness. The bottom line is that it will be some government entity determining the value of one person’s life over another. The motives for all this will never be clear cut. People who are in tuff circumstances will be depressed and they will tend to think that the world will be better off if they were dead even if part of them wants to live. Society will always have the conflict of interest in participating in suicide be it financial or just not wanting to deal with it. The Christian thing to do (and even the enlightened humanist ethical path) would be to share in the suffering and discover the meaning and value that is present in that depressed person’s life. This path is not easy when situations are ugly but it is the moral thing to do as a society and any quick fix solutions in these difficult situations are just going to lead to unjust ends.

Anonymous said...

Society has a conflict of interest in lots of things that people choose for themselves, but that does not stop them from allowing people to make choices. If you really want your handicapped friends to not kill themselves, then why not pressure them to sign a no-death pact so they cannot contract others to procure poisons. The Christian thing is to consider the other person's point of view and respond meaningfully, not with a quick-fix "no".