The medical practices of voluntary and non-voluntary euthanasia are increasingly common around the world. Are they beneficent? The discussion raises some issues that go to the heart of what is right and wrong. This is no abstract discussion of ethereal theory, but has real implications for how many are treated and viewed in society, particularly the elderly and disabled. As someone who is neither ethicist nor medical professional I offer some disconnected reflections, and welcome any comments, particularly corrections on points of fact or counter-examples to arguments I offer. If I find the time and motivation, I’ll write in future posts on various reasons to oppose euthanasia in principle and in practice (principles aside), the action-omission distinction and the importance of intentions, as well as the significance of the idea that administering morphine can hasten death through decreasing breathing – tied in with discussion of so-called ‘passive euthanasia’.
I write this post largely in response to ideas in the first chapter of “Medical Ethics – a very short introduction”, which argues for voluntary euthanasia. The author’s name, a tad ironically, is Tony Hope, a professor at Oxford. The term ‘euthanasia’ literally means something like ‘good (or true) death’. It’s a noble name for what I believe is an ignoble practice. Here I only discuss voluntary euthanasia, which I take to mean physician assisted suicide chosen by a patient deemed competent to choose.
Whenever we approach an ethical question which is contentious in the public square, I think it helps to recognise that one’s ultimate goals determine what one believes to be good. I take it that (though I’m open to hearing disagreement!) when we describe an action as ‘good’ we tend to implicitly be saying that it is ‘good for achieving an end proper for human actions’ i.e. good for something that ultimately matters. What ultimately matters? Is there even anything that matters in such a way that it creates obligations, so that we can legitimately move from merely ‘that’s good for X’ to ‘that’s good’? As a Christian my view of the good is (at least in theory) shaped by Jesus Christ. There is work to do in spelling out how it is that the end of Jesus Christ pulls us into certain actions and away from others, but for now it’s enough just to gesture in the direction of what I think the source of value, rights and duties is.
One way in which this applies in the case of euthanasia is in different answers that may be given to the question of how to balance suffering with whatever is the source of the value of life; i.e. how much suffering a life can have before it becomes better not to be lived. It is common to try to balance suffering with pleasure, and (as I understand it) many believe that when the experience of suffering in one’s life exceeds the experience of pleasure (and perhaps, can be expected to continue in this way into the foreseeable future), such a life is no longer worth living. Quite how to compare suffering and pleasure is an interesting question, as to me they don’t seem to be equal and opposite things, but let’s say that intuitions are enough here – the picture may be compelling in our society, but is it true? The Christian story gives meaning to suffering, in various ways. Centrally, the suffering of Jesus was redemptive – if we will but accept it, it buys us from our slavery to sin; and whether we like it or not it buys the whole broken world from its slavery to corruption and decay. Our own sufferings play a part in God’s plan for the world; they are not mere ‘anti-pleasure’ draining our account to an eventual zero point where our life becomes literally worthless. If God really is revealed in the life, sufferings, death and glorification of Jesus, then – I suggest – there is no-one who can be said to be ‘bankrupt’ from over-suffering. To mix my metaphors, Jesus has paid that debt in full – he’s suffered enough to show that suffering need not be pointless. You may of course say that you don’t buy the worldview I present here – fine, but do read on. Consideration of difficult ethical issues is sometimes thought to be detrimental to Christian faith, but I think the opposite is true.
Similarly, euthanasia may be said to be in the ‘best interests’ of a particular patient. When discussing voluntary euthanasia, it is assumed that a mentally competent patient is the one best-qualified to judge their own best interests. In our society, of course, this emphasis on personal autonomy over one’s values is virtually a core article of faith – to deny it is calumnious heterodoxy – thought to be wrong and offensive and probably dangerous. Nevertheless, I want to note that the idea of someone’s ‘best interest’ is not a religiously neutral concept. To assert that is in someone’s best interests to die and that a doctor can act on this assumes controversial claims about the nature of the human person that need to be defended against the traditional Christian view that the intentional taking of human life is not the prerogative of medical professionals.
Professor Hope states that “the reason why killing is a great wrong is because dying is a great harm”, and then goes on to argue that for some people, losing their life is benefit rather than harm. I’m inclined to dispute both claims, the first in particular. There are other accounts for why killing is wrong. One I offer for consideration is that as other persons and ourselves are both God’s handiwork, intentionally ending the personhood (life) of another is an action lying well above our paygrade. It would be beyond merely impolite to walk into an artist’s exhibition with a match and kerosene and cause it to burn to the ground. We might tend to think though, in contrast, that we are each responsible for the canvas of our own lives, and so naturally have the right to end it all when frustrated by a cruel world by covering it all in black paint. If someone says that they want to die, what right do those with religious scruples have to block this? But how plausible is it really that we are the authors of our own lives? I am responsible for much, but I was surely not responsible for my own creation. Perhaps my parents are the authors then; and yet my biological parents can take little responsibility for what happened much beyond my creation. My schools, churches, clubs, friends, environment must have all played a part. Either God has complete authority over my life or no-one does – to say that I do needs at best more development – and seems like it is mere arrogant nonsense. I offer a whimsical illustration: let’s say I own a furby (or perhaps a parrot) and I’m quite fond of it. Someone, for whatever reason, teaches it to say “my life sucks – kill me, crush me, end my existence, human!!!” It would be wrong of you to act on the advice of the furby, because whatever it is saying, I still love it (hypothetically speaking) and deserve the final say.
On the picture of the world where killing is wrong solely because the dead person has missed out on the experience of some good things in their hypothetical future life it seems like a burglar who killed an 86 year old grandmother in her sleep a few hours before she would have (coincidentally) died anyway has committed a far lesser wrong than one who kills a healthy infant. Egalitarianism has no hope on such a view. On the Christian view which holds all persons to have equal value before God, each act of murder is a great wrong.
The idea that harms such as pain and discomfort can be weighed against enjoyment in life, and that decisions about who should be intentionally killed can be made on this basis seems deeply confused to me. If the value of one’s life really could be measured in experiential terms of pleasure versus pain, then a socialite (a la Paris Hilton – or someone who is actually happy – perhaps, say, a self-satisfied but greedy financier living an upper-middle class life somewhere) would have lived a more valuable life than one who died in discomfort in service of the poor and oppressed. This cannot be true.
Those who care about social justice should oppose voluntary euthanasia. More thoughts on this on a future occasion perhaps.